Analysis of the Effect of Intensive Nursing Care on Improving Sleep Quality During the Perioperative Period of Severed Finger Reimplantation

Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed finger reimplantation between January 2023 and December 2023 were included.They were divided into two groups:the observation group(n=31)and the control group(n=31).The control group received basic nursing interventions,while the observation group received intensive nursing care.The comparison parameters included visual analog pain score(VAS),incidence of vascular crises,length of hospitalization,Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Score(HAM-D),Hamilton Anxiety Score(HAM-A),and patient satisfaction.Results:Postoperative VAS score,incidence of vascular crisis,hospitalization time,PSQI score,and HAM-A and HAM-D scores of the observation group were lower than those of the control group(P<0.05).Meanwhile,the patient satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Perioperative intensive nursing care for patients undergoing severed finger reimplantation demonstrates significant benefits.It reduces postoperative pain,lowers the incidence of vascular crises,shortens hospitalization durations,enhances sleep quality,alleviates negative emotions,and improves nursing satisfaction.These findings underscore the importance and applicability of such care practices.

The psychological rehabilitation nursing of the patients who have ten- finger complete amputation and survived after replantation

： Objective To explore the mental dynamic change of the ten－ finger replanted patients,to give psychological rehabilitation guidance,and to improve the survival of the replantation and function recovery. Methods Take psychological investigation with Scl－ 90 at different periods after operation,judge the exsisting negative psychological factors,and find the countermeasure of solution.Enable the patients to break away from the negative mentations in short period.Results Through the 1－ week,8－ week and 16－ week Scl－ 90 measurements after operation,we found that all the items’ score of the three times measurement was higher than the usual model(p<0.05),and fluctuated up and down with mental characteristics of different phases.The assessment of the replantation of the severed finger was good. Conclusion The psychological state of the patient would affect the survivial and function recovery of the replantation of severed finger directly.So the psychological rehabilitation nursing should be performed throughout the disease.

The Effect of Modified Postoperative Treatment on Finger Replantation Survival Rate

Objective:To explore the clinical effect of modified treatment after finger replantation and its impact on the survival rate of replantation.Methods:The research was conducted from March 2022 to March 2023.A total of 58 patients who underwent finger replantation at our hospital were selected.These patients were divided into two groups using the digital table grouping method:the research group(n=29)and the control group(n=29).Patients in the control group received standard treatment following finger replantation,while patients in the study group received modified treatment after the procedure.The incidence of vascular crisis and the survival rate of replantation were compared between the two groups.Results:The incidence of vascular crisis in the study group was lower than that in the control group(P<0.05);the replantation survival rate in the study group was higher than that in the control group(P<0.05).Conclusion:Modified treatment after replantation of severed fingers can reduce the incidence of vascular crisis replantation and improve the survival rate of replantation,so it should be popularized and applied in medical institutions.

Replantation of the amputated complex mass of fingers.

Objective To study the replantation methods of the amputated complex tissue mass of fingers. Methods Nine cases were replanted using the routine method and the artery-vein bridge grafting method respectively. Results All 9 cases survived. At 1 year postoperation, the length of the replanted finger was comparable to that of the healthy side with satisfactory appearance. The average finger function increased 30% when compared with pre-operation one. Conclusion For the amputated complex tissue mass of fingers, routine replantation should be carried out if there was one or two digital proper arteries. If a defect was present, the artery-vein bridge grafting method was chosen accordingly. 5 refs,2 figs.

Transient bone resorption following finger replantation： a report of 3 cases

Radiographic changes consisting of al- terations in mineral content, osteopaenia or destructive neuropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes developed in the first three months postoperatively with complete ＂restitution ad integrum＂. Three patients, 21-49 years old （average 36 years） sustained a clean-cut amputation of four fingers. The first patient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an amputation at the base of the first metacarpal bone and the proxi- mal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arteries and nerves were repaired. In the second case, one pal- mar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and twodigital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaarticular region and metaphyses of the bone. These changes were followed by subperiosteal, intracortical and endosteal bone resorption. No further surgical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks （average 12 weeks） postoperatively, the X-rays showed a complete recovery with new periosteal bone formation. We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel compromise and microinfarction and transient hyperemia secondary to neurovascular damage or to sympathetic progressive recovery.

Clinical Investigation and Experience with Distal phalanx Replantation

Objective： To explore the measures and methods for improving distal phalanx replantation. Methods： One hundred and forty-eight cases with distal phalanx replantation from Sep 2004 to Sep 2007 were investigated. The indication for surgery and the operative program was determined by the trauma type and the degree of injury. As many microcirculation pathways as possible were reconstructed during the operation, and postoperative tissue decompression was also performed. Results： The survival rate of distal phalanx replantation was 89.9% （169/148）. Conclusion： To improve the survival rate of distal phalanx replantation it is essential to reconstruct an effective local blood circulation, determine the degree of injury in cases with ecchymosis, and employ comprehensive postoperative measures.

指背静脉移植在血管缺损的断指再植术中的临床应用

目的探讨指背静脉移植在血管缺损的断指再植术中的应用效果。方法收集2021年4月至2022年8月于秦皇岛市第一医院进行断指再植术的35例手指离断患者(40指)的临床资料,术中均采用指背静脉移植桥接术。观察术中镜下挫伤血管内膜挫伤分布情况,记录血管移植的时间。比较同水平面指背静脉与缺损血管的管径,观察术后再植手指的成活情况、并发症发生情况和成活手指的功能恢复情况。结果术后手指成活率为95.0%(38/40)。自切取静脉至完成两处吻合口的时间一般约为40分钟,吻合质量良好。同水平面指背静脉与缺损血管的管径相当或略粗。术后6个月,在成活的38个再植手指中,手指功能优10指,良25指,差3指,优良率为92.1%(35/38)。结论在血管缺损的断指再植术中,指背静脉移植可在避免再植时过多缩短指骨、关节融合或截指的情况下获得满意的外形和优良的功能。

断指再植术后成活率及影响因素

目的分析断指再植术后的成活率及其影响因素。方法回顾性分析2020年1月至2023年6月行断指再植术并获得完整随访的382例断指再植患者的人口学信息,受伤相关指标及手术相关变量,分析断指再植术后的成活率及影响再植断指成活的因素。结果382例断指再植患者中男295例,女87例;平均年龄(36.4±4.7)岁,左侧多于右侧。切割伤305例,挤压伤54例,撕脱伤23例;完全离断者157例,不全离断者225例。离断平面分布中,中节指骨最多,近节指骨最少。其中成活349例,成活率为91.4%。多因素Logistic回归分析结果显示,吸烟(Or=2.14,95%CI:1.19~4.03,P=0.003)、受伤机制(Or=3.31,95%CI:2.87~6.50,P=0.000)、断指保存方式(Or=1.82,95%CI:1.12~3.77,P=0.012)、动静脉吻合比例(Or=6.83,95%CI:2.94~11.32,P=0.000)与再植术后断指是否存活相助相关。结论断指再植术后成活率约为91.4%,吸烟会增加再植术失败的风险,不同受伤机制下断指再植成活率亦不同,断指的低温干燥保存和高的动静脉吻合数量会显著增加再植断指的存活率。

再植指功能恢复效果的列线图预测模型构建

目的探讨再植指功能恢复差的危险因素,建立患指功能恢复差的预测模型。方法回顾性分析2017年5月至2022年5月在唐山市人民医院行断指再植术的309例(断指376个)手指离断患者的资料,其中男性231例断指274个,女性78例断指102个;年龄19~67岁,平均(41.57±8.59)岁。术后1年对患指功能的恢复效果进行判定,并分成恢复差组和对照组。收集患者一般人口特征、病情信息、手术信息、术前血常规指标行单变量筛查,通过多因素分析确定患指功能恢复差的危险因素,以森林图展现各指标效应大小。依据预测变量构建列线图模型,并通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)、校准曲线及决策曲线(decision curve analysis,DCA)检验其效能。结果309例(断指376个)患者中,有68例(断指81个)术后功能恢复差,占比21.54%。两组吸烟史、损伤性质、离断程度、离断平面、断指暴露时间、断指保存方式、是否遵医开展康复锻炼情况比较差异有统计学意义(P<0.05)。Logistic回归分析显示,术后患指功能恢复差的危险因素主要为有吸烟史、撕脱伤、离断平面为非末节指骨、断指暴露时间≥8 h、未遵医开展康复锻炼。内部验证显示,AUC为0.819(95%CI:0.762~0.875),模型预测患指功能恢复差的概率与实际概率高度吻合,拟合优度HL检验χ^(2)=7.389,P=0.286。DCA显示模型在风险阈值12%~75%时具有较好的实用性。结论根据有吸烟史、损伤性质、离断平面、断指暴露时间、是否遵医开展康复锻炼构建的列线图模型对断指再植术后患指功能恢复差的预测效果较好。

手指离断伤再植手术患儿家属精神和情绪改变及影响因素分析

目的分析手指离断伤再植手术患儿家属精神状态和情绪改变及影响因素。方法选取2012年5月至2022年12月手指离断伤再植手术患儿家属80例作为调查对象,收集患儿及其家属人口学特征,采用症状自评量表(SCL-90)和心理弹性量表(CD-RISC)对患儿家属进行调查,采用多因素Logistic回归模型分析患儿家属不良心理状况影响因素。结果剔除量表及问卷填写内容缺失的手指离断伤再植手术患儿家属6名,其余74名家属中精神、情绪良好者31名,精神、情绪不良者43名;患儿家属抑郁、焦虑、敌对、恐惧各维度评分及总评分均高于中国常模(P<0.05);患儿是否独生子女及家属学历、婚姻状况、心理坚韧性、心理乐观性、家庭人均月收入与患儿家属精神、情绪有关(P<0.05);经二元Logistic回归分析结果显示:患儿独生子女及家属中专及以下学历、再婚/离婚单亲均是患儿家属精神、情绪不良的危险因素(P<0.05),家庭人均月收入>5000元、心理坚韧性>39分及心理乐观性>12分是患儿家属精神、情绪变化的保护因素(P<0.05)。结论精神不佳及负面情绪水平较高是手指离断伤再植手术患儿家属常见问题,临床需给予足够重视,并根据相关影响因素采取相应措施,及时缓解患儿家属的不良情绪,改善其精神状态。

断指再植术后应用当归四逆汤的临床疗效观察

目的探讨断指再植术后应用当归四逆汤的临床疗效。方法240例手指离断行断指再植术后的患者随机分为对照组与治疗组各120例。对照组常规应用抗炎、抗凝、抗痉挛等经典西药3抗治疗;治疗组在对照组常规治疗基础上加用当归四逆汤颗粒剂,1剂·d^(-1),分2次水冲服,1疗程10 d。1疗程后观察患者再植指成活率、感染率、血运情况、疼痛评分。结果治疗组与对照组再植指成活率、感染率差异无统计学意义(P>0.05);治疗组血运情况、疼痛评分优于对照组(P<0.05)。结论当归四逆汤有抗凝、抗血栓形成、扩张末梢血管、增加血管灌流量及镇痛、抗炎、解痉作用,可明显改善再植指的血液循环,减轻患者疼痛,符合断指再植术后的3抗治疗原则,临床疗效良好。

手外科血管危象预防护理质量评价指标的构建及应用

目的构建手外科血管危象预防护理质量评价指标,并评价应用效果。方法以三维质量结构模式为理论框架,通过文献分析、半结构访谈及专家函询构建手外科血管危象预防护理质量评价指标。将200例单指断指再植或皮瓣移植患者按照入院时间分为对照组和观察组各100例,对照组给予常规护理,观察组根据构建的手外科血管危象预防护理质量评价指标进行护理。结果构建的手外科血管危象预防护理质量评价指标体系包含结构质量、过程质量、结果质量3项一级指标,10项二级指标及47项三级指标。质量评价指标应用后,观察组血管危象及时发现率、断指再植或移植皮瓣成活率及患者满意度评分显著高于对照组,患者血管危象发生率显著低于对照组(均P<0.05)。结论构建并应用手外科血管危象预防护理质量指标有利于及时发现血管危象,降低血管危象发生率,提高再植手指或移植皮瓣成活率及患者满意度。

仅吻合双侧指掌侧固有动脉甲根离断断指再植10例

目的探讨末节甲根部平面以远的离断指应用无需吻合静脉回流的再植方法及疗效。方法2019-2022年对10例于末节甲根部平面离断的手指,仅作双侧指掌侧固有动脉吻合而不需吻合静脉的再植修复。结果10例甲根部平面离断手指再植后,全部成活,再植成活率为100%。出院后10例均得到随访,随访时间3~6个月,再植后成活指体的功能与外观恢复良好,患者对手术结果满意。结论手指甲根部及以远的指体离断,基本无静脉可吻合。在再植时只吻合双侧指掌侧固有动脉而不吻合静脉的情况下,早期血流及供血通过双侧指掌侧固有动脉达到供血压力平衡、不会导致供血过多,而后重建动静脉网达到正常静脉血液回流,使其成活,术后断指成活情况较好,此方法可于临床推广应用。

断指再植术后血管危象的相关危险因素的Logistic回归分析

目的通过Logistic回归分析明确断指再植后出现血管危象的主要危险因素。方法回顾性分析2021年1月—2023年10月本院收治断指再植总共68例患者的临床资料,按手术结束后有无血管危象归纳成发生组和未发生组,比较两组基本资料及临床资料差异,对存在差异的项目进行Logistic回归分析,确定影响术后血管危象发生的主要危险因素。结果68例患者中12例发生血管危象(包含动脉危象7例和静脉危象5例),总发生率是17.65%。旋转撕脱伤、完全离断、末节离断、吸烟史、动脉修复1根、静脉未吻合、就医时间>1.5 h、缺血时间>1.5 h、焦虑为术后发生血管危象的危险因素,OR值均>1。结论旋转撕脱伤、完全离断、末节离断、吸烟史、动脉修复1根、静脉未吻合、就医时间或缺血时间>1.5 h、焦虑是术后血管危象的危险因素,对有以上危险因素者应尽量缩短术前时间,同时术中操作需更细致,尽量达到多根血管修复,对患者加强宣教及心理干预,并警惕吸烟给血管危象带来的影响。

断指再植康复期病人手功能锻炼依从性现状及影响因素分析

目的:探讨断指再植康复期病人手功能锻炼依从性现状及其影响因素。方法:采用便利抽样法,选取2022年5月—2023年5月在衡阳市某三级甲等医院进行断指再植术的154例病人作为调查对象,采取一般资料调查表、疼痛数字评定量表、骨科病人功能锻炼依从性量表、运动自我效能量表和社会支持评定量表进行调查。结果:断指再植康复期病人手功能锻炼依从性得分为(45.09±11.20)分。多元线性回归分析结果显示,文化程度、个人月收入、疼痛程度、运动自我效能、社会支持是断指再植康复期病人手功能锻炼依从性的影响因素(P<0.05)。结论:断指再植康复期病人手功能锻炼依从性有待进一步提高且受多种因素的影响,医护人员需结合病人的个体情况制定针对性的功能锻炼策略。

显微镜下末节手指不缩短断指再植术治疗手指离断患者的效果观察

目的显微镜下末节手指不缩短断指再植术在手指离断患者治疗中的应用优势,以期为此类患者治疗提供参考。方法回顾性选取2020年5月至2022年5月我院150例末节手指离断患者临床资料,根据手术方法分为研究组(78例)和常规组(72例)。研究组采用显微镜下末节手指不缩短断指再植术治疗,常规组行常规断指再植术治疗。比较两组临床疗效、手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]、断指血液循环[血流速度、阻力指数(RI)]、断指恢复情况。结果研究组手术优良率94.87%、皮瓣成活率98.72%,均高于常规组的76.39%、88.89%(P<0.05);术后3d、7d研究组Cor、NE、ACTH浓度均低于常规组(P<0.05);术后1个月、3个月、6个月研究组血流速度高于常规组,RI低于常规组(P<0.05);研究组断指长度、两点辨别觉、指尖关节活动度均优于常规组(P<0.05)。结论显微镜下末节手指不缩短断指再植术治疗末节手指离断效果确切,能减轻应激反应,改善断指血流,提高皮瓣成活率,改善预后。

掌侧动脉静脉化和背侧静脉吻合在末节断指再植中的疗效对比

目的:探究掌侧动脉静脉化和背侧静脉吻合再植对末节断指再植患者手指功能、术后并发症及外观满意度的影响。方法:研究主体为2019年1月-2022年10月于笔者医院接受断指再植手术的患者,将符合纳入排除标准的患者按照随机数字表法分为观察组与对照组,其中对照组50例(54指)患者给予背侧静脉吻合再植术,观察组53例患者(56指)给予掌侧动脉静脉化,统计比较两组围手术期相关指标、再植指功能、生活质量评分、并发症发生情况及患者满意度。结果:观察组住院时间及创口愈合时间均短于对照组(P<0.05),且再植成功率高于对照组(P<0.05),但两组手术时间及术中出血量比较差异无统计学意义(P>0.05);观察组手指功能恢复情况及生活质量评分均优于对照组(P<0.05);随访结果显示观察组并发症发生率低于对照组,且外观满意度高于对照组(P<0.05)。结论:掌侧动脉静脉化和背侧静脉吻合再植在末节断指再植患者中均有确切效果,但前者对促进手指功能及生活质量的恢复更具优势,且术后并发症发生率低,患者满意度也较高。

术中温度干预对断指再植术后功能恢复、炎症因子及并发症的影响

目的:探究术中温度干预对断指再植术后功能恢复、炎症因子及并发症的影响。方法:选取2021年9月-2023年8月笔者科室收治的72例断指预再植患者为研究对象,按双盲、随机数字表法分为对照组和观察组,各36例。对照组予以常规手术治疗及相关处理;观察组在对照组基础上予以术中温度干预。统计比较两组术中断指区域温度达标率、血液相关指标、再植指功能恢复情况、患者舒适度及并发症发生情况。结果:观察组术中断指区域温度达标率高于对照组(P<0.05)。术后3 h,观察组血液丙二醛(MDA)高于对照组(P<0.05),但术后24、48 h,观察组血液MDA低于对照组(P<0.05);术后3、24、48 h,观察组血液超氧化物歧化酶(SOD)均高于对照组(P<0.05)。术后3 h,观察组舒适度评分高于对照组。术后第5天,观察组IL-1、TNF-α水平低于对照组,IL-10水平高于对照组,差异均有统计学意义(P<0.05)。术后,观察组并发症发生率低于对照组(P<0.05),住院时间短于对照组(P<0.05),患者对手术效果的满意度评分高于对照组(P<0.05)。术后2个月,观察组患者再植手指功能恢复优良率高于对照组(P<0.05)。结论:术中温度干预可降低术后患者血液中炎症因子水平和并发症发生率,并能有效促进术后断指再植的功能恢复,值得在临床推广应用。

流程康复护理对断指再植术后患者功能恢复的效果

目的 探讨流程康复护理对断指再植术后关节活动度、握力、再植存活率及断指功能恢复的效果。方法 选取2019年2月至2022年12月浙江大学医学院附属第二医院临平院区收治的70例行断指再植术患者,采用红蓝球随机法将患者分为两组。对照组(n=35)采用常规护理,研究组(n=35)采用流程康复护理,对比两组患者的护理效果。结果 研究组患者护理后断指功能恢复优良率为97.14%(34/35),显著高于对照组的82.86%(29/35)(P<0.05);研究组患者护理后指关节活动度、握力、再植存活率及功能评分高于对照组(P<0.05);研究组患者护理3个月后关节活动度优良率为94.29%(33/35),显著高于对照组的74.29%(26/35)(P<0.05)。结论 流程康复护理可提高断指再植术患者的关节活动度及断指功能,可推广应用。

血管危象预警控制体系对断指再植手术患者预后的影响

目的 观察血管危象预警控制体系应用于断指再植手术患者中的效果,为改善患者预后提供思路。方法 分别于医院推行血管危象预警控制体系管理模式前(2019年8月—2020年12月,对照组)和推行后(2021年1月—2022年3月,观察组),随机抽取断指再植患者55例和50例;对比2组患者的围术期指标(皮瓣坏死率、手术成功率、血管危象率),及治疗期间的治疗依从性[Morisky服药依从性量表-8(MMAS-8)]和并发症发生情况;评估患者出院6个月的手指功能康复情况[断肢再植功能评估标准、手功能量表(MHQ)],记录患者出院时的局部血流动力学水平[平均血流速度(Vm)、阻力指数(RI)、舒张期血流速度(Vd)];采用Spitzer生活质量指数(SQLI)、生活质量综合评定问卷(GQOLI-74),评价并比较2组患者的生活质量。结果 2组患者手术成功率、皮瓣坏死率差异无统计学意义(P>0.05);观察组的血管危象率(4.0%)低于对照组(16.4%),差异有统计学意义(χ^(2)=4.269,P=0.039)。出院时,观察组断肢再植功能评估总优良率(84.0%)高于对照组(67.3%),MHQ、GQOLI-74、SQLI、MMAS-8评分和Vm、Vd水平均高于对照组,RI水平低于对照组,差异均有统计学意义(P<0.05)。治疗期间,2组患者的并发症总发生率差异无统计学意义(P>0.05)。结论 血管危象预警控制体系下的管理模式可有效降低患者血管危象事件发生率,改善断指局部血流动力学指标,对提高患者生活质量及治疗依从性具有积极影响。