不同年龄口腔癌根治同期皮瓣修复手术患者的临床分析及护理对策

Perioperative nursing characteristics and management of oral cancer patients underwent radical resection and flap reconstrution

目的回顾性分析口腔癌根治同期皮瓣修复手术患者的围手术期临床特点及其对护理对策的提示。方法选取2020年1—12月在中山大学孙逸仙纪念医院口腔颌面外科行口腔癌根治同期皮瓣修复患者658例,所有患者按年龄分为高龄组(≥60岁)279例及低龄组(<60岁)379例。收集2组患者围手术期临床资料,分析患者围手术期一般情况、术后并发症及带管出院的影响因素。结果2组患者在性别(χ^(2)=12.38,P<0.001)、术前BMI(t=2.43,P=0.015)、吸烟史(χ^(2)=18.34,P<0.001)、术前麻醉ASA分级(χ^(2)=25.61,P=0.001)、术前并存疾病(χ^(2)=46.97,P<0.001)、是否舌、口底肿瘤(χ^(2)=16.68,P<0.001)、是否游离皮瓣(χ^(2)=6.81,P=0.03)、手术时间(t=2.19,P=0.029)、术前检验指标血红蛋白(t=4.96,P<0.001)、白蛋白(t=5.44,P<0.001)、D-二聚体(Z=-13.52,P<0.001)、钙离子水平(t=4.07,P<0.001)及术后并发症发生情况(χ^(2)=14.55,P<0.001)方面比较,差异均有统计学意义。术后并发症的多因素分析结果显示:年龄(OR=1.021,95%CI 1.005~1.037,P=0.011)、术前D-二聚体水平(OR=1.219,95%CI 1.026~1.447,P=0.024)、术前并存疾病(OR=1.642,95%CI 1.108~2.432,P=0.013)是术后并发症的独立危险因素。带管出院的多因素分析结果显示:年龄(OR=1.017,95%CI 1.003~1.031,P=0.017)、术前BMI(OR=0.917,95%CI 0.873~0.963,P=0.001)、是否舌口底肿瘤(OR=2.135,95%CI 1.475~3.091,P<0.001)及手术时间(OR=1.220,95%CI 1.120~1.328,P<0.001)是带管出院的相关因素。结论针对上述各种危险因素,重视患者术前评估,做好充分术前准备,针对性的术后护理及观察,加强吞咽功能训练,做好出院准备服务,重视延续护理,建立三级医院-社区-家庭的康复体系有利于患者身心康复。

Objective To analyze the perioperative clinical characteristics of patients with oral cancer underwent radical resection and flap reconstrution and the nursing managements.Methods From January 2020 to December 2020,658 patients with oral cancer underwent radical resection and flap reconstrution in the Department of Oral and Maxillofacial Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University were retrospectively analyzed.All patients were divided into the elderly group(≥60 years)and the younger group(<60 years),including 279 cases in the elderly group and 379 cases in the younger group.The perioperative clinical data of the patients were collected,and the perioperative general situation,postoperative complications and influencing factors of complications were analyzed.Results There were differences between the two groups in the aspects of sex(χ^(2)=12.38,P<0.001),preoperative BMI(t=2.43,P=0.015),smoking history(χ^(2)=18.34,P<0.001),preoperative anesthesia grade(χ^(2)=25.61,P=0.001),preoperative coexisting disease(χ^(2)=46.97,P<0.001),whether oral floor or tongue cancer(χ^(2)=16.68,P<0.001),whether free flap(χ^(2)=6.81,P=0.003),operation time(t=2.19,P=0.029),preoperative test index hemoglobin(t=4.96,P<0.001),albumin(t=5.44,P<0.001),D-dimer(Z=-13.52,P<0.001),calcium levels(t=4.07,P<0.001)and postoperative complications(χ^(2)=14.55,P<0.001).Multivariate analysis of postoperative complications showed that the age(OR=1.021,95%CI=1.005-1.037,P=0.011),preoperative D-dimer(OR=1.219,95%CI=1.026-1.447,P=0.024)and the preoperative coexisting disease(OR=1.642,95%CI=1.108-2.432,P=0.013)were the risk factors for the postoperative complications.Multivariate analysis of discharge with tube showed that the age(OR=1.017,95%CI=1.003-1.031,P=0.017),preoperative BMI(OR=0.917,95%CI=0.873-0.963,P=0.001),whether oral floor or tongue cancer(OR=2.135,95%CI=1.475-3.091,P<0.001),and operation time(OR=1.220,95%CI=1.120-1.328,P<0.001)were the related factors for the discharge with tube.Conclusion In view of the above risk factors,it is beneficial for the physical and mental recovery of patients to pay attention to preoperative evaluation,make adequate preoperative preparation,postoperative nursing and observation,improve swallowing function training,prepare for discharge,pay attention to continuous nursing,and establish a tertiary hospital-community-family rehabilitation system.