颜面部软组织损伤急诊入院患者的手术效果的影响因素分析

Analysis of influencing factors of surgical effect in emergency patients with facial soft tissue injury

目的分析颜面部软组织损伤急诊入院患者的手术效果的影响因素,指导护理重点。方法选择2017年1月~2019年12月单纯颜面部软组织损伤急诊入院患者为研究对象,收集龄、性别、受教育程度、急诊至入院时间、创面位置、神经损伤、手术方法及术后效果等资料,采用Logistics回归分析进行影响因素筛查。结果本研究共纳入237例患者,年龄18~76岁,中位年龄36岁,平均年龄(37.61±10.37)岁;男200例(84.4%),女37例(15.6%)。一般资料比较结果显示,患者不同创面位置和不同手术方法,手术效果存在差异。单因素分析,结果提示,创面位于额部的患者手术效果优于口/眼/鼻(周)患者[OR=6.28,95%CI=(2.06,16.14),P=0.001];接受美容缝合法的患者手术效果优于普通缝合法[OR=4.57,95%CI=(1.60,13.01),P=0.004]。多因素分析结果显示,创面位于额部的患者手术效果更良好[OR=5.08,95%CI=(1.56,16.57),P=0.007]。手术采用皮瓣法的患者手术效果较差[OR=0.23,95%CI=(0.06,0.94),P=0.041]。结论创面位于口/眼/鼻(周)及面颊部的患者应积极给予抗瘢痕干预。创面适合直接拉拢者首选美容缝合法,而对于采用皮瓣法整复的患者应加强皮瓣护理。

Objective To analyze the influencing factors of surgical effect of emergency patients with facial soft tissue injury,and guide the key points of nursing.Methods From January 2017 to December 2019,patients with simple facial soft tissue injury were selected as the research objects.The data of age,gender,education level,emergency to admission time,wound location,nerve injury,surgical methods and postoperative effects were collected.Logistic regression analysis was used to screen the influencing factors.Results A total of 237 patients,aged from 18 to 76 years,with a median age of 36 years and an average age of(37.61±10.37)years,were included in this study,including 200 males(84.4%)and 37 females(15.6%).The results of general data comparison showed that there were differences in the surgical effect of patients with different wound positions and different surgical methods.The results of univariate analysis showed that the surgical effect of patients with forehead wound was better than that of patients with mouth/eye/nose(week)[or=6.28,95%CI=(2.06,16.14),P=0.001];the surgical effect of patients receiving cosmetic suture was better than that of ordinary suture[or=4.57,95%CI=(1.60,13.01),P=0.004].Multivariate analysis showed that patients with frontal wound had better surgical effect[or=5.08,95%CI=(1.56,16.57),P=0.007].The patients with skin flap operation had poor effect[or=0.23,95%CI=(0.06,0.94),P=0.041].Conclusion The patients with wound located in mouth/eye/nose(peri)and cheek should be given anti scar intervention actively.Cosmetic suture is the first choice for patients who are suitable for direct wound closure,and skin flap nursing should be strengthened for patients with skin flap repair.