石骨症患者在内窥镜联合影像导航下行视神经减压术的手术护理

目的:探讨8例8眼石骨症患者在内窥镜联合影像导航下经蝶筛径路行视神经减压术术中不同于常规手术的护理配合要点,提升护理配合质量.方法:收集本院于2012-02/2016-11收治的8例8眼(左眼3例,右眼5例)石骨症患者,在内窥镜联合影像导航下行视神经减压术,术前、术后需增加眼部检查资料比如视力、影像学等,对其临床资料及手术配合过程进行回顾性分析,总结该手术的配合要点.结果:患者8例8眼手术均顺利完成,无大量出血,视力从术前2.5±2.1提高到3.4±1.9,平均提高0.9±0.9;1例患者术中出现脑脊液鼻漏立即行脑脊液漏修补,术中、术后对该脑脊液鼻漏患者进行体位引流、病情监护、意识评估等专业护理,患者康复出院.结论:巡回护士对石骨症患者术中所出现的并发症及影像导航连接、使用进行高难度技能性配合,洗手护士备齐手术器械与耗材,熟练的传递器械并对器械进行精细化管理、使用与维护,两者的默契配合是确保手术成功实施的关键.

Nursing care in osteopetrosis treated by optic nerve decompression under image guidance system combined with endoscopic approach

AIM: To explore the nursing cooperation highlights of eight osteopetrosis patients underwent optic nerve decompression via transsphenoidal microsurgical approach instead of routine pathway, and to improve the quality of nursing cooperation.

METHODS: We enrolled 8 cases(left eye in 3 cases, right eye in 5 cases)of osteopetrosis patients referred from the Eye Hospital of Wenzhou Medical University during February 2012 to November 2016. Patients received ophthalmic examinations including visual acuity and diagnostic imaging tests in pre-operation and post-operation. All eyes were performed surgical optic nerve decompression through endoscopic approach in assist of image guidance system. We retrospectively analyzed the clinical data and surgical cooperation procedure of these cases and summarized nursing cooperation experience.

RESULTS: The operations of 8 patients were completed successfully without massive hemorrhage. Mean visual acuity improved from pre-operation(2.5±2.1)to post-operation(3.4±1.9). Cerebrospinal fluid leakage occurred in 1 patient and was instantly repaired during the operation. We performed the nursing strategy as postural drainage, condition monitoring and conscious assessment intra-and post-operation.

CONCLUSION: It is the critical for this kind of surgery that both circulating nurse''s high-skilled cooperation to the connection and operation of the navigation system, to treat with complication during the surgery, and scrub nurse''s sufficient preparation of surgical instruments and consumables, proficient equipment delivery, meticulous management, use and maintenance of equipment.