暴露疗法在下肢损伤皮瓣转移术后患者创面护理中的应用

Application of exposed therapy in wound nursing after the skin flap transplantation for lower extremity injury

目的：探讨暴露疗法在下肢损伤伴组织缺损行皮瓣转移修复术后创面护理中的应用效果。方法选择2012年1—8月住院行下肢损伤伴组织缺损皮瓣转移修复术，术后创面采用传统纱布包扎疗法的43例患者为对照组；选择2012年9月—2013年4月住院行下肢损伤伴组织缺损皮瓣转移修复术，创面于术后6～8 h拆除包扎敷料采用暴露疗法的42例患者为观察组。观察两组患者术后转移皮瓣的血液循环、皮瓣存活率、创面感染及医疗成本4方面指标，评价创面包扎疗法和暴露疗法的应用效果。结果术后，观察组患者的转移皮瓣肤色、肿胀、充盈度情况均优于对照组，差异有统计学意义（Z值分别为5．63，6．47，6．48；P＜0．01）。观察组患者转移皮瓣皮温正常率、皮瓣存活率分别为83．33％和97．62％，均高于对照组，差异有统计学意义（χ2值分别为7．40，5．91；P＜0．05）。观察组的创面感染率低于对照组，差异有统计学意义（ Z＝5．29，P＜0．01）。两组患者医疗成本比较，观察组的住院天数、换药次数、护理工时均低于对照组，差异有统计学意义（ t值分别为2．44，32．78，22．44；P＜0．05）。结论下肢损伤伴组织缺损行皮瓣转移修复术后创面护理实施暴露疗法，能有效降低创面感染的发生率，便于及时观察转移皮瓣的血液循环，并能早期发现转移皮瓣血管危象的征象，提高皮瓣的存活率。

Objective To explore the effect of exposed therapy in wound nursing after the skin flap transplantation for lower extremity injury.Methods During January and August 2012, forty three patients, who underwent skin flap transplantation for the lower extremity injuries with soft tissue defect and whose wounds were bandaged using conventional gauze bandaging therapy, enrolled as control group.From September 2012 to April 2013, forty two patients with lower extremity injuries applied the exposed therapy when wound dressings were removed during 6 to 8 hours after surgery after skin flap transplantation as intervention group.This study aimed to evaluate the effect of conventional bandage therapy and exposed therapy by conducting the comparisons on blood circulation of transplantation flap, flap survival rate, wound infection and medical cost.Results The color, swelling and filling degree of transplanted flap in the intervention group were better than those in the control group （Z=5.63,6.47,6.48, respectively;P〈0.01）.The rate of flap normal temperature and flap survival rate were 83.33%and 97.62%in the intervention group, higher than those in the control group （χ2 =7.40,5.91, respectively;P〈0.05）.The wound infection rate was lower in the intervention group than that in the control group （Z=5.29;P〈0.01）.The data of intervention group were lower than those in the control group at medical cost, hospitalized days, switching medicine times and length of nursing （ t =2.44,32.78, 22.44,respectively;P〈0.05）.Conclusions For patients with skin flap transplantation, exposed therapy can effectively reduce the incidence of wound infection, and facilitate the direct observation of the flap blood circulation and the early detection of vascular crisis, so as to adopt the effective measures to prevent vascular crisis and improve the survival rate of skin flap.