胸大肌皮瓣修复头颈部晚期恶性肿瘤术后缺损29例围术期护理

Nursing Care in Peroperative Period for 29Patients with Cephalic and Cervical Advanced Stage Malignant Tumor in Operative Defect Reconstruction of Pectoralis Major Myocutaneous Flap

目的探讨胸大肌皮瓣转移修复头颈部晚期恶性肿瘤术后缺损围术期的护理方法。方法我科2006年12月—2012年3月收治29例头颈部晚期恶性肿瘤术后缺损行胸大肌皮瓣转移修复患者。术前进行适应性训练,做好口腔护理和心理支持。术后严密观察胸大肌皮瓣的血液循环,尽早发现血管危象;保持正确体位,早期合理活动,以降低伤口和皮瓣张力,利于伤口愈合和皮瓣成活;做好口腔黏膜、伤口敷料和术腔负压引流的观察与护理,防止或及早发现出血、感染等潜在并发症;气道管理与术后营养支持是术后顺利康复的基本保证;做好相关护理可预防咽瘘。结果 29例中28例安全度过围术期,皮瓣成活。喉癌术后复发1例修复术后13 d突发术腔大出血致失血性休克死亡。结论完善的围术期护理对于胸大肌皮瓣成功修复头颈部晚期恶性肿瘤术后缺损至关重要。

Objective To explore methods of perioperative nursing of pectoralis major myocutaneous flap in reconstruction of cephalic and cervical advanced stage malignant tumor. Methods 29 patients with cephalic and cervical advanced stage malignant tumor admitted during December 2006 and March 2012 underwent pectoralis major myoeutaneous flap operative defect reconstruction. Preoperative training in patients adapted to the changes after the operation was carried out, and oral care and psychological support were also provided. Pectoralis major myocutaneous flap blood circu- lation were observed closely to find blood vessel crisis as early as possible; the correct posture was maintained and reason- able exercises were performed earlier which could reduce the tension of the flap and the wound, help flaps survive and the wound heal; clinical nursing care and observation of buccal mucosa, wound dressing and negative pressure drainage were made in order to find and prevent potential complications such as bleeding and infection; airway management and postoperative nutritional support were the security of successful rehabilitation. Pharyngeal fistula prevention was closely related to clinical nursing. Results Among 29 patients, 28 lived through perioperative period and flaps survived ; 1 patient with laryngeal carcinoma recurrence died of hemorrhagic shock. Conclusion Management and postoperative nutrition support are the basic guarantees for the postoperative rehabilitation.