精细化护理干预在会阴部瘢痕修复术中的运用
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摘要
目的探讨患者会阴部瘢痕修复术实施精细化护理干预的临床效果。方法选取2014年6月至2017年7月入住江苏省昆山市第一人民医院烧伤整形外科的132例接受皮瓣修复术的会阴部瘢痕修复术患者,采用随机数字表法分为干预组和对照组,每组各66例。对照组患者实施常规护理;干预组患者术前接受精细化心理、皮肤、肠道护理,手术设计及影像资料采集和体位训练,术后接受精细化麻醉苏醒、制动、创面护理及饮食、抗毒指导等护理干预。记录2组患者创面愈合时间、术后并发症发生情况;观察2组患者护理前后疼痛、瘙痒程度及情绪(抑郁、焦虑)变化情况。评价2组护理满意度及修复总优良率。数据行独立样本t检验、配对t检验及χ2检验。结果与对照组创面愈合时间[(37. 2±5. 3) d]比较,干预组患者创面愈合时间[(21. 6±3. 1) d]明显缩短,差异有统计学意义(t=6. 848,P <0. 05);干预组的并发症发生率为4. 55%(3/66),与对照组[22. 73%(15/66)]比较明显降低,差异有统计学意义(χ2=7. 784,P <0. 05)。护理前对照组、干预组患者在疼痛、瘙痒、抑郁及焦虑评分间差异均无统计学意义(P值均大于0. 05);护理后2组患者各项评分均低于护理前,差异均有统计学意义(P值均小于0. 05);护理后,干预组患者疼痛、瘙痒、抑郁及焦虑评分分别为(2. 4±0. 6)、(4. 5±1. 3)、(6. 9±2. 6)、(8. 6±2. 5)分,对照组患者对应评分分别为(4. 5±1. 2)、(6. 6±1. 1)、(11. 5±3. 4)、(12. 9±3. 8)分,2组比较差异均有统计学意义(t=5. 421、5. 663、7. 136、8. 205,P=0. 022、0. 017、0. 006、0. 002)。干预组患者的护理有效性、合理性、全面性及科学性方面评分分别为(11. 3±0. 8)、(22. 7±1. 8)、(22. 1±2. 7)、(22. 7±4. 1)分,均明显高于对照组[(6. 6±1. 5)、(19. 2±3. 3)、(18. 5±3. 6)、(17. 9±3. 8)分],差异均有统计学意义(t=8. 844、6. 811、7. 542、7. 916,P=0. 007、0. 024、0. 018、0. 014)。干预组患者修复总优良率[96. 97%(64/66)]明显高于对照组[84. 85%(56/66)],差异均有统计学意义(χ2=4. 492,P=0. 034)。结论会阴部瘢痕修复术皮瓣修复术患者精细化护理干预,可有效提治疗优良率,安全性高。
Objective To explore the clinical effect of refined nursing intervention in patients with perineal scar repair. Methods A total of 132 patients with perineal scars who underwent skin flap repair in the Department of Burns and Plastic Surgery,First People' s Hospital of Kunshan from June 2014 to July2017 were selected. They were divided into the control group and the intervention group according to random number table method,66 patients in each group. Patients in the control group were given routine nursing;patients in the intervention group received preoperative refinement psychology,skin and intestinal care,surgical design and image data collection and postural training,and after the operation,they received refinement anesthesia,brake,wound care,diet,anti-drug guidance and other nursing interventions. The healing time and postoperative complications of the two groups were recorded. The changes of pain,itching and mood(depression,anxiety) before and after treatment were observed. Nursing satisfaction and total recovery rate of two groups were evaluated. The data were processed with the independent sample t test,the paired sample t test and chi-square test. Results Compared with the control group[(37. 2 ± 5. 3) d],the healing time of the repaired area was significantly shortened in the intervention group [(21. 6 ± 3. 1) d],the difference was statistically significant(t = 6. 848,P < 0. 05). The incidence of complications in the intervention group was 4. 55%(3/66),which was significantly lower than the control group [22. 73%(15/66) ](χ2= 7. 784,P < 0. 05). There were no statistically significant differences in the scores of pain,itching,depression and anxiety between the control group and the intervention group before nursing(with P values above 0. 05); after nursing,the scores of patients in both groups were lower than those before nursing,and the differences were statistically significant(with P values below 0. 05). The scores of pain,itching,depression and anxiety after nursing in the intervention group were(2. 4 ± 0. 6),(4. 5 ± 1. 3),(6. 9 ± 2. 6),(8. 6 ± 2. 5) points,the scores of the control group were(4. 5 ± 1. 2),(6. 6 ± 1. 1),(11. 5 ± 3. 4),(2. 9 ± 3. 8) points,the differences between the two groups were statistically significant(t = 5. 421,5. 663,7. 136,8. 205; P = 0. 022,0. 017,0. 006,0. 002). The scores of effective,reasonable,comprehensive and scientific aspects of the intervention group [(11. 3 ± 0. 8),(22. 7 ± 1. 8),(22. 1 ± 2. 7),(22. 7 ± 4. 1) points] were significantly higher than those of the control group [(6. 6 ±1. 5),(19. 2 ± 3. 3),(18. 5 ± 3. 6),(17. 9 ± 3. 8) points](t = 8. 844,6. 811,7. 542,7. 916,P =0. 007,0. 024,0. 018,0. 014). The total excellent and good rate of repair in the intervention group[96. 97%(64/66) ]was significantly higher than that in the control group [84. 85%(56/66) ](χ2=4. 492,P = 0. 034). Conclusion The meticulous nursing intervention of patients with perineal scar repair flap repair can effectively improve the excellent rate and safety.
Objective To explore the clinical effect of refined nursing intervention in patients with perineal scar repair. Methods A total of 132 patients with perineal scars who underwent skin flap repair in the Department of Burns and Plastic Surgery,First People' s Hospital of Kunshan from June 2014 to July2017 were selected. They were divided into the control group and the intervention group according to random number table method,66 patients in each group. Patients in the control group were given routine nursing;patients in the intervention group received preoperative refinement psychology,skin and intestinal care,surgical design and image data collection and postural training,and after the operation,they received refinement anesthesia,brake,wound care,diet,anti-drug guidance and other nursing interventions. The healing time and postoperative complications of the two groups were recorded. The changes of pain,itching and mood(depression,anxiety) before and after treatment were observed. Nursing satisfaction and total recovery rate of two groups were evaluated. The data were processed with the independent sample t test,the paired sample t test and chi-square test. Results Compared with the control group[(37. 2 ± 5. 3) d],the healing time of the repaired area was significantly shortened in the intervention group [(21. 6 ± 3. 1) d],the difference was statistically significant(t = 6. 848,P < 0. 05). The incidence of complications in the intervention group was 4. 55%(3/66),which was significantly lower than the control group [22. 73%(15/66) ](χ2= 7. 784,P < 0. 05). There were no statistically significant differences in the scores of pain,itching,depression and anxiety between the control group and the intervention group before nursing(with P values above 0. 05); after nursing,the scores of patients in both groups were lower than those before nursing,and the differences were statistically significant(with P values below 0. 05). The scores of pain,itching,depression and anxiety after nursing in the intervention group were(2. 4 ± 0. 6),(4. 5 ± 1. 3),(6. 9 ± 2. 6),(8. 6 ± 2. 5) points,the scores of the control group were(4. 5 ± 1. 2),(6. 6 ± 1. 1),(11. 5 ± 3. 4),(2. 9 ± 3. 8) points,the differences between the two groups were statistically significant(t = 5. 421,5. 663,7. 136,8. 205; P = 0. 022,0. 017,0. 006,0. 002). The scores of effective,reasonable,comprehensive and scientific aspects of the intervention group [(11. 3 ± 0. 8),(22. 7 ± 1. 8),(22. 1 ± 2. 7),(22. 7 ± 4. 1) points] were significantly higher than those of the control group [(6. 6 ±1. 5),(19. 2 ± 3. 3),(18. 5 ± 3. 6),(17. 9 ± 3. 8) points](t = 8. 844,6. 811,7. 542,7. 916,P =0. 007,0. 024,0. 018,0. 014). The total excellent and good rate of repair in the intervention group[96. 97%(64/66) ]was significantly higher than that in the control group [84. 85%(56/66) ](χ2=4. 492,P = 0. 034). Conclusion The meticulous nursing intervention of patients with perineal scar repair flap repair can effectively improve the excellent rate and safety.
引文
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[7]王晋芳,徐杨,陈延亭,等.顺产产妇会阴损伤预防与修复循证指南的质量评价[J].中华护理杂志,2018,53(2):162-168.
[8]赵立娟.烧伤后瘢痕整形手术的围手术期护理探讨[J].中国医疗美容,2016,6(1):85-86.
[9]张郑,张天屹,翟月华,等.湿性医疗与美容整形技术结合治疗皮肤擦挫伤伴灰粒嵌入的临床观察[J].中国医药导报,2014,11(30):42-45.
[10] Yosipovitch G,Ansari N,Goon A,et al. Clinical characteristics of pruritus in chronic idiopathic urticaria[J]. Br J Dermatol,2015,147(1):32-36.
[11] Engin B,Uguz F,Yimaz E,et al. The levels of depression,anxiety and quality of life in patients with chronic idiopathic urticaria[J]. J Eur Acad Dermatol Venereol,2010,22(1):36-40.
[12]刘辉霞,卜平元.采用积极护理元素综合干预法在烧伤后瘢痕瘙痒患者中的应用效果[J].护理实践与研究,2016,13(22):131-132,133.
[13] Dunn AB,Paul S,Ware LZ,et al. Perineal Injury During Childbirth Increases Risk of Postpartum Depressive Symptoms and Inflammatory Markers[J]. J Midwifery Womens Health,2015,60(4):428-436.
[14]姜源波,鞠智卿,杨晓莲,等.慢性会阴部疼痛与焦虑及抑郁三者间关系临床研究[J].河北医学,2015,21(6):991-993.
[15]沈新苑,黄燕琼,陈慕芬.手外伤带蒂皮瓣修复术的围手术期护理[J].临床医学工程,2015,22(9):1225-1226.
[16]董雪梅.个性化护理对瘢痕整形手术患者抑郁情绪的影响[J].河北医药,2018,40(7):1110-1112,1116.
[17]邵竹君.体表肿瘤切除及皮瓣修复术后护理体会[J].中国烧伤创疡杂志,2018,30(2):136-138.
[18] Syed Alwi SA,Zainal AA,Lau JH. A rare cause of pain in the perineum[J]. Med J Malaysia,2015,70(1):45-47.
[19]刘英洁,王剑鹰,张晓丽,等.改良式一针一线两结缝合术在会阴伤口缝合术中的应用[J].陕西医学杂志,2015,44(7):893-894.
[20]何永芬,周桃英,钟李,等.烧伤瘢痕修复中的护理体会[J].中国现代医生,2013,51(11):121-122.
[21]缪力,袁举,贾玉俊,等.游离股前外侧皮瓣修复四肢软组织缺损的疗效和影响因素分析[J].中华全科医学,2015,13(11):1883-1885.
[22]苏珊珊,崔晓军,代盼盼.护理干预在会阴部及肛周重度瘢痕挛缩畸形整复术中的应用[J].中国医疗美容,2018,8(2):77-80.
[23]金荣,解海霞,刘艳,等.烧伤后瘢痕瘙痒患者的护理干预[J].护理学杂志,2015,30(2):38-39.
[2] Christmann-Schmid C,Wierenga AP,Frischknecht E,et al. A Prospective Observational Study of the Classification of the Perineum and Evaluation of Perineal Repair at the Time of Posterior Colporrhaphy[J]. Female Pelvic Med Reconstr Surg,2016,22(6):453-459.
[3]杜丽平,游晓波,唐贶昀,等.腹壁下动脉穿支皮瓣修复会阴肛周瘢痕挛缩的疗效观察[J].中国修复重建外科杂志,2015,29(8):992-995.
[4]邱旭眉.阴囊皮瓣修复会阴部瘢痕挛缩术一例护理[J].实用医技杂志,2015,22(8):898-899.
[5] Kargar R, Aghazadeh-Nainie A, Khoddami-Vishteh HR.Comparison of the Effects of Lidocaine Prilocaine Cream(EMLA)and Lidocaine Injection on Reduction of Perineal Pain During Perineum Repair in Normal Vaginal Delivery[J]. J Family Reprod Health,2016,10(1):21-26.
[6] Johnstone MS. Vertical Rectus Abdominis Myocutaneous Versus Alternative Flaps for Perineal Repair After Abdominoperineal Excision of the Rectum in the Era of Laparoscopic Surgery[J].Ann Plast Surg,2017,79(1):101-106.
[7]王晋芳,徐杨,陈延亭,等.顺产产妇会阴损伤预防与修复循证指南的质量评价[J].中华护理杂志,2018,53(2):162-168.
[8]赵立娟.烧伤后瘢痕整形手术的围手术期护理探讨[J].中国医疗美容,2016,6(1):85-86.
[9]张郑,张天屹,翟月华,等.湿性医疗与美容整形技术结合治疗皮肤擦挫伤伴灰粒嵌入的临床观察[J].中国医药导报,2014,11(30):42-45.
[10] Yosipovitch G,Ansari N,Goon A,et al. Clinical characteristics of pruritus in chronic idiopathic urticaria[J]. Br J Dermatol,2015,147(1):32-36.
[11] Engin B,Uguz F,Yimaz E,et al. The levels of depression,anxiety and quality of life in patients with chronic idiopathic urticaria[J]. J Eur Acad Dermatol Venereol,2010,22(1):36-40.
[12]刘辉霞,卜平元.采用积极护理元素综合干预法在烧伤后瘢痕瘙痒患者中的应用效果[J].护理实践与研究,2016,13(22):131-132,133.
[13] Dunn AB,Paul S,Ware LZ,et al. Perineal Injury During Childbirth Increases Risk of Postpartum Depressive Symptoms and Inflammatory Markers[J]. J Midwifery Womens Health,2015,60(4):428-436.
[14]姜源波,鞠智卿,杨晓莲,等.慢性会阴部疼痛与焦虑及抑郁三者间关系临床研究[J].河北医学,2015,21(6):991-993.
[15]沈新苑,黄燕琼,陈慕芬.手外伤带蒂皮瓣修复术的围手术期护理[J].临床医学工程,2015,22(9):1225-1226.
[16]董雪梅.个性化护理对瘢痕整形手术患者抑郁情绪的影响[J].河北医药,2018,40(7):1110-1112,1116.
[17]邵竹君.体表肿瘤切除及皮瓣修复术后护理体会[J].中国烧伤创疡杂志,2018,30(2):136-138.
[18] Syed Alwi SA,Zainal AA,Lau JH. A rare cause of pain in the perineum[J]. Med J Malaysia,2015,70(1):45-47.
[19]刘英洁,王剑鹰,张晓丽,等.改良式一针一线两结缝合术在会阴伤口缝合术中的应用[J].陕西医学杂志,2015,44(7):893-894.
[20]何永芬,周桃英,钟李,等.烧伤瘢痕修复中的护理体会[J].中国现代医生,2013,51(11):121-122.
[21]缪力,袁举,贾玉俊,等.游离股前外侧皮瓣修复四肢软组织缺损的疗效和影响因素分析[J].中华全科医学,2015,13(11):1883-1885.
[22]苏珊珊,崔晓军,代盼盼.护理干预在会阴部及肛周重度瘢痕挛缩畸形整复术中的应用[J].中国医疗美容,2018,8(2):77-80.
[23]金荣,解海霞,刘艳,等.烧伤后瘢痕瘙痒患者的护理干预[J].护理学杂志,2015,30(2):38-39.