Bradley Patrick J
Department ORL-HNS, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK.
Curr Opin Otolaryngol Head Neck Surg. 2007 Apr;15(2):63-7. doi: 10.1097/MOO.0b013e3280523c21.
Surgery remains a mainstay of treatment for head and neck cancer. Patients have significant comorbidities, and protracted surgery is associated with complications and may require a high-dependency nursing environment such as an intensive care or high-dependency unit postoperatively. The literature is reviewed to document the current evidence for early postoperative nursing care.
The mortality associated with major head and neck oncologic surgery is low, less than 3%, most frequently being myocardial infarction and pneumonia. The majority of patients can be nursed in a step-down (high-dependency unit) environment, which has one-to-one nursing, with experience and expertise, supported by medical staff. The decision where care is provided needs to be made locally, however, depending on staffing skill and levels, resources, and volume of workload.
The majority do not require the routine use of the intensive therapy unit in the immediate postoperative period. The use of a 'specialist care', high-dependency unit or ward is cost effective, without reducing quality of care. Appropriate and adequate nursing staff with experience and expertise, and sustained resourcing, is paramount to the implementation of such a care facility.
手术仍然是头颈癌治疗的主要手段。患者存在显著的合并症，长时间手术会引发并发症，术后可能需要在重症监护室或高依赖病房等高依赖护理环境中接受护理。本文对相关文献进行综述，以记录当前关于术后早期护理的证据。
头颈肿瘤大手术相关的死亡率较低，低于3%，最常见的是心肌梗死和肺炎。大多数患者可在配备一对一护理、有经验丰富且专业的医护人员支持的降阶梯（高依赖病房）环境中接受护理。然而，护理地点的决策需根据当地的人员技能和水平、资源以及工作量来做出。
大多数患者在术后即刻并不需要常规使用重症治疗病房。使用“专科护理”、高依赖病房或病区具有成本效益，且不会降低护理质量。配备经验丰富且专业的合适充足护理人员以及持续的资源投入，对于实施这样的护理设施至关重要。
