喉部分切除术后喉狭窄危险因素的分析与护理干预

The nursing intervention of risk factors causing laryngeal stenosis after partial laryngectomy

目的探讨喉部分切除术后发生瘢痕性喉狭窄的危险因素，并针对危险因素采取护理干预。方法选择138例喉部分切除术后患者，采用Logistic回归对相关因素进行多因素分析，并提出针对性护理干预措施。结果138例患者中发生喉狭窄25例，发生率为18．12％。多因素分析结果表明，术后发生喉狭窄与甲状软骨支架切除范围（χ^2=4．323，P=0．038），术后放疗（χ^2=6．002，P=0．014），术后肺部感染（χ^2=4．22，P=0．04），胃食管反流（χ^2=5．614，P=0．018）有关。结论甲状软骨支架切除范围、术后放疗、术后肺部感染、胃食管反流等是发生后狭窄的危险因素，应给予有针对性的护理干预，降低术后喉狭窄的发生率，提高患者生活质量。

Objective To investigate the clinical relevant factors causing laryngeal stenosis after partial laryngectomy and the its nursing intervention. Methods A retrospective study was carried out to review the history clinical data from 138 patients of partial laryngectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 1994 to October 2004. The clinical relevant factors causing laryngeal stenosis included age,sex,TNM stage, original position tumor, resects extension of thyroid cartilage, resects extension of larynx parenchyma, repair model, larynx pattern, duration of using bacteriophage postoperative, postoperative radiotherapy, lung infection postoperative, gastroesophageal reflux, diabetes. Multivariate stepwise logistic regression model was used for the analysis. Results Among 138 cases after partial laryngectomy, stenosis developed in 25 cases,incidence rate was 18.12%. In multivariate analysis,it was confirmed that the following variable correlated to laryngeal stenosis, resects extension of thyroid cartilage, postoperative radiotherapy, lung infection postoperative, and gastroesophageal reflux. Conclusions The clinical relevant factors causing laryngeal stenosis after partial laryngectomy were various. Statistical analysis showed that resects extension of thyroid cartilage, postoperative radiotherapy, lung infection postoperative, gastroesophageal reflux were risk factors which may cause laryngeal stenosis. The prophylactic nursing interventions should be taken to cut down the rate of laryngeal stenosis after partial laryngectomy and improve the quality of life.