A型肉毒毒素治疗儿童痉挛型肌张力障碍的护理

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1、【药械护理】A型肉毒毒素治疗儿童痉挛型肌张力障碍的护理李孚伟，燕丽(首都医科大学附属天坛医院儿科，北京100050)［摘要］局部肌内注射A型肉毒毒索治疗儿童痉挛型肌张力障碍是一种新的治疗方法。报道260例患儿接受A型肉毒灣素治疗前后的观察和护理。(1)治疗前对患儿关节活动度、肌张力进行评估，有针对性地做好心理护理，滅少因心理紧张而导致的过度肌肉痉挛；注射前准备好抢救药品及物品，做好操作过程中的应急措施。(2)注射时根据解剖知识触摸动脉走向，避开大血管，注射过程中不断与患儿交谈，安抚患儿，注意观察患儿有无呼吸异常、突然停止哭闹

2、、大汗、反应迟钝、不应答、面色苍白、四肢冰凉等不良反应。(3)注射后注意观察患儿的生命体征及药物不良反应，如咀嚼无力、吞噪困难、呼吸异常等；评估异常姿势、步态及关节活动度,进行康复训练指导；做好出院指导，告知家长及患儿在出院回家2~4周时为药物不良反应高峰期，可能出现注射肌群过度无力，耍求家长注意观察患儿走路是否易捋跤，有无明显双腿发软、无力等悄况。260例患儿经治疗后提高了关节活动范围，运动功能均得到不同程度的改善，有效率95%。所有患儿生命体征平稳，无吞咽困难、咀嚼无力、呼吸异常等现彖。［关键词］肌张力障碍；痉挛；A型肉

3、毎毒素；护理［中图分类号］R473・72；R453［文献标识码］A［文章编号］1008-9969(2008)11-0074-03NursingoftheChildrenwithSpasmDysmyotoniaTreatedwithTypeABotulinusToxinLIFu-wei,YANLi(Dept,ofPediatrics^TiantanHospital.,CapitalMedicalUniversity^Beijing100050.China)Abstract：LocalinjectionoftypeAbotuli

4、nustoxinisanoveltherapytotreatchiklspasmdysmyotonia・ThepaperreportstheobseiTationandnursingof260childrenpatientstreatedwithspasmdysmyotonia・(1)Beforetreatment,jointactivitiesandmusculartensionshouldbeevaluated;mentalcareshouldbeconductedto

5、)reventoverspasm;emergenc

6、ychugsshouldbepreparedbeforeinjectionandemergencyprecciutionsshouldbetcikenintoaccount.(2)Itiinjectioiuthegreatbloodvesselsshouldbekeptawayl)yfeelingdirectionofarteries;duringinjection,thenui'scsshouldsoothethembykeepingtalkingtothechildren;theadversereactionsshoul

7、dbeobservedcloselyincludingabnorniityinrespiration,suddenstoppingofcries,oversweating,slownessinresponse,noresponsepalenessinappearanceandcoldnessinextremities・(3)Afterinjection,theirvitalsignsandtheadversereactionofthedrugshouklbeobservedlikemasticatoryatonia^dysp

8、hagiaandahnonnilyinrespiration;theahnonnalpostureatwalkandjointaclivilyshouldbeevaluatedanclrehabilitationtrainingshouklbedonetothem;thefamiliesshouklbeinformedthatcrest-timeis2〜4weeksafterdischargefromhospitalandtheover-weaknessislikelylooccurintheinjectedmuscles;

9、nursesshouldwarnthefamiliestomakesureifIhechildrenareeasytofalllothegroundandthereisvisibleweaknessinthelowerexlremilies・Throughtreatment,allofth