游离足趾移植拇指再造手术围术期观察与护理.docVIP

游离足趾移植拇指再造手术围术期观察与护理 　　[摘要] 目的 探讨游离足趾移植拇指再造手术围术期的观察与护理。 方法 选取2008年9月～2011年4月在浙江省宁波市第六医院完成游离足趾移植拇指再造手术患者75例为研究对象，给予积极的术前、术中及术后护理，观察围术期患者血管危象的发生，评定拇指再造功能及护理前后患者的生活质量。 结果 75 例拇指再造手指全部成活，能对捏、持物，外形较美观，拇手指再造功能评定：优48例，良15例，可12例，优良率为84%。在15例出现术后血管危象患者中，第一跖骨背动脉肌内型、肌下型、浅表型依次递减为9例（60.0%）、5例（33.3%）、1例（6.7%）。48 h内发生者多因第一跖背动脉分支漏血、血管栓塞，半年后再造拇指；48 h后发生的多因血管痉挛和炎症。经护理后患者生活质量测评中的生理功能、生理职能、躯体疼痛、活力、情感职能、社会功能、精神健康、总体健康得分[（90.5±10.4）、（87.4±9.6）、（88.5±9.1）、（67.7±8.0）、（87.6±9.2）、（88.0±10.2）、（81.3±9.0）、（66.8±7.9）分]均高于护理前[（86.8±9.3）、（60.1±8.7）、（78.7±8.9）、（60.8±7.8）、（55.1±6.0）、（72.6±7.5）、（60.5±7.0）、（47.8±6.2）分]，差异有统计学意义（P 　　[关键词] 游离足趾；拇指再造；血管危象；围术期护理 　　[中图分类号] R473.6 [文献标识码] C [文章编号] 1673-7210（2014）02（a）-0112-04 　　Perioperative observation and nursing of thumb reconstruction with free toe transplantation 　　XU Aijun 　　Operation Room， the Sixth Hospital of Ningbo City， Zhejiang Province， Ningbo 315040， China 　　[Abstract] Objective To discuss the perioperative observation and nursing of thumb reconstruction with free toe transplantation. Methods 75 cases underwent thumb reconstruction with free toe transplantation from September 2008 to April 2011 in the Sixth Hospital of Ningbo City in Zhejiang Province were given positively preoperative， intraoperative and postoperative care. The incidence of perioperative vascular crisis of patients were observed， and the thumb reconstruction function and quality of life before and after nursing were evaluated. Results The reconstruction thumbs of 75 cases all survived and could pinch and hold， had beautiful appearance， the thumb reconstruction function evaluation results were excellent in 48 cases， good in 15 cases， fair in 12 cases， and the acceptance rate was 84%. Among 15 cases with vascular crisis after operation， the intramuscular， muscle and superficial type of first dorsal metatarsal artery in patients were reduced to 9 cases （60.0%）， 5 cases （33.3%）， 1 case （6.7%）. The major causes of vascular crisis occurred within 48 h and underwent thumb re