报告32例严重小腿毁损伤修复重建患者的护理经验。针对本组患者严重创伤后存在急性肾功能衰竭风险,血管、皮瓣移植术后有血管危象发生可能,以及创面负压封闭引流失效、骨外固定针道感染和多重耐药菌交叉感染等问题,予术后加强肾功能的监测,结合经皮氧饱和度监测判断患肢血液循环状况,掌握皮瓣观察方法和时机,分阶段落实针道护理方案及对多重耐药菌感染患者实施分室或独立收治。32例均保肢成功,平均住院时间21 d。随访1年以上,25例功能评价满意,5例功能基本恢复,2例最大限度保留患肢功能、行走跛行伴疼痛。
The nursing experience of repair and reconstruction for severely mangled legs in 32 patients was reported. In view of the risk of acute renal failure after severe trauma,the possibility of vascular crisis after vascular and skin flap transplantation,and the failure of negative pressure closure drainage of wound,infection of external bone fixation needle tract and cross infection of multiple drug-resistant bacteria,the monitoring of renal function should be strengthened after operation,and we combined with percutaneous oxygen saturation monitoring to judge the blood circulation of the affected limb,and grasped the observation method and opportunity of skin flap. The needle care program was implemented in stages and the patients infected with multi-drug-resistant bacteria were seperated into different rooms or treated independently. All the 32 cases got successful limb salvage,the average hospital stay was 21 days. They were followed up for more than 1 year,25 cases had satisfactory functional evaluation,5 cases had basic functional recovery,2 cases retained the function of the affected limb to the maximum extent and had walking lameness with pain.
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