Nursing care of a patient with esophageal and mediastinal fistula caused by a fishbone stuck in larynx

doi:10.3760/cma.j.issn.1007-1245.2024.01.029

Abstract

Abstract:

Perforation of the esophagus is a surgical emergency with a mortality rate as high as 40%-60% if it is complicated with septicemia, mediastinal abscess, and multiple organ failure. The clinical data of a patient with esophageal and mediastinal fistula caused by a fishbone stuck in the larynx admitted to First Hospital, Guangzhou Medical University in 2022 was retrospectively analyzed. The patient was treated with splitting the left half of sternum, incising neck abscess, mediastinal abscess exploration and drainage, and left subclavian vein suture hemostasis because of mediastinal abscess. After the management of artificial airway, effective drainage of mediastinal drainage tube, nutritional support, psychological nursing, and other nursing measures, the patient was cured and discharged on the 92nd day after the surgery. By summarizing and analyzing the treatment and nursing of this case, this article may provide some references for future related research.

Key words:

A fishbone stuck in larynx, Esophageal and mediastinal fistula, Nursing

摘要：

食管穿孔是一种外科急症，一旦并发败血症、纵隔脓肿及多器官功能衰竭等情况，病死率高达40%～60%。本文回顾性分析2022年广州医科大学附属第一医院收治的1例鱼刺卡喉食管穿孔伴食管纵隔瘘患者的临床资料。患者因鱼刺卡喉并发纵隔脓肿紧急行“胸骨左侧半劈开+颈部脓肿切开+纵隔脓肿探查及置管引流+左锁骨下静脉缝扎止血术”治疗，术后护理人员通过对患者人工气道的管理、纵隔引流管的有效引流、合理镇静镇痛、营养支持、心理护理等护理措施，患者术后第92天治愈出院。通过总结分析该案例的治疗和护理，希望为以后的相关研究提供参考。

关键词:

鱼刺卡喉, 食管纵隔瘘, 护理

Wang Yanyan, Su Xiangfen, Nie Anliu.

Nursing care of a patient with esophageal and mediastinal fistula caused by a fishbone stuck in larynx [J]. International Medicine and Health Guidance News, 2024, 30(1): 141-144.

王妍妍苏湘芬聂岸柳.

鱼刺卡喉食管穿孔伴食管纵隔瘘患者1例的护理 [J]. 国际医药卫生导报, 2024, 30(1): 141-144.

References

[1] Shiratori Y, Nakamura K, Ikeya T, et al. Treatment of esophageal perforation with mediastinal abscess by nasomediastinal drainage placement [J]. Clin J Gastroenterol, 2020, 13(5): 703-707. DOI: 10.1007/s12328-020-01144-1.
[2] Aronberg RM, Punekar SR, Adam SI, et al. Esophageal perforation caused by edible foreign bodies: a systematic review of the literature [J]. Laryngoscope, 2015, 125(2): 371-378. DOI: 10.1002/lary.24899.
[3] Fattahi Masoom SH, Nouri Dalouee M, Fattahi AS, et al. Surgical management of early and late esophageal perforation [J]. Asian Cardiovasc Thorac Ann, 2018, 26(9): 685-689. DOI: 10.1177/0218492318808199.
[4] 刘海鹏.良性食管穿孔的临床诊治及影响预后的危险因素分析[D].南昌: 南昌大学, 2021.
[5] 杨伟锋. 食管自发性破裂的诊治体会[J]. 国际医药卫生导报,2018,24(24):3773-3775. DOI: 10.3760/cma.j.issn.1007-1245.2018.24.018.
[6] 陈云开,黄楚,廖武华,等. 纵隔引流管防治食管癌切除术后吻合口瘘及心肺并发症的临床效果研究[J]. 吉林医学,2021,42(10):2491-2493. DOI: 10.3969/j.issn.1004-0412. 2021.10.072.
[7] 杨蓓,李筱蕾. 食管癌术后颈部吻合口瘘的循证护理[J]. 全科护理, 2015, 13(14): 1327-1328. DOI: 10.3969/j.issn.1674-4748.2015.14.032.
[8] 顾焱晖,韩广森,王振雷,等. 双造瘘联合纵膈引流管持续冲洗治疗食管空肠吻合口瘘的疗效分析[J]. 中华普通外科杂志,2020,35(6):495-496. DOI:10.3760/cma.j.cn113855-20200104-00008.
[9] 董大伟,邢星敏,冯波. 2种目标气囊压力监测下吸痰对气管插管患者的影响[J]. 护理学报,2017,24(17):62-64. DOI:10.16460/j.issn1008-9969.2017.17.062.
[10] 刘翠,唐建华,汤木翠,等. 3例食管癌并发气管食管瘘及气管憩室患者的护理[J]. 护理学报,2022,29(2):68-70. DOI:10.16460/j.issn1008-9969.2022.02.068.
[11] 朱明明,刘芳,王冉. 躁动镇静评分在重症患者中应用的研究进展[J]. 中华护理杂志,2018,53(2):247-250. DOI:10.3761/j.issn.0254-1769.2018.02.025.
[12] 天津市护理质控中心. 预防成人经口气管插管非计划性拔管护理专家共识[J]. 中华护理杂志,2019,54(6):822-828. DOI:10.3761/j.issn.0254-1769.2019.06.004.
[13] 周勇清,何玮,陈晓珍,等. 9例自发性食管破裂患者的护理[J]. 护理学报,2015(13):48-49. DOI:10.16460/j.issn1008-9969.2015.13.048.
[14] 倪兴梅. 2例机械通气合并气管食管瘘患者的护理措施[J]. 护理实践与研究,2016,13(20):158-159. DOI:10.3969/j.issn.1672-9676.2016.20.071.
[15] 徐萌婷,张馨誉,张丽丽. 循证护理在经口气管插管口腔护理中的应用[J]. 国际护理学杂志,2021,40(10):1889-1892. DOI:10.3760/cma.j.cn221370-20190617-00548.
[16] 唐慧婷,卢惠娟,杨晓莉,等. 口腔冲洗用于气管插管危重患者口腔护理效果的meta分析[J]. 中华护理杂志,2013,48(11):965-970. DOI:10.3761/j.issn.0254-1769. 2013.11.001.
[17] 米元元,黄培培,吴白女,等. ICU患者肠内营养相关性腹胀预防及管理最佳证据总结[J]. 护理学杂志,2022,37(2):91-95. DOI: 10.3870/j.issn.1001-4152.2022.02.091.
[18] 何海洪,王淑勉,周玉玲,等. 228例颈椎前路术后并发症的观察与护理[J]. 护理实践与研究,2011,8(16):51-53. DOI: 10.3969/j.issn.1672-9676.2011.16.025.
[19] 徐勇,吴海苏,徐一峰. 病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用——信度与效度分析[J]. 上海精神医学,2007,19(5):257-259,276. DOI:10.3969/j.issn.1002-0829.2007.05.001.
[20] 王瑜,陈然,张岚. 广泛性焦虑量表-7在中国综合医院住院患者中的信效度研究[J]. 临床精神医学杂志,2018,28(3):168-171. DOI: 10.3969/j.issn.1005-3220.2018.03.007.
[21] 何彬,高会霞,李玉萍,等. 肝移植患者术后谵妄的非药物干预[J]. 护理学杂志, 2022, 37(3): 32-34. DOI: 10.3870/j.issn.1001-4152.2022.03.032.