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[胸带在胸骨修复术后裂开患者中的应用效果]

[Application effects of armor chest straps in patients with sternal dehiscence after repair surgery].

作者信息

Yang J, Wang L, Zhang W F, Chen Y, Guan H

机构信息

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China.

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2024 Apr 20;40(4):358-364. doi: 10.3760/cma.j.cn501225-20230904-00074.

Abstract

To investigate the application effects of armor chest straps in patients with sternal dehiscence after repair surgery. This study was a retrospective cohort study. The 11 patients who were admitted to the First Affiliated Hospital of Air Force Medical University (hereinafter referred to as the hospital) from March 2020 to March 2021 and used conventional chest straps after sternal dehiscence repair surgery were included in conventional chest strap group. The 12 patients who were admitted to the hospital from April 2021 to March 2022 and used armor chest straps after sternal dehiscence repair surgery were included in armor chest strap group. A special team for sternal dehiscence repair was set up, and the nurses in charge in the team instructed the patients in 2 groups on the correct abdominal breathing method, and the members of the surgical team performed the personalized surgery and wore the corresponding chest straps for the patients in 2 groups. The abdominal breathing frequency and chest breathing frequency on the first day after surgery were recorded. The pain intensity at 6, 24, 48, and 72 h after surgery was self-rated by the patients using numerical rating scale. The time of the first active cough and the time of wound healing after surgery were recorded. At postoperative suture removal, the cutting length of sutures induced by respiratory exercise was recorded. Whether there were complications such as redness, swelling, and exudation in flaps within 2 weeks after surgery were recorded, whether there were complications such as wound dehiscence or infection during follow-up of 3-12 months were recorded, and the incidence proportion of postoperative complications was calculated. At 6 months after surgery, the patients' scar status was evaluated by the Vancouver scar scale. The abdominal breathing frequency of patients in armor chest strap group was (16.3±1.2) times/min on the first day after surgery, which was significantly higher than (5.3±1.4) times/min in conventional chest strap group (=20.00, <0.05), and the chest breath-ing frequency was (1.2±0.8) times/min, which was significantly lower than (12.4±1.5) times/min in conventional chest strap group (=22.36, <0.05). The pain intensity scores of patients in armor chest strap group at 6, 24, 48, and 72 h after surgery were significantly lower than those in conventional chest strap group (with values of 15.07, 14.70, 13.66, and 11.03, respectively, <0.05). The time of the first active cough and the time of wound healing after surgery of patients in armor chest strap group were significantly sooner than those in conventional chest strap group (with values of 5.51 and 8.90, respectively, <0.05). At postoperative suture removal, the cutting length of sutures induced by respiratory exercise of patients in conventional chest strap group was 2.0 (0, 5.0) mm, which was significantly longer than 2.0 (1.0, 2.0) mm in armor chest strap group (=4.10, <0.05). There was no statistically significant difference in the incidence proportion of postoperative complications of patients between the 2 groups (>0.05). At 6 months after surgery, the scar score of patients in armor chest strap group was 4.1±1.4, which was significantly lower than 5.6±1.4 in conventional chest strap group (=2.71, <0.05). The application of armor chest strap in patients with sternal dehiscence after repair surgery can increase the abdominal breathing frequency, reduce the wound cutting force, effectively relieve postoperative pain, increase the first active cough and wound healing speed, and alleviate postoperative scar proliferation, achieving good application effect.

摘要

探讨铠甲式胸带在胸骨裂开修复术后患者中的应用效果。本研究为回顾性队列研究。选取2020年3月至2021年3月在空军军医大学第一附属医院(以下简称“该医院”)住院且胸骨裂开修复术后使用传统胸带的11例患者纳入传统胸带组。选取2021年4月至2022年3月在该医院住院且胸骨裂开修复术后使用铠甲式胸带的12例患者纳入铠甲式胸带组。成立胸骨裂开修复专项小组,小组内责任护士指导两组患者正确的腹式呼吸方法,手术团队成员为两组患者实施个性化手术并佩戴相应胸带。记录术后第1天的腹式呼吸频率和胸式呼吸频率。患者使用数字评分量表自评术后6、24、48及72 h的疼痛强度。记录首次主动咳嗽时间和术后伤口愈合时间。术后拆线时,记录呼吸运动导致的缝线切割长度。记录术后2周内皮瓣有无红肿、渗液等并发症,记录3 - 12个月随访期间有无伤口裂开或感染等并发症,并计算术后并发症发生率。术后6个月,采用温哥华瘢痕量表评估患者瘢痕状况。铠甲式胸带组患者术后第1天的腹式呼吸频率为(16.3±1.2)次/分钟,显著高于传统胸带组的(5.3±1.4)次/分钟(t = 20.00,P < 0.05),胸式呼吸频率为(1.2±0.8)次/分钟,显著低于传统胸带组的(12.4±1.5)次/分钟(t = 22.36,P < 0.05)。铠甲式胸带组患者术后6、24、48及72 h的疼痛强度评分均显著低于传统胸带组(t值分别为15.07、14.70、13.66及11.03,P < 0.05)。铠甲式胸带组患者首次主动咳嗽时间和术后伤口愈合时间均显著早于传统胸带组(t值分别为5.51和8.90,P < 0.

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