改良头部皮肤护理在开颅手术围手术期中的应用

Perioperative application of modified scalp skin care in craniotomy

目的探讨改良头部皮肤护理在择期开颅手术围手术期临床运用的可行性.方法根据指南和文献指引制定改良头部皮肤护理的指引,即在常规护理的基础上,术前使用电动剃头刀局部剪短头发,患者术中使用聚丙烯不可吸收缝线缝合或皮肤钉缝合头部切口,术后常规第5天开始用清水洗头。研究改良头部皮肤护理对手术切口感染率的影响。结果择期开颅手术实行改良头部皮肤护理的患者66例,切口感染率为0(0/66),甲级愈合率为97.0%(64/66),与对照组(本院神经外科同期实行传统全头范围备皮患者)的切口感染率(0.4%,1/249)和甲级愈合率(99.2%,247/249)差异均无统计学意义(P>0.05)。两组患者的手术切口愈合均符合清洁手术切口甲级愈合率的要求(≥97%).结论改良头部皮肤护理法不仅不会增加择期开颅手术患者手术切口的感染率,还可维持患者的外观形象,提高舒适性,具有积极的临床意义,值得在神经外科推广。

Objective To investigate the feasibility of clinical application of modified head skin care in peri-operative period of elected craniotomy.Methods Modified head skin care was applied according to the guidelines and literatures.The hair was locally cut with an electric razor before operation.The incisions were sutured with polypropylene non-absorbable sutures or skin nails during the operation.The hair was washed with clean water on the fifth day after operation.The infection rate of surgical incision was analyzed.Results From January 2017 to June 2019,66 patients undergoing elected craniotomy in Hong Kong University Shenzhen Hospital were treated with modified head skin care.The incision infection rate was 0%(0/66),and the Grade A healing rate was 97.0%(64/66).The incision infection rate and the Grade A healing rate in the control group(th e patients received traditional full head skin preparation)during the study period was 0.4%(1/249)and 99.2%(247/249),respectively,with no statistical difference between these two group(P>0.05).The Grade A healing rates of the patients in these two group bothmet the requirement of clean surgical incision(≥97%).Conclusion The modified head skin care method won’t increase the infection rate of surgical incision in patients with elected craniotomy.In addition,it improves patients' comfort and m aintains the appearance of patients.It has positive clinical significance and worth popularizing in neurosurgery.