精细化护理干预在会阴部瘢痕修复术中的运用

目的探讨患者会阴部瘢痕修复术实施精细化护理干预的临床效果。 方法选取2014年6月至2017年7月入住江苏省昆山市第一人民医院烧伤整形外科的132例接受皮瓣修复术的会阴部瘢痕修复术患者，采用随机数字表法分为干预组和对照组，每组各66例。对照组患者实施常规护理；干预组患者术前接受精细化心理、皮肤、肠道护理，手术设计及影像资料采集和体位训练，术后接受精细化麻醉苏醒、制动、创面护理及饮食、抗毒指导等护理干预。记录2组患者创面愈合时间、术后并发症发生情况；观察2组患者护理前后疼痛、瘙痒程度及情绪(抑郁、焦虑)变化情况。评价2组护理满意度及修复总优良率。数据行独立样本t检验、配对t检验及χ²检验。 结果与对照组创面愈合时间(37.2±5.3) d]比较，干预组患者创面愈合时间(21.6±3.1) d]明显缩短，差异有统计学意义(t＝6.848，P<0.05)；干预组的并发症发生率为4.55%(3/66)，与对照组22.73%(15/66)]比较明显降低，差异有统计学意义(χ²＝7.784，P<0.05)。护理前对照组、干预组患者在疼痛、瘙痒、抑郁及焦虑评分间差异均无统计学意义(P值均大于0.05)；护理后2组患者各项评分均低于护理前，差异均有统计学意义(P值均小于0.05)；护理后，干预组患者疼痛、瘙痒、抑郁及焦虑评分分别为(2.4±0.6)、(4.5±1.3)、(6.9±2.6)、(8.6±2.5) 分，对照组患者对应评分分别为(4.5±1.2)、(6.6±1.1)、(11.5±3.4)、(12.9±3.8) 分，2组比较差异均有统计学意义(t＝5.421、5.663、7.136、8.205，P＝0.022、0.017、0.006、0.002)。干预组患者的护理有效性、合理性、全面性及科学性方面评分分别为(11.3±0.8)、(22.7±1.8)、(22.1±2.7)、(22.7±4.1) 分，均明显高于对照组(6.6±1.5)、(19.2±3.3)、(18.5±3.6)、(17.9±3.8) 分]，差异均有统计学意义(t＝8.844、6.811、7.542、7.916，P＝0.007、0.024、0.018、0.014)。干预组患者修复总优良率96.97%(64/66)]明显高于对照组84.85%(56/66)]，差异均有统计学意义(χ²＝4.492，P＝0.034)。 结论会阴部瘢痕修复术皮瓣修复术患者精细化护理干预，可有效提治疗优良率，安全性高。

Application of meticulous nursing intervention in patients with perineal scar repair

ObjectiveTo explore the clinical effect of refined nursing intervention in patients with perineal scar repair. MethodsA total of 132 patients with perineal scars who underwent skin flap repair in the Department of Burns and Plastic Surgery, First People′s Hospital of Kunshan from June 2014 to July 2017 were selected. They were divided into the control group and the intervention group according to random number table method, 66 patients in each group. Patients in the control group were given routine nursing; patients in the intervention group received preoperative refinement psychology, skin and intestinal care, surgical design and image data collection and postural training, and after the operation, they received refinement anesthesia, brake, wound care, diet, anti-drug guidance and other nursing interventions. The healing time and postoperative complications of the two groups were recorded. The changes of pain, itching and mood (depression, anxiety) before and after treatment were observed. Nursing satisfaction and total recovery rate of two groups were evaluated. The data were processed with the independent sample t test, the paired sample t test and chi-square test. ResultsCompared with the control group(37.2±5.3) d], the healing time of the repaired area was significantly shortened in the intervention group (21.6±3.1) d], the difference was statistically significant (t=6.848, P<0.05). The incidence of complications in the intervention group was 4.55%(3/66), which was significantly lower than the control group 22.73% (15/66)](χ²=7.784, P<0.05). There were no statistically significant differences in the scores of pain, itching, depression and anxiety between the control group and the intervention group before nursing (with P values above 0.05); after nursing, the scores of patients in both groups were lower than those before nursing, and the differences were statistically significant (with P values below 0.05). The scores of pain, itching, depression and anxiety after nursing in the intervention group were (2.4±0.6), (4.5±1.3), (6.9±2.6), (8.6±2.5) points, the scores of the control group were (4.5±1.2), (6.6±1.1), (11.5±3.4), (2.9±3.8) points, the differences between the two groups were statistically significant (t=5.421, 5.663, 7.136, 8.205; P=0.022, 0.017, 0.006, 0.002). The scores of effective, reasonable, comprehensive and scientific aspects of the intervention group (11.3±0.8), (22.7±1.8), (22.1±2.7), (22.7±4.1) points] were significantly higher than those of the control group (6.6±1.5), (19.2±3.3), (18.5±3.6), (17.9±3.8) points] (t=8.844, 6.811, 7.542, 7.916, P=0.007, 0.024, 0.018, 0.014). The total excellent and good rate of repair in the intervention group 96.97%(64/66)]was significantly higher than that in the control group 84.85%(56/66)] (χ²=4.492, P=0.034). ConclusionThe meticulous nursing intervention of patients with perineal scar repair flap repair can effectively improve the excellent rate and safety.