丁红梅 孙建华 姜春庭 吴文华 顾双双

[摘要]目的：探讨个性化护理在大面积头皮缺损皮瓣修复围手术期的应用价值。方法：选取2017年3月-2019年5月在医院行皮瓣修复术的大面积头皮缺损患者82例，以随机数字法将其分为研究组、对照组，各41例。对照组术后实施普通护理，观察组术后实施个性化护理，两组均干预两周及以上，并随访1年。比较两组皮瓣成活率及护理满意度，住院时间及瘢痕评分，干预前后焦虑、抑郁评分以及随访1年后疗效。结果：两组皮瓣成活率比较差异无统计学意义（97.56% vs 92.68%，P>0.05）。研究组护理满意度高于对照组（92.68% vs 75.61%），差异有统计学意义（P<0.05）。研究组住院时间短于对照组，瘢痕评分低于對照组，差异有统计学意义（P<0.05）。与干预前比较，干预两周后，两组焦虑自评量表（Self-rating anxiety scale，SAS）、抑郁自评量表（Self-rating depression scale，SDS）评分均降低，研究组低于对照组，差异有统计学意义（P<0.05）。随访1年，两组预后疗效比较，研究组高于对照组，差异有统计学意义（90.24% vs 70.73%，P<0.05）。结论：对皮瓣修复术后大面积头皮缺损患者实施个性化护理，临床治疗效果显著，能够改善患者创面愈合效果，缓解患者焦虑抑郁症状，提高患者满意度和预后疗效。

[关键词]个性化护理;皮瓣修复术;大面积头皮缺损;护理满意度;焦虑;抑郁

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2021）07-0158-04

Evaluation of Individualized Nursing in the Perioperative Period of Large Area Scalp Defect Skin Flap Repair

DING Hong-mei1，SUN Jian-hua2，JIANG Chun-ting1，WU Wen-hua1，GU Shuang-shuang1

（1.Department of Burn and Plastic Surgery;2.Nursing Department，Suzhou Medical District，No.904 Hospital，Joint Logistics Support Force of the Chinese People's Liberation Army，Suzhou 215000，Jiangsu，China）

Abstract： Objective  To explore the effect evaluation of the individualized nursing in the perioperative period of large area scalp defect skin flap repair. Methods  A total of 82 patients with large-area scalp defect who underwent flap repair in our hospital between March 2017 and May 2019 were selected， and they were divided into the research group and the control group by random number method， with 41 cases in each group. The control group received general nursing after operation. The observation group received individualized nursing after operation， both groups intervention for two weeks or more， and follow-up for one year. The flap survival rate and nursing satisfaction， hospital stay and scar score， anxiety and depression scores before and after intervention， and the curative effect after one year of follow-up were compared between the two groups. Results  There was no significant difference in the survival rate of the flaps between the two groups （97.56% vs 92.68%， P>0.05）. The nursing satisfaction in the research group was higher than the control group （92.68% vs 75.61%）， the difference was statistically significant （P<0.05）. The hospitalization time in the research group was shorter than the control group， and the score of scar was lower than the control group （P<0.05）. Compared with before intervention， after 2 weeks of intervention， the scores of SAS and SDS in both group decreased， and the research group was lower than the control group （P<0.05）. After follow-up for one year， the prognostic efficacy of the two groups was compared， the research group was higher than the control group （90.24% vs 70.73%， P<0.05）. Conclusion  Individualized nursing of patients with large scalp defect after flap repair was effective， which could significantly improve the wound healing effect， shorten the hospital stay， relieve the anxiety and depression symptoms， improve patient satisfaction and prognostic treatment effect.

Key words： individualized nursing; skin flap repair; large-area scalp defect; nursing satisfaction; anxiety; depression

临床上，造成大面积头皮缺损的主要原因有严重烧伤、颅脑外伤、高压电击伤及头皮肿瘤切除等[1]。对头皮缺损患者进行修复不仅为了创面恢复，也为了改善患者外观形象，为患者树立信心[2]。相关文献[3]报道，皮瓣修复术可修复患者大面积创面缺损，但由于修复创面面积大，常需考虑到供区皮瓣的大小、厚薄，且术后皮瓣成活率的高低、瘢痕恢复情况等一系列问题都会对患者造成严重的心理压力。因此，术后采用积极有效的护理干预具有重要意义[4]。有学者[5]发现，通过护理可不同程度改善患者术后感染、瘢痕等情况，但常规护理常对患者术后不良情况改善不明显。个性化护理遵循优质护理服务原则，是一种强调以人为本的护理措施，其可对患者产生积极正向的作用，从而提高患者临床治疗效果。但目……