Perioperative nursing care of neonatal congenital diaphragmatic hernia treated by thoracoscopic diaphragmatic hernia repair

doi:10.3877/cma.j.issn.1674-392X.2019.06.023

Abstract

Abstract:

Objective

To explore the effect of perioperative monitoring and nursing in the treatment of neonatal congenital diaphragmatic hernia (CDH) by thoracoscopic repair of diaphragmatic hernia.

Methods

64 children with CDH who were treated in Beijing Luhe hospital from January 2010 to October 2018 were randomly divided into the comprehensive nursing group (32 cases) and the routine nursing group (32 cases). The routine nursing group was given routine perioperative nursing, while the comprehensive nursing group was given comprehensive nursing on the basis of routine perioperative nursing. The perioperative indicators, blood gas analysis indicators, the scores of comfort, compliance, nursing quality and complications were observed and compared between the two groups.

Results

There was no significant difference in operation time and bleeding volume between the comprehensive nursing group and the routine nursing group (114.29±11.54 min vs 116.83±12.73 min; 2.58±1.01 ml vs 2.81±1.03 ml, P>0.05), while the hospitalization time and mechanical ventilation time after operation in the comprehensive nursing group were lower than those in the routine nursing group (12.18±4.11 d vs 17.52±5.25 d; 2.04±1.17 d vs 2.89±2.03 d; P<0.05). There was no significant difference in blood gas between the two groups at three time points of pre-operation, 10 minutes after pneumoperitoneum and 30 minutes after deflation (P>0.05). Compared with pre-operation, 10 minutes after pneumoperitoneum, the levels of PaCO₂, peak airway pressure and end-expiratory CO₂ pressure increased in both groups (P<0.05). While there was no significant difference in PaCO₂, peak airway pressure and end-expiratory CO₂ pressure between the two groups when comparing pre-operation and 30 minutes after deflation (P>0.05). The scores of comfort (91.05±10.22), compliance (91.48±7.64) and nursing quality of children (93.11±10.08) in comprehensive nursing group were higher than those in routine nursing group (81.69±9.81, 80.27±7.05, and 80.97±8.19, P<0.05). The incidence of postoperative complications in the comprehensive nursing group (3.125%) was lower than that in the conventional nursing group (21.875%) (P<0.05).

Conclusion

Comprehensive nursing intervention plays an important role in the treatment of neonatal CDH by thoracoscopic diaphragmatic herniorrhaphy. It can significantly shorten the recovery time after operation, keep the blood gas index normal and stable, effectively reduce the incidence of complications after operation, and significantly improve the comfort, compliance and nursing satisfaction of children. It is worthy of clinical promotion.

Key words: Thoracoscopic diaphragmatic hernia repair, Neonatal CDH, Blood gas analysis, Complications

Haixin Zhu, Ling Peng. Perioperative nursing care of neonatal congenital diaphragmatic hernia treated by thoracoscopic diaphragmatic hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(06): 572-576.

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References 15

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组别	例数	手术时间(min)	术中出血量(ml)	住院时间(d)	术后机械通气时间(d)
综合护理组	32	114.29±11.54	2.58±1.01	12.18±4.11	2.04±1.17
常规护理组	32	116.83±12.73	2.81±1.03	17.52±5.25	2.89±2.03
t值	?	0.862	0.900	4.670	2.115
P值	?	0.392	0.356	<0.001	0.038

组别	例数	手术时间(min)	术中出血量(ml)	住院时间(d)	术后机械通气时间(d)
综合护理组	32	114.29±11.54	2.58±1.01	12.18±4.11	2.04±1.17
常规护理组	32	116.83±12.73	2.81±1.03	17.52±5.25	2.89±2.03
t值	?	0.862	0.900	4.670	2.115
P值	?	0.392	0.356	<0.001	0.038

时间	组别	例数	PaCO₂(mmHg)	气道峰压(cmH₂O)	呼气末CO₂分压(mmHg)
术前	综合护理组	32	36.08±4.28	14.86±3.05	34.75±3.12
?	常规护理组	32	37.11±4.13	15.03±3.08	34.61±3.14
?	t值	?	1.010	0.229	0.184
?	P值	?	0.316	0.820	0.854
气腹后10 min	综合护理组	32	45.72±4.26^a	19.11±4.06^a	46.04±4.15^a
?	常规护理组	32	45.96±4.33^a	19.43±4.09^a	46.01±4.26^a
?	t值	?	0.230	0.324	0.029
?	P值	?	0.819	0.747	0.977
放气后30 min	综合护理组	32	36.81±3.73^b	15.36±3.52^b	36.18±2.81^b
?	常规护理组	32	37.24±3.81^b	15.72±3.61^b	36.75±2.79^b
?	t值	?	0.470	0.416	0.839
?	P值	?	0.630	0.679	0.404

时间	组别	例数	PaCO₂(mmHg)	气道峰压(cmH₂O)	呼气末CO₂分压(mmHg)
术前	综合护理组	32	36.08±4.28	14.86±3.05	34.75±3.12
?	常规护理组	32	37.11±4.13	15.03±3.08	34.61±3.14
?	t值	?	1.010	0.229	0.184
?	P值	?	0.316	0.820	0.854
气腹后10 min	综合护理组	32	45.72±4.26^a	19.11±4.06^a	46.04±4.15^a
?	常规护理组	32	45.96±4.33^a	19.43±4.09^a	46.01±4.26^a
?	t值	?	0.230	0.324	0.029
?	P值	?	0.819	0.747	0.977
放气后30 min	综合护理组	32	36.81±3.73^b	15.36±3.52^b	36.18±2.81^b
?	常规护理组	32	37.24±3.81^b	15.72±3.61^b	36.75±2.79^b
?	t值	?	0.470	0.416	0.839
?	P值	?	0.630	0.679	0.404

组别	例数	舒适度	治疗依从性	护理质量
综合护理组	32	91.05±10.22	91.48±7.64	93.11±10.08
常规护理组	32	81.69±9.81	80.27±7.05	80.97±8.19
t值	?	3.853	6.288	5.450
P值	?	<0.001	<0.001	<0.001

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