手外伤腹部带蒂皮瓣修复术后患者的围术期护理

Perioperative Nursing Practice on Abdominal Skin Flap Surgery for Patients with Hand Injury

目的观察强化围术期护理措施对手外伤腹部带蒂皮瓣修复术后肩关节功能障碍患者影响。方法便利抽样法选择2011年5月至2013年5月在解放军第401医院全军手外科中心因手、腕部或前臂皮肤缺损行腹部带蒂皮瓣修复术的患者60例,按随机数字表法分为对照组和观察组各30例,对照组接受常规围术期护理,观察组在此基础上强化术前术后心理疏导、术后护理人员全程协助肩关节功能锻炼。比较两组患者出院前及出院8周后肩关节功能障碍的发病率。结果观察组患者术后肩关节功能障碍的发生率(轻度肩关节功能障碍为10%、肩周炎为0)显著低于对照组(轻度肩关节功能障碍为20%、肩周炎为40%),差异有统计学意义(P<0.01);出院8周后随访结果显示,观察组患者肩关节功能障碍全部康复,对照组仍有13.3%的患者轻度肩关节功能障碍,差异有统计学意义(P<0.01)。结论强化围术期护理可降低手外伤腹部带蒂皮瓣手术后患者肩关节功能障碍的发生率,同时可缩短该类患者肩关节功能障碍的康复时间。

Objective To investigate the effects of strengthened perioperative nursing interventions on complication of shoulder movement disorder after abdominal skin flap surgery for hand injury.Methods Totally 60 patients with hand injury accepted abdominal skin flap surgery in our hospital were randomly di- vided into two groups, experimental group（n = 30）receiving strengthened care during perioperative period and control group（n = 30）receiving conventional care. Comparisons were conducted between two groups on the incidence of shoulder movement disorder prior to discharge and 8 weeks after discharge.Results The incidence of shoulder movement disorder prior to discharge in experimental group（10% mild type and 0% scapulohumeral periarthritis） is lower than which in control group（20% mild type and 40% scapulohumer- al periarthritis） （P〈 0.01）.By 8 weeks after discharge,all the patients in experimental group recovered, while there are still 13.3% mild type shoulder movement disorder in control group,and the difference is significant（P 〈 0.01）. Conclusion Strengthened perioperative nursing interventions effectively reduced complication of shoulder movement disorder after abdominal skin flap surgery for hand injury, and short- ened the recovery time.