瘘口封闭式负压引流在全喉切除术后咽瘘患者护理中的应用

Application of Closed Negative Pressure Drainage of Fistula in Nursing of Patients With Pharyngeal Fistula After Total Laryngectomy

目的探究瘘口封闭式负压引流在全喉切除术后咽瘘患者护理中应用价值。方法选择厦门大学附属第一医院2019年1月—2021年12月就诊的86例接受全喉切除术治疗患者为研究对象,以随机数字表法分为对照组与观察组,各43例,对照组应用常规换药方式干预,观察组采用瘘口封闭式负压引流干预。比较两组患者疼痛程度、瘘口愈合时间、情绪状态、生活质量及护理满意度。结果护理第1天,观察组视觉模拟评分(visual analogue score,VAS)与对照组比较,差异无统计学意义(P>0.05)。观察组VAS评分第3天(3.20±1.03)分、第5天(2.46±0.70)分、第7天(1.75±0.34)分均低于对照组,差异有统计学意义(t=3.039、3.508、2.805,P<0.05)。观察组瘘道愈合时间为(14.70±3.48)d,短于对照组的(18.24±5.66)d,差异有统计学意义(t=3.494,P<0.05)。护理前,两组焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分比较,差异无统计学意义(P>0.05);护理后,观察组SAS评分(47.00±5.34)分、SDS评分(48.39±7.93)分均低于对照组(51.47±6.29)分、(52.03±4.68)分,差异有统计学意义(t=3.552、2.592,P<0.05)。护理前,两组生活质量综合评定量表(generic quality of life inventory74,GQOL-74)总分及各维度评分比较,差异无统计学意义(P>0.05);护理后,观察组的物质生活评分(84.47±6.78)分、心理功能评分(86.01±6.94)分、躯体功能评分(80.63±7.24)分、社会功能评分(80.25±6.97)分均高于对照组的(79.80±6.48)分、(86.01±6.94)分、(75.33±7.12)分、(76.33±6.74)分,且GQOL-74总分为(351.03±17.68)分,明显高于对照组的(339.47±16.29)分,差异有统计学意义(P<0.05)。观察组护理满意度为95.35%,高于对照组的81.40%,差异有统计学意义(P<0.05)。结论在对全喉切除术后咽瘘护理中,与常规换药方式相比,应用瘘口封闭式负压引流干预,可缓解患者疼痛感受,缩短瘘口愈合时间,缓解患者不良情绪,并有助于生活质量水平与护理满意度的提升,效果显著。

Objective To explore the application value of closed negative pressure drainage of fistula in nursing of patients with pharyngeal fistula after total laryngectomy.Methods A total of 86 patients who received total laryngectomy from January 2019 to December 2021 of the First Affiliated Hospital of Xiamen University were selected as the research objects,and divided into the control group and the observation group by random number table method,43 cases in each group,and routine dressing changes were applied respectively.Methods intervention and fistula closed negative pressure drainage intervention were used to compare the pain degree,fistula healing time,emotional state,quality of lifeand,nursing satisfaction of the two groups of patients.Results On the first day of nursing,the VAS score of the observation group was similar control group,the difference was not significant(P>0.05).The 3 d VAS score(3.20±1.03)points,5 d VAS score(2.46±0.70)points and 7 d VAS score(1.75±0.34)points in the observation group were lower than control group,the difference was significant(t=3.039,3.508,2.805,P<0.05).The fistula healing time in the observation group was(14.70±3.48)d shorter than that in the control group(18.24±5.66)d,and the difference was statistically significant(t=3.494,P<0.05).Before nursing,the scores of selfrating anxiety scale(SAS)and self-rating depression scale(SDS)between the two groups were similar,and there was no significant difference(P>0.05).After nursing,the SAS score(47.00±5.34)points and SDS score(48.39±7.93)points of the observation group were lower than control group(51.47±6.29)points and(52.03±4.68)points,and the differences were significant(t=3.552,2.592,P<0.05).Before nursing,the total scores and dimension scores of generic quality of life inventory 74(GQOL-74)were similar between the two groups,with no significant difference(P>0.05).After nursing,the material life score(84.47±6.78)points,psychological function score(86.01±6.94)points,physical function score(80.63±7.24)points and social function score(80.25±6.97)points in the observation group were higher than those in the control group(79.80±6.48)points,(86.01±6.94)points and(75.33±7.12)points,(76.33±6.74)points,and the total score of GQOL-74 was(351.03±17.68)points,significantly higher than control group(339.47±16.29)points,the differences were significant(P<0.05).The nursing satisfaction of the observation group was 95.35%higher than control group(81.40%),the difference was significant(P<0.05).Conclusion In the nursing of pharyngeal fistula after total laryngectomy,compared with the conventional dressing change,the application of closed negative pressure drainage of the fistula can relieve the patient's pain,shorten the healing time of the fistula,relieve the patient's negative emotions,and improve the prognosis.It also contributes to the improvement of quality of life and nursing satisfaction,the effect is remarkable.