断指再植术后成活率影响因素分析及护理对策

The countermeasure of nursing after amputated digit replantation

目的研究影响断指再指术后成活率的因素,探讨相应的护理对策,提高断指再植术后成功率。方法回顾性分析2005年1月—2013年12月断指再植1583例(共1976指)患者的临床特征,研究影响断指再植术后发生坏死的类型、原因及相应的护理措施。结果 1976指中1888指术后恢复良好,82例88指发生坏死,术后总成活率为95.5%(1888/1976);其中患者年龄大于60岁、有长期吸烟史,热缺血时间超过6 h、断指完全离断、粉碎性伤、断面血管血栓形成、血管痉挛、不恰当的断指保存方法及术后出现焦虑抑郁的患者断指成活率较低(P<0.05),而患者的性别、断指数目及输血情况与患指的存活与否无相关性。结论断指再植术后存活与患者的年龄、吸烟史、热缺血时间、断指离断情况、损伤类型、断面血管血栓形成、血管痉挛、断指保存方法及术后心理状态等因素密切相关,重视断指再植术后影响存活的相关危险因素,在预防、断指相关知识普及、术前及术后护理工作中采取相应的护理措施有利于提高断指再植术后成活率。

Objective To study the countermeasure of nursing after amputated digit replantation. Methods A retrospective analysis of 1976 amputated digits among 1583 cases in our hospital from January 2005 to December 2013. Results 1888 among 1976 amputated digits had a good recovery after surgery,88 amputated digits among 82 cases occurred necrosis,postoperative survival rate was 95. 5% of total（ 1888 /1976）; the patients with older than 60 years,long history of smoking,warm ischemia time more than 6 hours,completely amputated finger,crushing injuries,vascular thrombosis,vascular vasospasm,inappropriate finger preservation and postoperative anxiety and depression situation had lower survival rate of amputated digit replantation（ P〈0. 05）. Conclusion Paying more attention to the patients with the risk factors, popularizing the knowledge of amputated digit,taking appropriate preoperative and postoperative nursing care were important to improve the survival rate of amputated digit replantation.