Ting Yi-Yun, Hung Chao-Chia, Cheng Yi-Ho
BSN, RN, Department of Nursing, Taipei Veterans General Hospital, Hsinchu Branch, Taiwan, ROC.
PhD, RN, Associated Professor, Department of Nursing, Yuanpei University of Medical Technology, Taiwan, ROC.
Hu Li Za Zhi. 2019 Oct;66(5):86-94. doi: 10.6224/JN.201910_66(5).12.
Superior mesenteric artery syndrome (SMAS) is a rare and life-threatening disease that affects women more frequently than men. SMAS is characterized by extensive compression of the 3rd part of the duodenum between the aorta and the superior mesenteric artery. This compression results in chronic, intermittent or acute obstruction of the small bowel due mainly to the lack of fat between the aorta and the superior mesenteric artery, which increases the angle between the aorta and superior mesenteric artery and the end of the duodenum, causing intestinal obstruction. The goal of supportive treatment is to increase both body weight and the angle between the mesenteric artery and the abdominal aorta. This case involved a 14-year-old girl with low body weight who suffered from SMAS. Her symptoms included recurrent, severe vomiting and bloating, which necessitated her taking time off from school, causing further anxiety and leading to agitation, resistance to further treatment and care, and more-severe symptoms. During the period of nursing care from August 14th to August 30th, 2017, the author identified symptoms of nutritional imbalance and anxiety. Care initiated to improve nutritional status included: (1) improving nutritional intake, (2) promoting comfort, and (3) maintaining caloric intake. Care initiated to reduce anxiety included: (1) increasing self-control, (2) providing opportunities to participate in treatment planning, and (3) refocusing attention on self-worth. At the end of care, the patient had gained weight, the angle between the upper mesenteric artery and the abdominal aorta had increased, the symptoms had subsided, and anxiety had been alleviated. This nursing experience offers a reference for nurses facing similar cases of clinical care.
肠系膜上动脉综合征（SMAS）是一种罕见且危及生命的疾病，女性比男性更易患病。SMAS的特征是十二指肠第三部在主动脉和肠系膜上动脉之间受到广泛压迫。这种压迫主要由于主动脉和肠系膜上动脉之间缺乏脂肪，导致小肠出现慢性、间歇性或急性梗阻，这增加了主动脉与肠系膜上动脉以及十二指肠末端之间的夹角，从而引起肠梗阻。支持性治疗的目标是增加体重以及肠系膜动脉与腹主动脉之间的夹角。该病例涉及一名体重低的14岁女孩，她患有SMAS。她的症状包括反复严重呕吐和腹胀，这使她不得不请假不上学，进而引发进一步焦虑，导致躁动、抗拒进一步治疗和护理，症状也更加严重。在2017年8月14日至8月30日的护理期间，作者识别出营养失衡和焦虑症状。为改善营养状况而采取的护理措施包括：（1）改善营养摄入；（2）促进舒适感；（3）维持热量摄入。为减轻焦虑而采取的护理措施包括：（1）增强自我控制能力；（2）提供参与治疗计划制定的机会；（3）将注意力重新集中在自我价值上。护理结束时，患者体重增加，肠系膜上动脉与腹主动脉之间的夹角增大，症状消退，焦虑得到缓解。这一护理经验为面临类似临床护理病例的护士提供了参考。
