应用腹壁下动脉穿支皮瓣乳房再造术的手术并发症分析和护理策略

［摘要］ 目的 探讨乳腺癌患者乳房根治切除同期应用腹壁下动脉穿支（DIEP）皮瓣乳房再造术围术期感染的预防控制及并发症观察的护理方法。方法 回顾分析我院2016年6月至2018年6月接受DIEP皮瓣乳房再造术的96例乳腺癌患者进行围手术期感染监控和并发症观察，及早采取有效的护理干预。结果 手术时间7.0±1.5 h，术后住院时间11.4±3.7 d，96例手术患者发生并发症17例，发生率为17.7%，其中4例切口感染，感染率为4.1%，经过实施综合护理，患者均痊愈出院。结论 乳腺癌患者乳房根治切除同期应用DIEP皮瓣乳房再造术的临床治疗风险与护理难度大，重视游离皮瓣移植术后血管危象的观察与处理、预防性应用抗生素是提高临床效果的重要因素。

Prevention and nursing measures of perioperative infection and complications of breast reconstruction with deep inferior epigastric perforator flap

［Abstract］ Objective To investigate the perioperative nursing care interventions of immediate breast reconstruction with deep inferior epigastric perforator （DIEP） flap after breast cancer resection. Methods A total of 96 patients who got breast reconstruction with deep inferior epigastric perforator （DIEP） flap treatment， from June 2016 to June 2018 were enrolled in this study. Perioperative infection and complications were observed. Effective nursing care interventions were taken timely. Results The operation time was 7.0±1.5 h， the postoperative hospital stay was 11.4±3.7d， 17 cases in all 96 patients occurred with perioperative complications， an incidence of 17.7%， in which an infection rate of 4.1% was observed. Conclusion Great treatment risk and nursing difficulty are found in immediate breast reconstruction with DIEP flap after breast cancer resection. Synthetic perioperative nursing interventions should be carried out， including making patients fully prepared for a successful operation， a strict sterile procedure and the prophylactic use of antibiotics. Moreover， the observation and treatment of vascular crisis after free flap transplantation and infection monitoring play a vital role， which improve the effectiveness of clinical treatment and the quality of recovery.