摘要
总结30例患者逆行岛状皮瓣移植术后出现血运障碍早期应用地塞米松治疗的护理经验。术后第1个24h内每30min严密观察皮瓣1次，主要观察颜色、温度、毛细血管的充盈反应以及肿胀情况；24h后每1h观察皮瓣1次，至术后3d；3d后每4h观察皮瓣1次。本组有5例患者术后2-6h内出现动脉供血不足，25例患者术后22h内出现静脉回流障碍，均在30min内给予地塞米松治疗；应用地塞米松后每15min观察皮瓣1次，并仔细记录用药后皮瓣的反应，给予针对性心理护理，做好体位护理：5例皮瓣动脉供血不足的患者，患肢平放于床上，以利于动脉血流；25例静脉回流障碍患者，患肢抬高10～20cm，以利皮瓣静脉及淋巴回流。同时做好敷料管理，术后伤口敷料底层保持湿润，以利于伤口生长及减少敷料干燥对皮瓣形成压迫。经精心治疗与护理，30例出现血运障碍的皮瓣，完全成活27例，大部分成活2例，1例大部分坏死，改行其他皮瓣治疗。认为严密观察皮瓣血运，在皮瓣血运障碍可疑的情况下早期应用地塞米松治疗，能有效改善逆行岛状皮瓣血运障碍。
The paper summarizes the experiences in nursing 30 patients with blood circulation disorder after reverse-flow island skin flap grafting treated by early use of dexamethasone. For the first day, the flaps were observed closely every 30 min in terms of the color, temperature, capillary filling reaction and swelling; for the second and third days, the flaps were observed every one hour and then every 4 hours. 5 patients with blood supply insufficiency during 2-6 hours and 25 ones with venous return disorder in 22 hours after grafting were all treated with dexamethasone in 30 min. After use of dexamethasone, the flaps were observed every 15 min, with the reaction on flaps recorded, and mental care and posture nursing were conducted. The 5 patients with supply insufficiency had their affected limbs placed on the bed for the good of arterial blood flow. The 25 patients with venous return disorder had their affected limbs raised 10-20 cm for the good of venous and lymphatic returns. Meanwhile, the dressings were handled properly, with the bottom layer kept wet for the good of wound healing. For the 30 patients with blood circulation disorder, all of the flaps in 27 patients grew alive, most of the flaps in 2 grow alive and most of the flaps in 1 patient grew into necrosis through careful treatment and nursing. It is assumed that close observation of flap blood circulation and early use of dexamethasone in case of blood circulation disorder can treat the disorder of reverse-flow island skin flaps.
出处
《护理学报》
2010年第3期64-66,共3页
Journal of Nursing（China）
基金
汕头市科技攻关项目(汕科[2007]76号)
关键词
逆行岛状皮瓣
血运障碍
地塞米松
护理
reverse-flow island skin flap
blood circulation disorder
dexamethasone
nursing
