本文選題：系統(tǒng)性護理 + 游離皮瓣　； 參考：《吉林大學》2015年碩士論文

【摘要】：目的： 探討系統(tǒng)性護理干預對游離皮瓣移植術(shù)后發(fā)生靜脈危象的影響，從而規(guī)范游離皮瓣移植術(shù)后的護理方法，進而降低靜脈危象的發(fā)生率，為手術(shù)的成功提供保障。 方法： 將吉林大學第一醫(yī)院手足外科及吉林大學口腔醫(yī)院頜面外科2013年4月至2014年10月進行游離皮瓣移植術(shù)的105例病例（其中前臂瓣65例，腓骨肌皮瓣21例，股前外側(cè)瓣19例），按入院順序編號依據(jù)單雙號隨機分為試驗組和對照組，試驗組患者54例，對照組患者51例。針對對照組，采取目前科內(nèi)常規(guī)的護理干預，即：保持術(shù)區(qū)抬高10-20cm，使用棉枕固定；使用電烤燈對手術(shù)區(qū)域進行照射；給與心理護理，安撫患者情緒；密切觀察皮瓣變化，及時發(fā)現(xiàn)靜脈危象。針對試驗組，采用系統(tǒng)性的護理干預，即：用自制特定支架準確抬高、固定手術(shù)區(qū)域；用自制恒溫恒濕箱對術(shù)區(qū)進行保溫保濕；用SAS、SDS自評量表對患者進行心理評估，制定護理處方進行心理護理；用棉簽按摩法對皮瓣進行按摩。兩組術(shù)后患者均按相同的時間點進行觀察，并記錄靜脈危象的發(fā)生情況。使用SPSS17.0軟件包，對實驗結(jié)果進行統(tǒng)計學分析。 結(jié)果： 兩組在性別組成、年齡、皮瓣面積等方面無統(tǒng)計學差異（P0.05）。兩組患者手術(shù)原因、皮瓣種類,手術(shù)醫(yī)生組等方面，無統(tǒng)計學意義（均P0.05）。 （1）對比游離皮瓣移植術(shù)后患者試驗組與對照組心理狀態(tài)，其焦慮、抑郁情況：手術(shù)前、手術(shù)當日、術(shù)后第1日及術(shù)后第3日的評分對比P0.05，無統(tǒng)計學差異；術(shù)后第5日及術(shù)后第7日兩組患者的評分對比，，P0.05，有統(tǒng)計學差異。 （2）對比游離皮瓣移植術(shù)后患者試驗組與對照組靜脈危象發(fā)生時間情況：靜脈危象發(fā)生時間對比P0.05，有統(tǒng)計學差異。 （3）對比游離皮瓣移植術(shù)后患者試驗組與對照組各期靜脈危象發(fā)生情況：對一期靜脈危象的控制的對比P0.05，有統(tǒng)計學差異。對二期、三期及四期靜脈危象的控制的對比P0.05，無統(tǒng)計學差異。 （4）對比游離皮瓣移植術(shù)后患者試驗組與對照組靜脈危象發(fā)生情況：靜脈危象發(fā)生總體情況的對比P0.05，有統(tǒng)計學差異。 結(jié)論： （1）使用制定的處方對游離皮瓣移植術(shù)后患者進行心理干預，可緩解患者焦慮、抑郁的情緒。 （2）系統(tǒng)性的護理干預可以有效延緩靜脈危象的發(fā)生時間。 （3）系統(tǒng)性的護理干預對一期靜脈危象的控制有顯著效果，但對二期、三期及四期的靜脈危象沒有明顯的效果。 （4）使用系統(tǒng)性的護理干預措施，可以明顯降低游離皮瓣移植術(shù)后靜脈血管危象的發(fā)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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R473.6

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