病例报告:早产儿合并罕见肾外恶性横纹肌样瘤的多学科管理和护理:临床病例研究。

IF 2 3区 医学 Q2 PEDIATRICS
Frontiers in Pediatrics Pub Date : 2025-09-04 eCollection Date: 2025-01-01 DOI:10.3389/fped.2025.1638115
Qiaojia Zhou, Yuanhong Lü, Mingna Chen, Lu Zhang, Qiong Chen, Yuan Li, Queyun Zhou, Xi Huang
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引用次数: 0

摘要

目的:报道一例早产儿肾外恶性横纹肌瘤合并肿瘤真菌感染的多学科治疗及围手术期护理策略,并评价人性化护理措施对面临恶性肿瘤致死性结局的家庭的效果。方法:采用病例分析方法报道一例早产儿肾外恶性横纹肌样瘤的围手术期处理及护理。术前,治疗包括积极的抗感染治疗和隔离措施,以防止真菌传播,同时一个多学科团队合作制定个性化的皮肤管理计划,以保持肿瘤的完整性。术后实施综合护理措施,包括围手术期低温预防、伤口感染控制和精细疼痛管理。在住院期间,关注患者父母的心理需求,提供人文关怀和早期识别,降低产妇创伤后应激障碍(PTSD)的风险。出院后,提供个体化指导和随访家访,以确保护理的连续性,医疗团队、护士和家庭共同努力,延长婴儿的生存时间,提高生活质量。结果:患儿术前病情得到有效控制;真菌感染得到控制,无院内传播,保持肿瘤完整性,无新发溃疡。术后,婴儿的生理功能明显改善,无低体温或伤口感染。疼痛评分成功维持在轻度至中度水平。人文关怀方法与积极的社会心理结果相关;出院时,母亲的焦虑评分从31分下降到17分,父母对婴儿的预后表现出平静的接受。婴儿生长良好,两个月大时达到4.9公斤。最终,这名婴儿存活了214天,于2024年2月17日因肿瘤复发并颅内转移而去世。结论:综合、多学科的治疗方法对罕见的侵袭性新生儿肿瘤至关重要。在这种情况下,有针对性的围手术期护理策略在控制感染、保持肿瘤完整性和稳定婴儿生理功能方面发挥了至关重要的作用。此外,综合人文关怀对于减轻家庭心理压力,提高婴儿的生活质量至关重要。本案例为类似疑难病例的综合医疗护理提供了有价值的参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Case Report: Multidisciplinary management and nursing care for a preterm infant with rare extrarenal malignant rhabdoid tumor: a clinical case study.

Case Report: Multidisciplinary management and nursing care for a preterm infant with rare extrarenal malignant rhabdoid tumor: a clinical case study.

Case Report: Multidisciplinary management and nursing care for a preterm infant with rare extrarenal malignant rhabdoid tumor: a clinical case study.

Case Report: Multidisciplinary management and nursing care for a preterm infant with rare extrarenal malignant rhabdoid tumor: a clinical case study.

Objective: To report the multidisciplinary management and perioperative nursing strategies for a preterm infant with extrarenal malignant rhabdoid tumor complicated by fungal infection of the tumor, and to evaluate the effectiveness of humanistic care measures for the family facing a fatal outcome due to malignancy.

Methods: This paper reports the perioperative management and nursing care of a preterm infant with extrarenal malignant rhabdoid tumor using a case study approach. Preoperatively, the management included aggressive anti-infective therapy and isolation measures were applied to prevent fungal transmission, while a multidisciplinary team collaborated to develop a personalized skin management plan to preserve tumor integrity. Postoperatively, comprehensive care measures were implemented, including prevention of perioperative hypothermia, control of wound infection, and refined pain management. During hospitalization, attention was given to the psychological needs of the patient's parents, providing humanistic care and early identification to reduce the risk of maternal post-traumatic stress disorder (PTSD). After discharge, individualized guidance and follow-up home visits were provided to ensure continuity of care, with the medical team, nurses, and family working together to extend the infant' s survival and improve quality of life.

Results: The infant's preoperative condition was effectively managed; the fungal infection was controlled with no nosocomial transmission, and tumor integrity was preserved without new ulcerations. Postoperatively, the infant's physiological functions improved significantly, with no instances of hypothermia or wound infection. Pain scores were successfully maintained at mild-to-moderate levels. The humanistic care approach was associated with positive psychosocial outcomes; the mother's anxiety score decreased from 31 to 17 by discharge, and the parents demonstrated calm acceptance of the infant's prognosis. The infant showed good growth, reaching 4.9 kg at two months of age. Ultimately, the infant survived for 214 days, passing away on February 17, 2024, from tumor recurrence with intracranial metastasis.

Conclusion: A comprehensive, multidisciplinary management approach is critical for rare and aggressive neonatal tumors. In this case, targeted perioperative nursing strategies played a vital role in controlling infection, preserving tumor integrity, and stabilizing the infant's physiological functions. Furthermore, integrated humanistic care was essential in alleviating family psychological stress and improving the infant's quality of life. This case provides a valuable reference for the integrated medical and nursing care of similar challenging cases.

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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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