摘要
目的总结血管化腓骨瓣修复下颌骨放射性骨坏死的围手术期护理方法。方法对2018年1月—2019年4月在本科采用血管化腓骨瓣修复下颌骨放射性骨坏死的40例患者术前予加强口腔卫生、营养状况评估及完善术前检查、准备,术后加强呼吸道管理、皮瓣观察及下肢深静脉血栓的观察护理,注意患者营养情况,加强营养支持,落实皮肤护理、活动指导,关注患者心理变化,做好心理护理。结果术后4例出现肺部感染。4例伤口未愈合。2例皮瓣边缘坏死;3例出现皮瓣坏死,其中1例行皮瓣清创处理,2例行皮瓣清创后行胸大肌瓣修复术,术后胸大肌皮瓣血运好;其余血管化腓骨肌皮瓣均成活。结论术前对患者加强口腔卫生、营养状况评估及完善术前检查、准备,术后加强呼吸道管理、皮瓣观察及下肢深静脉血栓的观察护理,注意患者营养情况,加强营养支持,落实皮肤护理、活动指导,关注患者心理变化,做好心理护理,对手术成功和患者康复出院起着重要的作用。
Objective To explore the perioperative nursing methods of vascularized fibula flap in repairing mandibular osteonecrosis.Methods From January 2018 to April 2019,40 patients with radiation-induced osteonecrosis of mandible were treated with vascularized fibula flap.Oral hygiene,nutritional status assessment,preoperative examination and preparation were strengthened before operation,and respiratory tract was strengthened after operation Management,skin flap observation and observation and nursing of deep venous thrombosis of lower limbs,pay attention to the nutritional status of patients,strengthen nutritional support,implement skin care,activity guidance,pay attention to the psychological changes of patients,and do a good job of psychological nursing.Results Pulmonary infection occurred in 4 cases after operation.Four cases were not healed.2 cases of flap edge necrosis;3 cases of flap necrosis,including 1 case of skin flap debridement,2 cases of flap repair of pectoralis major flap after debridement,the blood supply of pectoralis major myocutaneous flap was good;the other vascularized fibular muscle flap survived.Conclusion Preoperative oral hygiene,nutritional status assessment and improvement of preoperative examination and preparation,postoperative respiratory tract management,skin flap observation and observation and nursing of deep venous thrombosis of lower limbs should be strengthened.Attention should be paid to the nutritional status of patients and nutritional branches should be strengthened It plays an important role in the success of operation and the recovery and discharge of patients.
作者
张丽萍
刘秋玲
吴娟
王友元
ZHANG Li-ping;LIU Qiu-lin;WU Juan;WANG You-yuan(Sun Yat Sen Memorial Hospital of Sun Yat sen University,510120,Guangzhou,GuangDong)
关键词
下颌骨
放射性骨坏死
腓骨
移植
护理
mandible
radiation osteonecrosis
fibula
transplantation
nursing care
