[1]张美芳,薛晴,张新元.多学科协作手术治疗妊娠晚期合并颅内巨大动静脉畸形伴破裂出血的围手术期护理[J].中国临床神经外科杂志,2024,29(03):169-171.[doi:10.13798/j.issn.1009-153X.2024.03.010]
　ZHANG Mei-fang,XUE Qing,ZHANG Xin-yuan.Perioperative nursing of patients with giant ruptired brain arteriovenous malformations in late pregnancy undergoing surgery assisted by multidisciplinary cooperation[J].,2024,29(03):169-171.[doi:10.13798/j.issn.1009-153X.2024.03.010]
点击复制

多学科协作手术治疗妊娠晚期合并颅内巨大动静脉畸形伴破裂出血的围手术期护理()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年03期
页码:
169-171
栏目:
护理技术
出版日期:
2024-03-31

文章信息/Info

Title:
Perioperative nursing of patients with giant ruptired brain arteriovenous malformations in late pregnancy undergoing surgery assisted by multidisciplinary cooperation
文章编号:
1009-153X（2024）03-0169-04
作者:
张美芳; 薛晴; 张新元
430060武汉，武汉大学人民医院东院神经外科（张美芳、薛晴、张新元）
Author(s):
ZHANG Mei-fang;  XUE Qing;  ZHANG Xin-yuan
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
关键词:
颅内动静脉畸形; 脑出血; 妊娠晚期; 多学科协作; 手术治疗; 围手术期; 护理
Keywords:
Brain ruptured arteriovenous malformations;  Cerebral hemorrhage;  Late pregnancy;  Multidisciplinary cooperation;  Surgical treatment;  Perioperative period;  Nursing
分类号:
R 743; R 473.6
DOI:
10.13798/j.issn.1009-153X.2024.03.010
文献标志码:
B
摘要:
目的 总结多学科协作手术治疗妊娠晚期合并颅内巨大动静脉畸形（AVM）伴破裂出血的围手术期的护理经验。方法 回顾性分析1例妊娠30+3周合并颅内巨大AVM伴破裂出血的临床资料，结合文献总结护理经验。结果 30岁女性，因突发头痛伴意识不清、抽搐8 h余入院。头颈部CTA及CT平扫示右侧枕叶AVM，大小约4.8 cm×3.7 cm×5.0 cm，双侧侧脑室、第三脑室及第四脑室铸型。为保障母婴安全，积极采用多学科联合会诊共同手术治疗。先在产科与麻醉科医生配合下实施剖宫产手术，娩出一男婴，阿氏评分7分；胎儿娩出后，将病人更换体位后实施神经外科手术，利用神经内镜切除颅内血管畸形团，同时清除颅内血肿。围手术期积极采用多学科护理模式控制血压，营养支持、心理干预、延续性护理等方面进行有效干预，住院37 d后康复出院，并与婴儿建立良好的母子关系。结论 妊娠晚期合并颅内巨大动静脉畸形伴破裂出血病人，建议积极采用多学科联合会诊共同手术治疗。围手术期注意监测病人血压，加强营养支持和心理干预，并积极预防手术并发症。
Abstract:
Objective To summarize the perioperative nursing experience of patients with giant ruptired brain arteriovenous malformations (AVM) in late pregnancy undergoing surgery assisted by multidisciplinary cooperation. Methods The clinical data of a 30+3 weeks pregnant woman with a giant ruptured brain AVM were retrospectively analyzed, and the nursing experience was summarized. Results A 30-year-old woman was admitted to our hospital due to sudden headache with unconsciousness and convulsion for more than 8 hours. The head and neck CTA and CT scanning showed a right occipital lobe AVM, with a size of about 4.8 cm×3.7 cm×5.0 cm, and casts in the bilateral lateral ventricle, the third ventricle and the fourth ventricle. In order to ensure the safety of the patient and her infant, multidisciplinary consultation was actively adopted for surgical treatment. Cesarean section was performed under the cooperation of obstetrics and anesthesiology doctors, and a boy was born with an Apgar score of 7 points. After the delivery of the fetus, the patient was changed into a different position and underwent neurosurgery, using neuroendoscopy to remove the brain AVM and intracranial hematoma. Multidisciplinary nursing mode was actively adopted during the perioperative period to control blood pressure, nutritional support, psychological intervention, and continuous nursing. After 37 days of hospitalization, the patient was discharged and established a good mother-child relationship. Conclusions It is suggested to actively adopt multidisciplinary consultation for surgical treatment of patients with giant ruptured brain AVM in late pregnancy. During the perioperative period, attention should be paid to monitoring the patient's blood pressure, strengthening nutritional support and psychological intervention, and actively preventing surgical complications.

参考文献/References:

[1]RIEDE K, THUDIUM M, BOSTROM A, et al. Controlled arterial hypotension during resection of cerebral arteriovenous malformations [J]. BMC Neurol, 2021, 21(1): 339.
[2]YU J, WANG J, JI YY, et al. Nursing care of a patient in the second trimester of pregnancy who underwent hypothermia after ruptured cerebellar arteriovenous malformation [J]. Chin J Nurs, 2023, 58 (24): 3018-3022.
俞　洁，王　军，纪媛媛，等. 1例小脑动静脉畸形破裂行低温治疗的中期妊娠患者的护理[J]. 中华护理杂志，2023，58（24）：3018-3022.
[3]ZUURBIER SM, Al-SHAHI SALMAN R. Interventions for treating brain arteriovenous malformations in adults [J]. Cochrane Database Syst Rev, 2019, 9(9): CD003436.
[4]ALEXANDER MD, CONNOLLY ES, MEYERS P M. Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm [J]. World J Radiol, 2010, 2(6): 230-232.
[5]ZENG YX. Nursing intervention of patients with normal perfusion pressure breakthrough syndrome after cerebral arteriovenous malformations [J]. Chin Clin Nurs, 2016, 8(4): 324-326.
曾云香. 颅内动静脉畸形术后正常灌注压突破综合征患者的护理干预[J]. 中国临床护理，2016，8（4）：324-326.
[6]LI DY, HUO WW. The efficacy of levetiracetam in the treatment of epilepsy during pregnancy and its effect on maternal and infant outcomes [J]. Chin J Pract Nerv Dis, 2020, 23(10): 889-892.
李东豫，霍文雯. 左乙拉西坦治疗妊娠期癫痫的疗效及对母婴结局的影响[J]. 中国实用神经疾病杂志，2020，23（10）：889-892.
[7]HOU BQ, ZHOU SL, LIU F. Application effect of pump-controlled continuous lumbar cistern drainage [J]. Chin J Pract Nerv Dis, 2023, 26(4)：490-493.
侯保秋，周少龙，刘　方. 泵控制的持续性腰大池引流应用效果[J]. 中国实用神经疾病杂志，2023，26（4）：490-493.
[8]YANG G, WANG HZ, ZHU PJ, et al. Study on the effects of barometric therapeutic apparatus for hemodynamics of lower extremity vein and incidence rate of DVT post cesarean section [J]. China Med Equip, 2020, 17(3): 104-107.
杨　光，王会芝，朱培静，等. 气压治疗仪对剖宫产后下肢静脉血流动力学及深静脉血栓形成发生率的影响研究[J]. 中国医学装备，2020，17（3）：104-107.
[9]WANG JR, LIU SS, LI XY. Investigation of depression of pregnant women with induced labor because of fetal abnormalities and its influencing factors analysis [J]. Chin J Fam Plann, 2023, 31(12): 2793-2798.
王娟绒，刘珊珊，李晓瑛. 胎儿异常孕产妇抑郁情况调查及影响因素分析[J]. 中国计划生育学杂志，2023，31（12）：2793-2798.

相似文献/References:

[1]郑　涛　赵兰夫　高国栋.多囊肾尿毒症期并发脑出血综合治疗1例[J].中国临床神经外科杂志,2016,(05):320.[doi:10.13798/j.issn.1009-153X.2016.05.024]
[2]孔令舜　刘玉光.钻孔引流术治疗阿司匹林相关幕上脑出血的效果与安全性[J].中国临床神经外科杂志,2016,(03):181.[doi:10.13798/j.issn.1009-153X.2016.03.019]
[3]皮水平　刘　杰　黄前樟.长期服用抗凝药物的老年颅脑损伤患者治疗体会[J].中国临床神经外科杂志,2016,(02):117.[doi:10.13798/j.issn.1009-153X.2016.02.022]
[4]张　源　王文浩　林　洪　林俊明　黄　巍　李　君　罗　飞　胡连水.侧脑室后角穿刺术的新方法介绍[J].中国临床神经外科杂志,2016,(01):26.[doi:10.13798/j.issn.1009-153X.2016.01.009]
[5]赵　平　汪　雷　马金阳.Onyx胶栓塞颅内动静脉畸形的临床分析[J].中国临床神经外科杂志,2015,(08):476.[doi:10.13798/j.issn.1009-153X.2015.08.010]
　ZHAO Ping,WANG Lei,MA Jin-yang..Endovascular embolization of cerebral arteriovenous malformations with Onyx glue[J].,2015,(03):476.[doi:10.13798/j.issn.1009-153X.2015.08.010]
[6]谢　敏　周小炫 综述　吴成翰 审校.Toll样受体4与脑出血的研究进展[J].中国临床神经外科杂志,2015,(01):55.[doi:10.13798/j.issn.1009-153X.2015.01.019]
[7]王洪流,张爱明,董又坤.同时发生的双侧基底节区出血1例[J].中国临床神经外科杂志,2016,(11):736.[doi:10.13798/j.issn.1009-153X.2016.11.033]
[8]罗　明　段发亮　吴京雷　闵　强　陈晓斌　黄乔春　杨国平.神经导航下内镜手术治疗不典型自发性脑出血14例[J].中国临床神经外科杂志,2017,(01):40.[doi:10.13798/j.issn.1009-153X.2017.01.015]
[9]张施远　曾　春　石海平　龙　勇　唐　爽.术中超声辅助下急诊手术切除破裂出血的大型脑动静脉畸形[J].中国临床神经外科杂志,2017,(12):811.[doi:10.13798/j.issn.1009-153X.2017.12.004]
　ZHANG Shi-yuan,ZENG Chun,SHI hai-ping,et al.Intraoperative ultrasound-assisted emergency microsurgery for large cerebralarteriovenous malformations with hemorrhage[J].,2017,(03):811.[doi:10.13798/j.issn.1009-153X.2017.12.004]
[10]张如梦　王轶群　陈　甲　薛东章　杨世泉　魏学志　程晋成.脑出血抗栓药物应用研究进展[J].中国临床神经外科杂志,2017,(12):860.[doi:10.13798/j.issn.1009-153X.2017.12.022]

备注/Memo

备注/Memo:
（2023-12-23收稿，2024-02-20修回）
基金项目：湖北省重点实验室开放项目（2021KFH002）；武汉大学临床护理专项科研培育基金项目（LCHL202308）
通信作者：张新元，Email：xyz_flying@163.com
更新日期/Last Update: 2024-03-31