What are the cure measures for children's funnel chest?

Congenital funnel chest in children is a common chest wall malformation, accounting for 90% of the chest wall malformation in children. The clinical manifestation is centered on the lower sternum and xiphoid process, and the sternum and costal cartilage on both sides are sunken inward, which looks like a funnel, hence the name funnel chest. Some sternum tilted asymmetrically on both sides, with concave and convex coexisting, which is irregular funnel chest. The cause of the disease is unknown, and it has a family genetic tendency.

The abnormal signs of children with pectus excavatum can appear in the neonatal period and get worse with age.

Intensify. In addition to chest deformity, it is often accompanied by neck and shoulders leaning forward, hunchback and abdominal protrusion. Children over 7 years old with funnel chest often have different degrees of scoliosis. The deformation and depression of sternum not only affects the appearance of the body, but also oppresses the heart and lungs, causing different degrees of damage to the heart and lung function.

The radical cure of this disease is surgical correction. Our department adopts "sternum V-shaped osteotomy and rib osteotomy".

Multi-segmental cartilage excision and Kirschner wire internal fixation "has the characteristics of less trauma, obvious orthopedic effect and fewer complications in the treatment of funnel chest in children." The nursing experience is introduced as follows:

First of all, preoperative care

1. Psychological care:

Older children have serious ideological concerns, mainly manifested in fear of surgery and anesthesia.

Worried about the effect of orthopedic surgery and the impact of surgery on study and life. Nurses should communicate with children and their families in time to understand their psychological status and cooperate with doctors to carry out disease knowledge education. According to the age and psychological characteristics of different children, the necessity, brief process and postoperative effect of the operation are explained. You can introduce past undergraduate cases, and you can also use publicity materials such as pictures, photos and words.

2. Nutritional support:

Because the sternum compresses the heart, lungs and esophagus, some children with funnel chest are stunted and emaciated.

It is prone to respiratory tract infection and food reflux after eating. Before operation, we should evaluate the nutritional status of children, explain the importance and necessity of preoperative nutritional support, and guide children to eat a diet with high protein, high calorie and high vitamins, such as meat, eggs, milk, fresh fruits and vegetables. Intravenous infusion, energy and vitamins, antibiotics and hemostatic drugs should be used when necessary.

3. General preoperative preparation:

Increase or decrease clothes according to temperature changes to prevent colds. Instruct children to practice effective cough.

Expectoration and abdominal breathing, practice defecation in bed. Make good preparations for the skin in the operation area, keep it clean, and abstain from water for 8 hours before operation to prevent aspiration pneumonia and asphyxia caused by anesthesia or vomiting during operation. Keep the ward clean and quiet, ensure the children sleep, and give sedatives and sleeping pills according to the doctor's advice when necessary.

Second, postoperative care

1. Keep the respiratory tract unobstructed and prevent suffocation.

According to the routine nursing after general anesthesia, the bedside is equipped with oxygen and sputum suction devices to ensure the safety.

Sure. okay. After the operation, the child went back to the room and lay on the pillow, with his head tilted to one side, and inhaled oxygen through the nasal catheter. Suck out respiratory secretions in time to keep the respiratory tract unobstructed. If there is agitation, use sedatives. Observe the child's face and breathing closely, and notify the doctor in time if there is any abnormality. Bedside equipped with first aid equipment, medicines, etc.

2. Body position

Postoperative posture of funnel chest is special and important, which is different from general thoracic surgery.

Stay flat, choose a hard bed, and don't use soft mattresses such as sponges. Older children can rest on thin pillows and cover them thinly to avoid putting a burden on their chests. At the same time, it is forbidden to turn over and lie on your side, so as to avoid chest compression and deformation, sternum, costal cartilage suture and Kirschner wire displacement, which will affect the orthopedic effect and lead to surgical failure. The bedside can be gradually raised one week after operation, and you can get out of bed after 10. When sitting up, pay attention to supporting the child's back, keep the chest and back straight, and don't just pull the upper limbs.

Step 3 prescribe diet

Children should fast and drink water on the day after operation, and those without abdominal distension, nausea and vomiting can fast and drink water on the second day after operation.

In terms of diet, generally advanced liquid and semi-liquid diets gradually transition to normal diets. Guide children to strengthen nutrition and eat more nutritious meat, eggs, milk and fresh fruits and vegetables. Because of the long time in bed after operation, we should pay attention to eating vegetables and bananas rich in fiber to prevent constipation.

4. Postoperative complications

The main complication is pneumothorax, because pleura may be caused when sternum and ribs are stripped during operation.

Damaged. After operation, closely observe the breathing state, frequency and rhythm of the child, and regularly auscultate whether the breathing sounds of both lungs are clear and consistent, and whether there are signs of hypoxia such as alar flap and cyanosis, so as to find and deal with them as soon as possible. Thoracic puncture is feasible for a small number of pneumothorax, and closed thoracic drainage is needed for a large number of pneumothorax.

5. Drug therapy

Hemostatic drugs, such as Zhixuemin, Zhixuefangan and vitamin K, were given routinely after operation.

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Wait a minute. At the same time, intravenous infusion of antibiotics. In order to keep the respiratory tract unobstructed after operation and prevent the lungs

Department infection, according to the doctor's advice, regular atomization inhalation can dilute sputum and make it easy to cough up. Gentamicin, chymotrypsin, flumetasone, mucosolvan, etc. It is usually chosen as a drug for aerosol inhalation.

6. Drainage nursing

For those who put the drainage tube behind the sternum, keep the drainage tube unobstructed and observe the amount and nature of drainage fluid.

Generally, a small amount of bloody or slightly bloody liquid is drained, and it does not exceed 50 ml in 24 hours. For the patients with drainage skin graft, the doctor squeezed the local exudate and changed the dressing every day for 3 days after operation. There may be a small amount of bloody exudation outside the skin graft drainage wound dressing, so children and their families should be informed to avoid unnecessary panic. Drainage tube and drainage skin graft were mostly removed 3 days after operation.

7. Basic nursing care

Keep the chest strap firmly fixed to prevent loosening. Bed units should be flat, clean and dry, and should be ironed regularly.

Rub the compressed part to prevent bedsore. The ward is ventilated with windows every day and disinfected with ultraviolet rays to keep the indoor air fresh.

Third, rehabilitation nursing

After plastic surgery for children with pectus excavatum, nurses should give rehabilitation guidance when they leave the hospital.

Ensure satisfactory plastic surgery effect, and at the same time ensure the normal life and study of children. There are mainly the following points:

1. Keep your chest clean after discharge and continue to sleep on a hard bed for three months without Simmons bed.

Pad. Sleep on your back, not on your side. The cover is light, and the clothes are not too tight. Try to avoid putting a burden on your chest. Parents of young and active children should strengthen nursing to prevent trauma and falls, and wear protective vests in the short term after operation.

2. After 6 months of operation, you can guide your child to expand his chest and abdomen and exercise his chest and abdomen.

Muscle. Some elderly children are still used to leaning forward and hunching their necks and shoulders after surgery. Parents should correct it in time, guide their children to stand and walk with their heads held high, and get rid of bad habits. If necessary, use orthopedic belts such as "good back" to correct bad posture such as chest hunchback.

You can go to school and kindergarten normally after 3.3 months, but avoid strenuous exercise within one year after operation.

Exercise, such as kicking the ball, to prevent the chest from being hit by heavy objects. Strengthen nutrition and physical fitness. Regular review (65438+ 0, 3 and 6 months after operation), and internal fixation was taken out after 2 years. (Hebei Children's Hospital Peng Xiaoyan Tao Jingping Zhao Fei Xiaojie)

"Funnel chest" refers to a congenital chest deformity in which the middle and lower parts of the sternum are depressed inward and its adjacent costal cartilage is also depressed, forming a funnel-shaped appearance. Although it can cause rickets, it is mostly congenital dysplasia. Some scholars believe that it is due to the excessive growth and backward bending of costal cartilage, which leads to the sagging of chest wall and the formation of funnel chest.

Mild funnel chest has little effect on circulation and breathing, while severe funnel chest depression of sternum and ribs oppresses chest organs such as heart and lungs, which makes children prone to respiratory tract infection, poor exercise tolerance, emaciated body and unwilling to be quiet and inactive. Funnel chest not only affects children's physiology, but also causes great mental burden and psychological pressure to children and their parents. These children are often ashamed to show their breasts in public. Dare not wear vest in summer; Dare not take a bath in the public bathroom; Dare not go swimming in the swimming pool, and some even become psychologically withdrawn.

Children with mild pectus excavatum do not need urgent treatment because they have little effect on respiratory circulation, and may correct themselves with their growth and development. Children with moderate and severe pectus excavatum should be corrected by surgery. Generally, children over 2-3 years old can tolerate surgery and the operation is simple. Ribs and costal cartilage are easy to shape, but they have low tolerance to anesthesia and surgery, and may recur after correction. Therefore, surgery is usually performed at the age of 6- 10. After the age of 20, the chance of self-correction is small, the operation is difficult and the effect is not ideal.

Generally speaking, surgical treatment can obviously improve the chest appearance of children with chest diseases, relieve the oppression of depressed sternum and ribs on the heart and lungs, significantly reduce respiratory tract infection, and improve their mobility and endurance. On the other hand, it can relieve children's psychological pressure and make their mental state more exciting than before.