颌面部创伤后缺损修复中护理配合对预后的影响

侯珍珍 熊阳 蔡艳丽 张美霞

[摘要]目的：探讨颌面部创伤后缺损修复中护理配合对预后的影响。方法：选择本院2013年6月-2016年6月收治的26例股前外侧皮瓣同期移植修复颌面部缺损患者作为研究对象，围手术期实施显微修复、心理调适等方面的护理配合，观察预后情况，比较干预前后SDS、SAS评分。结果：护理干预后，SDS、SAS评分为（32.11±5.43）分、（34.72±7.06）分均明显低于入院时[（67.15±5.42）分、（68.93±8.73）分]，差异有统计学意义（P<0.05）。26例皮瓣全部成活，术后回访4～6个月，患者无明显功能障碍，遗留瘢痕较小，外观佳。结论：颌面部缺损患者给予股前外侧皮瓣同期移植修复手术围手术期护理配合可显著改善其负面情绪，减少瘢痕产生，值得临床推广应用。

[关键词]颌面部创伤；皮瓣；护理配合；预后

[中图分类号]R473.6 [文献标志码]B [文章编号]1008-6455（2018）04-0130-03

Effect of Nursing Coordination on Prognosis after Maxillofacial Trauma Repair

HOU Zhen-zhen，XIONG Yang，CAI Yan-li，ZHANG Mei-xia

（Department of Plastic Surgery，the First Affiliated Hospital of PLA，Air Force Medical University，Xi'an 710032，Shaanxi，China）

Abstract： Objective To investigate the effect of nursing coordination on prognosis after maxillofacial trauma repair. Methods A total of 26 patients with maxillofacial defects who underwent simultaneous transplantation of anterolateral thigh flap in our hospital from June 2013 to June 2016 were enrolled in this study. Perioperative implementation of microscopic repair， psychological adjustment and other aspects of nursing cooperation. The prognosis of the patients was observed and the SDS and SAS scores were compared before and after the intervention. Results After nursing intervention， the scores of SDS and SAS （32.11±5.43） and （34.72±7.06） were significantly lower than those in admission[（67.15±5.42），（68.93±8.73]， the difference were statistically significant（P<0.05）. All 26 flaps survived， and the patients were followed up for 4 to 6 months without obvious dysfunction， with less scar and good appearance. Conclusion Maxillofacial defects in patients with anterolateral anterior flaps for simultaneous transplantation repair surgery perioperative care and cooperation can significantly improve their negative emotions and reduce scarring， worthy of clinical application.

Key words： maxillofacial trauma； flap； nursing fit； prognosis

隨着汽车保有量的快速增加以及大量基础设施建设，我国交通事故和工伤在临床中越来越多见，人体暴露部位的口腔颌面部非常容易受到如爆炸伤、撞击伤、刀伤、坠落伤、挤压伤等多种形式的创伤[1]。意外造成的颌面部外伤后，对患者正常生理功能和容貌都有较大影响，可使面部塌陷、眼球内陷、转动受限、复视、咬合受限、张口困难，影响进食、吞咽、说话及表情等功能，患者往往会出现剧烈的心理波动[2]。近年来颌面部肿瘤切除患者也逐年增多，手术造成的大面积组织缺损修复是困扰口腔颌面外科医生的难题[3]。随着患者对外观的要求越来越高，必须从美容角度全面考虑，以减少术后瘢痕及患者不良情绪[4]。自1984年徐传达、罗力生等报道股前外侧皮瓣的解剖和临床应用以来，由于该皮瓣具有解剖标志清楚、变异少、易于切取、血管蒂恒定、供区隐蔽、不牺牲肢体主干血管等优点，成为较大软组织缺损修复最佳皮瓣供区之一[5]。……