马娜　马璐　苏敏　杨敏利

[摘要]目的：探讨围术期多元化保温措施在四肢严重挤压伤创面游离皮瓣移植术后护理中的应用。方法：选取2017年1月-2020年1月于笔者医院治疗四肢严重挤压伤创面的102例患者作为研究对象，均采取游离皮瓣移植术，根据围术期保温措施不同分为观察组（52例）和对照组（50例），其中对照组采取常规保温干预，观察组采取多元化保温干预，比较两组患者在干预处理后局部血运情况、血管危象发生情况以及局部皮瓣成活情况。结果：觀察组毛细血管充盈时间评分、局部皮瓣弹性评分均显著高于对照组，差异有统计学意义（P<0.05）。观察组血管危象一期与二期发生率均显著低于对照组，差异有统计学意义（P<0.05）;三、四期比较差异无统计学意义（P>0.05）。观察组血管危象发生率为11.54%，明显低于对照组的30.00%;观察组皮瓣存活率为94.23%，明显高于对照组的78.00%，差异均统计学意义（P<0.05）。结论：在游离皮瓣移植术围术期采取多元化保温干预，不仅有利于改善皮瓣局部血液循环，同时还有助于降低血管危象发生率，提高皮瓣成活率，在临床上值得推广应用。

[关键词]围术期护理;多元化保温措施;游离皮瓣移植术;血管危象;挤压伤

[中图分类号]R473.6    [文献标志码]B    [文章编号]1008-6455（2021）10-0175-03

Application of Perioperative Diversified Thermal Insulation Measures in Postoperative Nursing of Free Flap Repair of Severe Crush Wound of Limbs

MA Na，MA Lu，SU Min，YANG Min-li

（Department of Plastic Surgery，the First Affiliated Hospital of Air Force Medical University， Xijing Hospital，Xi'an 710032，Shaanxi，China）

Abstract： Objective  To investigate the application of perioperative diversified thermal insulation measures in postoperative nursing of free flap repair of severe crush wound of limbs. Methods  From January 2017 to January 2020， 102 patients with severe crush wounds on extremities treated by free skin flap transplantation were selected as study subjects. According to the perioperative diversified thermal insulation measure， the patients were divided into the observation group （52 cases， diversified thermal insulation measure） and the control group （50 cases， conventional thermal insulation）. The local blood supply， the incidence of vascular crisis and the survival of local skin flaps after intervention were compared between the two groups. Results  The scores for capillary filling time and local flap elasticity of the observation group were higher than those of the control group， the difference was statistically significant （P<0.05）. The incidence of phase Ⅰ and phaseⅡ vascular crisis in the observation group were significantly lower than those in the control group （P<0.05）. There was no significant difference in the incidence of phase Ⅲ and phase Ⅳ vascular crisis （P>0.05）. The incidence of vascular crisis in the observation group was 11.54%， significantly lower than that in the control group （30.00%， P<0.05）. The flap survival rate in the observation group was 94.23% significantly higher than that in the control group （78.00%， P<0.0）. Conclusion  Adopting diversified thermal insulation intervention during the perioperative period of free flap transplantation not only is beneficial to improve the local blood circulation of the flap， but also helps to reduce the incidence of vascular crisis and increase the survival rate of flaps.

Key words： perioperative nursing; diversified thermal insulation measure; free flap transplantation; vascular crisis; crush injury

挤压伤多发生于房屋倒塌、工程塌方、交通事故等意外伤害中，此外，在昏迷与手术的患者中也会偶有发生，由于肢体长时间被固定体位的自压而致。另外，在四肢严重挤压伤患者中，通常还会合并骨折和大面积软组织缺损[1]。由于皮肤、肌肉等软组织发生坏死，因此常使创面长期不愈合，若未及时采取有效方式进行修复，则极易引起严重感染，也会增加其致残风险[2]。目前，常用的治疗方法为一期清创、固定骨折，然后采取皮瓣移植的方法对创面进行覆盖[3]。不过，随着显微外科技术的不断发展……