李海燕

[关键词] 小儿急性坏死性小肠结肠炎;术后造瘘口;护理;3M敷贴;氧化锌软膏

[中图分类号] R473.72          [文献标识码] B          [文章编号] 1673-9701（2021）17-0178-03

Comparison of the nursing effects of two nursing methods on the postoperative stoma of children with acute necrotizing enterocolitis

LI Haiyan

The Third Department of Surgery， Taian Maternal and Child Health Hospital， Taian   271000， China

[Abstract] Objective To analyze the effect of two different nursing methods on postoperative stoma of acute necrotizing enterocolitis （NEC） in children. Methods A total of 76 children with NEC who were diagnosed and treated in Tai'an Maternal and Child Health Hospital between May 2018 and June 2020 were treated with a stoma during the operation. The patients were retrospectively analyzed. Based on the nursing method， 39 cases were included in the group A and received routine nursing and 3M application care; 37 cases were included in the group B and received routine care and zinc oxide ointment care. The skin condition around the stoma， adverse reactions， length of stay in the hospital， and compliance of children were compared. Results The skin integrity rate of group A （82.05%） after sorting out the data was higher than that （51.35%） of group B （P<0.05）. The adverse reaction rate of group A （5.13%） was higher than 24.32% of group B （P<0.05）. The length of hospital stay of group A （3.35±0.95） days was higher than （4.83±0.99） days of group B （P<0.05）. The compliance of group A （97.44%） was higher than 81.08% of group B （P<0.05）. Conclusion Carrying out 3M application care for children with NEC can improve the skin condition， with good safety and benefit， shorter hospitalization period， and better compliance for the children.

[Key words] Acute necrotizing enterocolitis in children; Postoperative stoma; Nursing; 3M application; Zinc oxide ointment

小兒急性坏死性小肠结肠炎（Necmtizing entemcolitis，NEC）的病理改变为小肠组织伴出血性亦或广泛性炎症，属于消化系统的最常见急性病症。其症状有便血、腹痛等，且发病十分突然，进展较为迅速，被认为是小儿群体的危重型疾病[1]。患儿常合并休克，且多为早产儿和男婴。发病时间主要在娩出后2～12 d，偶有娩出1d内即发病者。临床预估其发病机制是感染，也可能由喂养不当亦或是早产等因素诱发。分期手术是其理想化疗法，可以恢复肠道部分功能，但需要做一造瘘口，极易诱发术后副反应。为此，造瘘口的先进化护理成为NEC的治疗难点，加之患儿的皮肤十分娇嫩，无法表述主观感受，更佳增加护理难度。本研究选取2018年5月至2020年6月入我院的NEC患儿76例，用于分析3M敷贴+常规护理的效用，现报道如下。

1 资料与方法

1.1 一般资料

患儿2018年5月至2020年6月诊治于泰安市妇幼保健院，共76例，类型NEC。所有患儿经影像学等方法确诊为NEC;脏器功能正常排除合并其他系统先天疾病;脏器功能不全;伴有恶性肿瘤[2]。根据护理方法分组，A组39例，男女21∶18;年龄3 d间断至40 d，平均（15.65±0.55）d;病程5d间断至35 d，平均（12.65±2.41）d。B组37例，男女20：17;年龄4 d间断至42 d，平均（15.80±0.67）d;病程6 d间断至37 d，平均（13.05±2.30）d。两组临床资料比较，差异无统计学意义（P>0.05），具有可比性。

1.2 方法

B组实行常规护理：①切口护理：每日定时观察切口是否有渗血亦或是红肿表现，保证切口敷料及时性更换，使切口保持干燥，并及时清理粪便，避免其污染切口。②……