王凯 李芙蓉 张新颜

[摘要]目的：探讨循证护理干预对行桥式皮瓣移植术的手外伤患者皮瓣成活率及手部功能恢复情况的影响。方法：以2017年3月-2019年3月笔者医院行桥式皮瓣移植术的52例手外伤患者为研究对象。随机将其分为常规组（26例）和研究組（26例）。其中常规组实施常规护理，研究组实施循证护理干预，两组均连续护理4周。比较两组护理后的皮瓣成活率及血管危象发生率、断蒂时间、手部功能恢复优良情况以及生活质量评分。结果：护理后，研究组皮瓣成活率为100.00%，显著高于常规组的76.92%，动脉血管危象发生率为3.85%，显著低于常规组的30.77%，差异均有统计学意义（P<0.05）。研究组断蒂时间显著短于常规组，断蒂后手部功能恢复优良时间<3d的患者比例显著高于常规组，差异有统计学意义（P<0.05）。研究组手部功能恢复优良率为96.15%，高于常规组的69.23%，差异有统计学意义（P<0.05）。研究组生活质量各维度评分均显著高于常规组，差异均有统计学意义（P<0.05）。结论：循证护理干预能够显著提高行桥式皮瓣移植术的手外伤患者的皮瓣成活率，降低血管危象发生率，并能显著缩短功能恢复时间，提高患者生活质量，值得临床进一步研究推广使用。

[关键词]循证护理;桥式皮瓣移植术;手外伤;功能恢复时间;皮瓣成活率;血管危象

[中图分类号]R473.6    [文献标志码]B    [文章编号]1008-6455（2020）12-0169-03

Effect of Evidence-based Nursing Intervention on Flap Survival Rate and Hand Function Recovery in Patients with Hand Injury undergoing Bridge Flap Transplantation

WANG Kai1，LI Fu-rong1，ZHANG Xin-yan2

（1.Department of Osteoarticular;2.Department of Clinical Psychology，Qingdao Municipal Hospital，Qingdao 266071，Shandong，China）

Abstract： Objective  To explore the effect of evidence-based nursing intervention on the survival rate of flap and the recovery of hand function after pedicled surgery in patients with hand injury after bridge flap transplantation. Methods  52 patients with hand injury who underwent bridge flap transplantation in our hospital were selected as the research objects between March 2017 and March 2019. They were divided into the regular group （26 cases） and the research group （26 cases） by random number table method. The regular group received routine nursing， and the research group implemented evidence-based nursing intervention. Both groups were continuously cared for 4 weeks. The survival rate of flap， the incidence of vascular crisis， the time of pedicle fracture， the excellent recovery of hand function and the quality of life score were compared between the two groups. Results  After nursing， the survival rate of flap in the research group was 100.00%， significantly higher than that of the regular group （76.92%）， the incidence of arterial crisis in the research group was 3.85%， significantly lower than that in the regular group （30.77%）， the differences were statistically significant （P<0.05）. The pedicle cutting time of the research group was significantly shorter than that of the regular group （P<0.05）. The proportion of patients with excellent recovery time of hand function less than 3 days after pedicle amputation of the research group was significantly higher than that of the regular group （P<0.05）. The excellent and good rate of hand function recovery in the research group was 96.15%， which was higher than that in the regular group （69.23%， P<0.05）. The scores of quality of life in the research group were significantly higher than those in the regular group （P<0.05）. Conclusion  Evidence-based nursing intervention can significantly improve the survival rate of flap in patients with hand injury after bypass grafting， reduce the incidence of vascular crisis， and shorten the functional recovery time and improve the quality of life of patients. It is worthy of further clinical research and application.

Key words： evidence based nursing; bridge flap transplantation; hand injury; functional recovery time; flap survival rate; vascular crisis

桥式皮瓣移植术作为临床外科常用手术，其治疗效果理想，但治疗难度较高，手外伤患者术后易出现皮瓣坏死、血管危象等不良症状，且该手术容易导致患者出现焦虑、抑郁等不良情绪，不利于患者的康复[1-3]。因此，桥式皮瓣移植术后采取积极有效的护理措施对促进手外伤患者皮瓣移植的成功具有十分重要的意义。一般的常规护理，未切身考虑患者实际情况，容易出现护理不周，影响患者功能恢复。相关研究发现[4-5]，循证护理是一种将科研资料、临床经验与护理经验相结合的一种护理措施，可以有效增加医护人员对患者的护理有效率，优化护理结局。因此，为探讨循证护理干预对桥式皮瓣移植患者皮瓣成活率及断蒂后功能恢复的影响，现做如下报道。……