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目的探讨因急性下肢动脉缺血导致足趾坏死行截肢手术患者术后的临床护理方法。方法回顾性分析2015年1月—2016年1月蚌埠医学院第一附属医院血管外科收住的18例因急性下肢动脉缺血导致足趾坏死行截肢治疗患者术后的临床护理资料,护理上包括积极的心理疏导、残端创面的精心护理、饮食健康指导、康复训练等,一期愈合不良的创面经过一段时间清创待新鲜肉芽组织生长后行负压封闭引流1周,观察术肢残端愈合及患者恢复情况。结果本组12例患者术后残端创面一期愈合;5例患者术后创面发生脂肪液化,部分切缘不愈合,加强换药联合负压封闭引流术,二期缝合;3例患者术后出现肺部感染,4例患者术后出现心衰症状;经综合治疗与护理,17例患者残端伤口均愈合,肢体功能锻炼良好,肺部感染、心衰症状得到有效控制,餐后血糖均控制在9.0 mmol/L以下,1例高龄患者术后4 d发生心肺功能衰竭死亡。结论下肢缺血性疾病导致足趾坏死截肢术后需要配合安全、精心的护理与健康饮食指导,对促进患者康复、创面愈合、减少并发症、提高患者生活质量有着重要意义。
Objective To investigate the clinical nursing of postoperative patients with amputation due to acute ischemia of lower extremities. Methods Retrospective analysis of clinical nursing data of 18 patients with amputation caused by acute lower extremity arterial ischemia resulting from acute lower extremity artery occlusion during January 2015 to January 2016 in the First Affiliated Hospital of Bengbu Medical College, Including active psychological counseling, meticulous care of stump wounds, diet and health guidance, rehabilitation training and so on. The wounds with poor healing were debrided for a period of time to be fresh granulation tissue, followed by negative pressure for 1 week, End healing and patient recovery. Results In the 12 patients, the wounds of the stump were healed one time after operation. In 5 patients, fat liquefaction occurred on the wound surface, partial incision margin did not heal, dressing change combined with negative pressure closed drainage and suture were performed in 2 patients, and postoperative 4 cases of postoperative heart failure symptoms; after comprehensive treatment and nursing, 17 patients with stump wound healed, limb function exercise well, pulmonary infection, heart failure symptoms are effectively controlled, postprandial blood glucose Control below 9.0 mmol / L, 1 case of elderly patients died of cardiopulmonary failure 4 days after surgery. Conclusion It is necessary to cooperate with safe and meticulous care and healthy diet guidance after amputation of ischemic limbs in the lower extremities. It is of great significance to promote patient rehabilitation, wound healing, reduce complications and improve the quality of life of patients.