儿童喜欢活动和探索 ,但运动功能发育不全 ,对危险的辨别能力及自我保护能力较弱 ,是骨折的高危群体 ,每年有 2.50％ ～ 6.25％ 的儿童发生骨折 ,其中四肢骨折常见[1-2] .在对患儿患肢进行护理、观察、换药等操作时 ,均需穿脱传统手术服.四肢骨折患儿因疼痛 ,肢体肿胀 ,石膏、支具等外固定器具的使用 ,外加年龄小、理解力不足、忍痛能力差等原因[3] ,导致穿脱传统手术服存在困难.为减轻患儿疼痛 ,保护患儿隐私 ,同时方便医护人员的观察、护理及操作,本研究自行设计并制作了儿童四肢骨折手术专用服 ,已获得国家实用新型专利(专利号ZL 202220825871 .7) ,在临床应用中取得满意的效果 ,现报告如下.

总结 1 例Ⅲa型喉裂合并重度营养不良患儿的围手术期护理.重点包括建立多学科团队做好围手术期照护计划、原位模拟应对误吸等气道紧急状况,采用俯卧位保证有效通气,实施动态营养筛查评估,制定个体化营养支持策略,进行口腔运动康复锻炼.经治疗及护理,患儿病情稳定出院,术后 1 年随访,患儿营养状况良好,生长发育水平处于同龄儿童中位数.

Objective:To design and manufacture the female infant diaper, and to explore the application effect of the diaper in routine urine collection of female infants.Methods:Female infants hospitalized in department of Orthopedic Rehabilitation of Children′s Hospital of Zhejiang University School of Medicine from July 2020 to June 2021 were selected as the research objects. According to the chronological order, 148 female infants admitted from July to December 2020 were selected as the control group, and 154 female infants admitted from January 2021 to June 2021 were selected as the experimental group. In the experimental group, urine routine was collected by female infants diapers, while in the control group, urine routine was collected by traditional disposable urine collection bag. The time required for routine urine collection, the number of urine collection bags, the incidence of perineal skin injury and the satisfaction of parents were observed.Results:The time required for routine urine collection was (16.86 ± 12.58) h in the experimental group and (28.76 ± 22.20) h in the control group. The difference between the two groups was statistically significant ( t=5.70, P<0.05). The number of female infant diapers in experimental group was (1.69 ± 0.67); The number of disposable urine collection bags used in the control group was (2.76 ± 1.32), and the difference between the two groups was statistically significant ( t=8.81, P<0.05). In the experimental group, the incidence of perineal skin injury was 0. In the control group, the incidence of perineal skin injury was 24.8%(42/148). The difference between the two groups was statistically significant ( Z=-9.78, P<0.01). The satisfaction of parents in the experimental group was 98.7% (152/154), witch higher than that in the control group was 79.7% (118/148), and the difference was statistically significant ( Z=-9.68, P<0.01). Conclusions:Compared with the traditional disposable urine collection bag, the diaper collection for female infants can shorten the time required for routine urine collection, reduce the number of urine collection tools, reduce the incidence of perineal lesions in children, improve the satisfaction of parents of children, reflect the people-oriented nursing concept, and provide greater clinical convenience.

腺样体或扁桃体肥大是患儿最常见的疾病之一,严重的腺样体或扁桃体肥大会引起上气道堵塞,出现睡眠打鼾伴张口呼吸,扰乱患儿正常通气和睡眠结构,称为患儿阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom,OSAHS)[1].OSAHS 是一种临床常见的具有潜在危险的疾病[2],治疗不当可致严重并发症[3].

总结7例咽部毛息肉患儿围手术期的护理经验.针对本组患儿发生低氧血症、呼吸道症状、喂养困难易反流、术后护理等问题,采取经鼻高流量湿化氧疗的管理改善低氧血症;执行个体化气道廓清治疗方案保持呼吸道通畅;给予患儿发育支持,包括提供充足的营养支持、主动预防反流误吸、做好以患儿为主导的喂养实践,积极改善患儿的营养状态;预防和处理咽部切口并发症、重视口腔护理及出院患儿的延续护理等措施.经严密监护和精准化管理,本组患儿术后3～7d痊愈出院.随访中本组患儿均获得高质量的康复效果,未见毛息肉复发.

目的 观察思维导图联合三阶式teach-back在扁桃体切除患儿围手术期健康宣教中的应用效果.方法 选取行扁桃体切除手术治疗的患儿及照顾者,以实施思维导图联合三阶式teach-back为时间节点分为对照组和观察组,两组患儿及照顾者各58例.对照组采用常规围手术期宣教,观察组采用思维导图联合三阶式teach-back方法 进行健康宣教,比较干预前后两组患儿治疗依从性、并发症发生率及照顾者的疾病不确定感水平.结果 干预后观察组照顾者疾病不确定感评分为(52.91±10.99)分,低于对照组的(61.98±13.72)分(P<0.05).观察组患儿治疗依从性为86.21％(50/58),高于对照组的62.07％(36/58)(P<0.05).结论 思维导图联合三阶式teach-back健康教育可降低扁桃体切除术患儿照顾者疾病不确定感,提高患儿围手术期治疗依从性.

气管切开术是儿童急危重症常用的方法之一,行小儿气管切开术后的护理是一个相对漫长的过程,多数患儿须带管出院回归家庭,但很多家长对回归家庭后如何护理感到手足无措.因此,对患儿带管回归家庭的护理宣教及指导显得尤为重要.做好家庭延续护理,可以提高患儿的生活质量,促进患儿康复.

总结2017年3月13日浙江大学医学院附属儿童医院收治的1例白质消融性白质脑病患儿的护理经验.护理重点包括及时做好患儿的病情观察,发热与抽搐的对症护理,吞咽困难的护理,患儿家长心理护理;抽血基因检测及患儿的康复训练.经过2周的精心治疗和护理,患儿病情稳定,出院继续康复训练.

总结了儿童定点专科医院耳鼻咽喉科病区感染防控管理措施.通过医院政策解读、陪护人员管理、医护人员防护管理、住院及手术流程协调、防护物资管理、病区环境管理6个方面的管理措施,有效保障了儿童定点专科医院耳鼻咽喉科病区的安全管理.

The prevention and control of 2019 novel coronavirus (2019-nCoV) is currently the primary task of all industries in China. The virus infection is mainly transmitted by respiratory droplets, airborne and close contact. Pediatric foreign body in the respiratory tract is a common otorhinolaryngology emergency, especially occurred in 1-3 years old children, and usually causes airway obstruction, suffocation and pneumonia, which may become an acute threat to life. The principle treatment in otorhinolaryngology emergency room is direct laryngoscope, bronchoscope and foreign body removal. Due to the close contact between the relevant medical staff and child during the operation, a large number of droplets and aerosols can be produced during the reactive cough of the child. Combined with the characteristics of the operation, this article intends to provide advices on diagnosis and treatment of airway foreign body removal for pediatric otorhinolaryngology colleagues during the prevention and control of 2019-nCoV. Adjustments could be made subsequently due to changes of the epidemic situation and the recognition of 2019-nCoV.

重症肌无力(myasthenia gravis,MG)是一种自身免疫性疾病[1].约85％的眼肌型重症肌无力(oc-ular myasthenia gravis,OMG)起始症状以眼外肌无力和复视为主,大约有90％的OMG患者在3年内进展为全身型MG(generalized MG,GMG)[2-4].当重症肌无力发展到一定程度时,患者往往伴随咽喉部肌肉无力或者功能出现问题,出现饮水进食呛咳,吞咽无力,声音嘶哑或言语不清等,我们称之为"球麻痹",即延髓麻痹.然而,对于绝大部分重症肌无力患者,其病情是渐进性的,即发病初期眼或肢体酸胀不适,视物模糊,易疲劳.随着病情发展,骨骼肌明显疲乏无力,显著特点是肌无力于下午或傍晚劳累后加重,晨起或休息后减轻,此种现象称之为"晨轻暮重".而"球麻痹"为唯一表现的重症肌无力是十分少见的,这对疾病的诊断和治疗提出了挑战[5-7].现报道1例以"球麻痹"为唯一表现的重症肌无力的儿童.

总结1例婴儿痉挛症使用丙戊酸钠出现全血细胞减少症的护理.护理要点为加强病情观察,重视感染、出血的预防,做好皮肤和黏膜护理,同时加强促肾上腺皮质激素的给药护理,做好患儿家长的心理护理.经治疗和护理,患儿住院24 d后病情好转出院.

总结1例儿童抗N-甲基-D-天冬氨酸受体脑炎行利妥昔单抗治疗的护理.护理重点为做好特殊用药护理,加强安全护理、预防压疮,给予营养支持,积极预防并发症,做好疾病相关知识的健康宣教及随访.经过2个月的治疗和护理,患儿好转出院.