1. Preoperative nursing 1. Psychological care: Older children have serious ideological concerns, mainly manifested in fear of surgery and anesthesia, worried about the effect of surgical correction, and worried about 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 pectus excavatum are stunted and emaciated, which is prone to respiratory 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 and expectoration, abdominal breathing and bed defecation. 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, and the performance is guaranteed to be good. 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. Posture The posture of funnel chest after orthopedic surgery is special and important, which is different from general thoracic surgery. Be sure to lie flat after surgery, 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. 3. Children with diet should fast and drink water on the day after operation, and those without abdominal distension, nausea and vomiting can eat on the second day after operation. Generally, we should eat liquid and semi-liquid diet and gradually transition to normal diet. 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. The main complication after operation is pneumothorax, because peeling the sternum and ribs during operation may damage the pleura. Observe the breathing state, frequency and rhythm of the child closely after operation, and auscultate regularly 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. Hemostatic drugs, such as Zhixuemin, Zhixuefangan, vitamin K 1, etc. Routine administration after drug treatment. At the same time, intravenous infusion of antibiotics. In order to keep the respiratory tract unobstructed after operation and prevent lung infection, the sputum can be atomized and inhaled regularly and coughed up according to the doctor's advice. Gentamicin, chymotrypsin, flumetasone, mucosolvan, etc. It is usually chosen as a drug for aerosol inhalation. 6. Put the drainage tube behind the sternum for drainage nursing, keep the drainage tube unobstructed, and observe the quantity 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 keeps the chest strap fixed firmly to prevent loosening. Bed units should be flat, clean and dry, and the compressed parts should be massaged regularly to prevent bedsores. The ward is ventilated with windows every day and disinfected with ultraviolet rays to keep the indoor air fresh. Third, nursing children with pectus excavatum in the rehabilitation period after plastic surgery, nurses should give guidance in the rehabilitation period after patients are discharged from hospital to ensure the satisfactory effect of plastic surgery and ensure the normal life and study of children. The main points are as follows: 1. Keep your chest clean after discharge, continue to sleep on a hard bed for three months, and don't use Simmons mattress. 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 muscles. 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 you should avoid strenuous exercise, such as playing football, within one year after operation to prevent your 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. "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.