临床心理干预对改良穿支皮瓣V—Y治疗小腿远端及足踝部创面术后患者恢复的影响(1)
[摘要] 目的 探討对改良穿支皮瓣V-Y治疗小腿远端及足踝部创面的术后患者采用临床干预辅助治疗，明确临床干预对术后患者康复的影响及效果。 方法 选择我院2015年2月～2017年3月间用改良穿支皮瓣V-Y治疗小腿远端及足踝部创面术后患者80例，用随机量表法将入选的患者分成观察组(A组)和对照组(B组)，每组40例。A组采用以心理干预为主，辅助术前、术中、术后针对性的、规范的开展临床干预；B组以临床专科干预为主，并根据临床表现给予干预措施辅助治疗。记录两组术患者血管危险发生率、临床干预的满意度，以及临床干预对术后穿支皮瓣成活率的影响因素等情况，最后进行对比分析。 结果 A组患者中有3例在术后48 h血管危象，在48 h内好转2例，未成活皮瓣1例。而B组患者在术后48 h内有10例患者出现血管危象，未成活皮瓣7例。A组患者移植皮瓣成活率、血管危象发生率、干预满意度与B组比较，差异有统计学意义(P<0.05)。术后皮瓣的蒂部受压，患者容量不足、过度精神紧张、疼痛控制不理想、操作不到位及术后伤口感染是影响移植成功与否的主因素。且A组患者移植皮瓣成活总影响率与B组比较，差异有统计学意义(P<0.05)。 结论 临床综合干预措施贯穿应用于改良穿支皮瓣V-Y治疗小腿远端及足踝部创面术后患者的整个治疗过程中，有利于患者术后康复。
[关键词] 临床干预；改良穿支皮瓣；创面；恢复
[中图分类号] R658.3 [文献标识码] B [文章编号] 1673-9701(2017)32-0085-05
[Abstract] Objective To explore the clinical intervention adjuvent therapy in the patients with distal calf and foot and ankle wound surface after modified perforator flap V-Y， so as to clarify the influence and effect of clinical intervention on postoperative rehabilitation. Methods A total of 80 patients with distal calf and foot and ankle wound surface who were treated with modified perforator flap V-Y in our hospital from February 2015 to March 2017 were selected. The patients were divided into observation group(group A) and control group(group B) by random number table， with 40 patients in each group. Group A was given psychological intervention， assisted with preoperative， intraoperative and postoperative targeted and standardized clinical intervention；group B was mainly given specialized clinical intervention， and was also given adjuvant therapy of intervention measures according to the clinical manifestations. The incidence rate of vascular risk， the satisfaction of clinical intervention， as well as the influencing factors of clinical intervention on the survival rate of postoperative perforator flap were recorded， and finally analyzed and compared. Results In group A， 3 patients had vascular crisis within 48 hours after the surgery. 2 cases were improved within 48 hours， and 1 case with the flap not survived. In group B， there were 10 patients with vascular crisis after the surgery， with 7 cases with the flap not survived. The survival rate of transplanted flap， the incidence rate of vascular crisis and the satisfaction with intervention in group A were statistically significantly different with those in group B (P<0.05). Postoperative flap pedicle compression， lack of patient capacity， excessive mental stress， pain control being not ideal， operation not in place and postoperative wound infection were the main factors affecting the success of transplantation. Also， there was statistically significant difference in the total influence rate of survival of transplanted flap between group A and group B(P<0.05). Conclusion The clinical comprehensive intervention measures applied throughout the treatment of distal calf and foot and ankle wound surface by modified perforator flap V-Y are beneficial to the postoperative recovery of patients., 百拇医药(李佳敏 陈小燕 蔡晓斌)
[关键词] 临床干预；改良穿支皮瓣；创面；恢复
[中图分类号] R658.3 [文献标识码] B [文章编号] 1673-9701(2017)32-0085-05
[Abstract] Objective To explore the clinical intervention adjuvent therapy in the patients with distal calf and foot and ankle wound surface after modified perforator flap V-Y， so as to clarify the influence and effect of clinical intervention on postoperative rehabilitation. Methods A total of 80 patients with distal calf and foot and ankle wound surface who were treated with modified perforator flap V-Y in our hospital from February 2015 to March 2017 were selected. The patients were divided into observation group(group A) and control group(group B) by random number table， with 40 patients in each group. Group A was given psychological intervention， assisted with preoperative， intraoperative and postoperative targeted and standardized clinical intervention；group B was mainly given specialized clinical intervention， and was also given adjuvant therapy of intervention measures according to the clinical manifestations. The incidence rate of vascular risk， the satisfaction of clinical intervention， as well as the influencing factors of clinical intervention on the survival rate of postoperative perforator flap were recorded， and finally analyzed and compared. Results In group A， 3 patients had vascular crisis within 48 hours after the surgery. 2 cases were improved within 48 hours， and 1 case with the flap not survived. In group B， there were 10 patients with vascular crisis after the surgery， with 7 cases with the flap not survived. The survival rate of transplanted flap， the incidence rate of vascular crisis and the satisfaction with intervention in group A were statistically significantly different with those in group B (P<0.05). Postoperative flap pedicle compression， lack of patient capacity， excessive mental stress， pain control being not ideal， operation not in place and postoperative wound infection were the main factors affecting the success of transplantation. Also， there was statistically significant difference in the total influence rate of survival of transplanted flap between group A and group B(P<0.05). Conclusion The clinical comprehensive intervention measures applied throughout the treatment of distal calf and foot and ankle wound surface by modified perforator flap V-Y are beneficial to the postoperative recovery of patients., 百拇医药(李佳敏 陈小燕 蔡晓斌)