自护技能指导对降低喉癌术后感染可行性探讨

Self-care skills instruction on the feasibility of reducing infections after laryngeal cancer surgery

目的探讨喉癌患者术后发生感染的危险因素,分析自护技能指导对降低喉癌术后感染的效果,为临床护理提供参考依据。方法选取医院2011年1月-2013年1月喉癌手术患者86例,按照随机数表法分为观察组与对照组各43例,采取多因素logistic分析对术后感染的危险因素进行回顾性分析;对照组给予常规护理,观察组针对患者易感因素采取自护技能指导,比较两组患者不同护理模式的效果。结果术前有气管切开、手术时间>5h、误吸、痰痂堵塞的喉癌患者术后感染率,分别为21.82%、26.67%、27.39%、23.68%,是术后发生感染的危险因素,差异有统计学意义(P<0.05);经多因素logistic回归分析,临床分期(β=0.324、OR=1.372)、手术范围(β=0.455、OR=2.432)、误吸(β=0.374、OR=1.469)、痰痂堵塞(β=0.372、OR=2.149)以及术前气管切开(β=0.279、OR=2.581)是术后感染发生的独立危险因素(P<0.05);不同模式护理后,术后感染率观察组为6.98%、对照组为23.26%,差异有统计学意义(P<0.05)。结论喉癌手术中除缩短手术时间及提高操作技巧等外,还要指导患者熟练掌握各项自护技能,在术后正确实施各项护理操作,以降低喉癌术后感染的发生。

OBJECTIVE To discuss the risk factors of infections in patients after laryngectomy ,and analyze the effect of self-care skill guidance on infections and reduce postoperative laryngeal cancer , so as to provides the reference for the clinical nursing .METHODS A total of 86 cases of laryngeal cancer patients were select the hospital in Jan .2011 ~ Jan .2013 ,in accordance with the random number table method divided into observation group and control group of 43 cases .Multivariate logistic analysis of risk factors for postoperative infection were analyzed retrospectively .The patients in observation group were given predisposing factors to take self-care skill instruction .The effects of the two nursing mode were compared in two groups of patients . RESULTS The infection after operation rates of preoperative trachea incision , operation time longer than 5 hours , mistake aspiration ,sputum blockage were 21 .82% ,26 .67% ,27 .39% and 23 .68% ,which were the risk factors for infections with statistical significance （ P〈 0 .05 ）;clinical stage （β= 0 .324 , OR= 1 .372 ） , operation range （β=0 .455 ,OR= 2 .432 ） , mistake aspiration （β = 0 .374 , OR = 1 .469 ） , sputum blockage （β = 0 .372 , OR=2 .149） and preoperative tracheotomy （β = 0 .279 , OR = 2 .581 ） were the independent risk factors for infection after operation （P〈0 .05） ,based on the multivariate logistic analysis .the infection rate after operation were 6 .98% in observation group and 23 .26% in control group under different nursing modes and the differences were significant （P〈0 .05） .CONCLUSIONS Except improving the surgical techniques and shortening operation time ,the guidance to patients how to use self-care skill is important too .The nursing procedure postoperation could reduce incidence of infections after laryngeal cancer operation .