系统性护理干预对游离皮瓣移植术后静脉危象发生的影响研究

发布时间：2018-06-22 14:29

本文选题：系统性护理 + 游离皮瓣　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：探讨系统性护理干预对游离皮瓣移植术后发生静脉危象的影响，从而规范游离皮瓣移植术后的护理方法，进而降低静脉危象的发生率，为手术的成功提供保障。方法：将吉林大学第一医院手足外科及吉林大学口腔医院颌面外科2013年4月至2014年10月进行游离皮瓣移植术的105例病例（其中前臂瓣65例，腓骨肌皮瓣21例，股前外侧瓣19例），按入院顺序编号依据单双号随机分为试验组和对照组，试验组患者54例，对照组患者51例。针对对照组，采取目前科内常规的护理干预，即：保持术区抬高10-20cm，使用棉枕固定；使用电烤灯对手术区域进行照射；给与心理护理，安抚患者情绪；密切观察皮瓣变化，及时发现静脉危象。针对试验组，采用系统性的护理干预，即：用自制特定支架准确抬高、固定手术区域；用自制恒温恒湿箱对术区进行保温保湿；用SAS、SDS自评量表对患者进行心理评估，制定护理处方进行心理护理；用棉签按摩法对皮瓣进行按摩。两组术后患者均按相同的时间点进行观察，并记录静脉危象的发生情况。使用SPSS17.0软件包，对实验结果进行统计学分析。结果：两组在性别组成、年龄、皮瓣面积等方面无统计学差异（P0.05）。两组患者手术原因、皮瓣种类,手术医生组等方面，无统计学意义（均P0.05）。（1）对比游离皮瓣移植术后患者试验组与对照组心理状态，其焦虑、抑郁情况：手术前、手术当日、术后第1日及术后第3日的评分对比P0.05，无统计学差异；术后第5日及术后第7日两组患者的评分对比，，P0.05，有统计学差异。（2）对比游离皮瓣移植术后患者试验组与对照组静脉危象发生时间情况：静脉危象发生时间对比P0.05，有统计学差异。（3）对比游离皮瓣移植术后患者试验组与对照组各期静脉危象发生情况：对一期静脉危象的控制的对比P0.05，有统计学差异。对二期、三期及四期静脉危象的控制的对比P0.05，无统计学差异。（4）对比游离皮瓣移植术后患者试验组与对照组静脉危象发生情况：静脉危象发生总体情况的对比P0.05，有统计学差异。结论：（1）使用制定的处方对游离皮瓣移植术后患者进行心理干预，可缓解患者焦虑、抑郁的情绪。（2）系统性的护理干预可以有效延缓静脉危象的发生时间。（3）系统性的护理干预对一期静脉危象的控制有显著效果，但对二期、三期及四期的静脉危象没有明显的效果。（4）使用系统性的护理干预措施，可以明显降低游离皮瓣移植术后静脉血管危象的发生。
[Abstract]:Objective: to explore the effect of systematic nursing intervention on venous crisis after free flap transplantation, so as to standardize the nursing methods after free flap transplantation and reduce the incidence of venous crisis. To provide a guarantee for the success of the operation. Methods: 105 cases (65 forearm flaps and 21 fibular musculocutaneous flaps) were treated with free flaps from April 2013 to October 2014 in the Department of hand and foot surgery in the first Hospital of Jilin University and the Department of Maxillofacial surgery in the Stomatology Hospital of Jilin University from April 2013 to October 2014. 19 cases of anterolateral femoral valve were randomly divided into experimental group (54 cases) and control group (51 cases) according to the serial number of admission. For the control group, the routine nursing intervention of Kone was adopted, that is, keeping the operation area up 10-20 cm, using cotton pillow fixation, using electric lamp to irradiate the operation area, giving psychological care to appease the patient's mood, and observing the change of the flap closely. Timely detection of venous crisis. In the experimental group, systematic nursing intervention was used, that is, the operation area was accurately raised and fixed with self-made special stent, the operation area was kept warm and moisturized by self-made thermostatic and humidity box, and the patients were evaluated with SASS-SDS self-rating scale. Make nursing prescription for psychological nursing and massage flap with cotton swabs. The patients in both groups were observed at the same time and the occurrence of venous crisis was recorded. SPSS 17.0 software package was used to analyze the experimental results statistically. Results: there was no significant difference in sex composition, age and flap area between the two groups (P0.05). There was no significant difference in the cause of operation, the type of flap and the operation doctor group between the two groups (P0.05). (1). The psychological status, anxiety and depression of the patients after free flap transplantation were compared with those of the control group. On the day of operation, there was no statistical difference between the scores of the 1st postoperative day and the 3rd postoperative day compared with P0.05; (2) the time of venous crisis in the trial group and the control group after free flap transplantation was compared: the venous crisis occurred when the venous crisis occurred. (3) compare the occurrence of venous crisis in the trial group and the control group after free flap transplantation: there was statistical difference in the control of the primary venous crisis (P0.05). For the second phase, There was no significant difference in the control of the third and fourth stages of venous crisis (P0.05). (4) the incidence of venous crisis in the experimental group and the control group after free flap transplantation was compared with that in the control group (P0.05), and there was statistical difference in the overall occurrence of venous crisis (P0.05). Conclusion: (1) the psychological intervention of the patients after free flap transplantation with the prescribed prescription can relieve the anxiety of the patients. Depression mood. (2) systematic nursing intervention can effectively delay the occurrence time of venous crisis. (3) systematic nursing intervention has significant effect on the control of primary venous crisis. (4) the use of systematic nursing intervention can significantly reduce the occurrence of venous crisis after free flap transplantation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R473.6

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