盔甲式胸带在胸骨裂开患者修复术后的应用效果

杨姣; 王玲; 张万福; 陈阳; 官浩

doi:10.3760/cma.j.cn501225-20230904-00074

盔甲式胸带在胸骨裂开患者修复术后的应用效果

doi: 10.3760/cma.j.cn501225-20230904-00074

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

基金项目:

国家自然科学基金面上项目 82272268

教育部中国高校产学研创新基金 2021JH030

详细信息

通讯作者:
官浩，Email：guanhao@hotmail.com

计量
- 文章访问数: 91
- HTML全文浏览量: 17
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-04

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

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

Funds:

General Program of National Natural Science Foundation of China 82272268

Industry-University-Research Innovation Fund of Ministry of Education of China 2021JH030

More Information

Corresponding author: Guan Hao, Email: guanhao@hotmail.com

摘要

摘要: 目的探讨盔甲式胸带在胸骨裂开患者修复术后的应用效果。方法该研究为回顾性队列研究。将2020年3月—2021年3月空军军医大学第一附属医院（以下简称本院）收治的行胸骨裂开修复术且术后使用常规胸带的11例患者纳入常规胸带组，将2021年4月—2022年3月本院收治的行胸骨裂开修复术且术后使用盔甲式胸带的12例患者纳入盔甲式胸带组。成立胸骨裂开修复专项小组，组内责任护士为2组患者指导正确腹式呼吸方法，手术组成员为2组患者开展个性化手术并佩戴相应胸带。统计术后第1天腹式呼吸频率、胸式呼吸频率；患者采用数字评定量表自评术后6、24、48、72 h疼痛强度；记录术后第1次主动咳嗽时间和伤口愈合时间；记录术后拆线时呼吸运动致伤口缝线切割长度；记录术后2周内皮瓣局部有无红肿、渗出等并发症，随访3~12个月有无伤口裂开或感染等并发症，计算术后并发症发生比例；术后6个月，采用温哥华瘢痕量表评价瘢痕情况。结果盔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/min，明显高于常规胸带组的（5.3±1.4）次/min（ t=20.00， P<0.05）；胸式呼吸频率为（1.2±0.8）次/min，明显低于常规胸带组的（12.4±1.5）次/min（ t=22.36， P<0.05）。盔甲式胸带组患者术后6、24、48、72 h疼痛强度评分均明显低于常规胸带组（ t值分别为15.07、14.70、13.66、11.03， P<0.05）。盔甲式胸带组患者术后第1次主动咳嗽时间、伤口愈合时间均明显早于常规胸带组（ t值分别为5.51、8.90， P<0.05）。术后拆线时，常规胸带组患者呼吸运动致伤口缝线切割长度为2.0（0，5.0）mm，明显长于盔甲式胸带组的2.0（1.0，2.0）mm（ Z=4.10， P<0.05）。2组患者术后并发症发生比例比较，差异无统计学意义（ P>0.05）。术后6个月，盔甲式胸带组患者瘢痕评分为（4.1±1.4）分，明显低于常规胸带组的（5.6±1.4）分（ t=2.71， P<0.05）。结论在胸骨裂开患者修复术后应用盔甲式胸带可提高腹式呼吸频率，减轻伤口切割力，有效缓解术后疼痛，加快第1次主动咳嗽和伤口愈合速度，减轻术后瘢痕增生，应用效果较好。
- 胸骨 /
- 胸骨切开术 /
- 手术后并发症 /
- 护理 /
- 外科皮瓣 /
- 盔甲式胸带
Abstract: Objective To investigate the application effects of armor chest straps in patients with sternal dehiscence after repair surgery. Methods 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. Results 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 ( t=20.00, P<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 ( t=22.36, P<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 t values of 15.07, 14.70, 13.66, and 11.03, respectively, P<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 t values of 5.51 and 8.90, respectively, P<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 ( Z=4.10, P<0.05). There was no statistically significant difference in the incidence proportion of postoperative complications of patients between the 2 groups ( P>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 ( t=2.71, P<0.05). Conclusions 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.
- Sternum /
- Sternotomy /
- Postoperative complications /
- Nursing care /
- Surgical flaps /
- Armor chest strap
杨姣：研究设计、数据采集、统计学分析及论文撰写；王玲、张万福：研究实施、数据采集；陈阳：统计学分析；官浩：研究指导、论文修改、经费支持

所有作者均声明不存在利益冲突

HTML全文

参考文献(22)

[1]	张月,韩飞,官浩.内窥镜技术在胸大肌肌瓣修复开胸术后胸骨裂开创面中的应用[J/CD].中华损伤与修复杂志(电子版),2020,15(4):291-293.DOI: 10.3877/cma.j.issn.1673-9450.2020.04.011.
[2]	官浩,陈阳.重视胸骨切开术后胸骨深部伤口感染的预防和处理[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 125-130. DOI: 10.3760/cma.j.cn501225-20231212-00235.
[3]	蔡丽娜, 李明兄, 徐京, 等.负压封闭引流联合持续微氧渗透技术在新生儿胸骨切口深部感染中的应用[J]. 护理学杂志, 2023, 38(5): 25-28. DOI: 10.3870/j.issn.1001-4152.2023.05.025.
[4]	张熠杰,陈刚,官浩,等.胸骨切开术后裂开及组织瓣移植修复研究进展[J]. 中华烧伤杂志, 2019, 35(12): 879-883. DOI: 10.3760/cma.j.issn.1009-2587.2019.12.010.
[5]	CabbabeEB, CabbabeSW. Surgical management of the symptomatic unstable sternum with pectoralis major muscle flaps[J].Plast Reconstr Surg, 2009, 123(5): 1495-1498. DOI: 10.1097/PRS.0b013e3181a07459.
[6]	俞长君,杨婷,张会慧,等.不同呼吸训练方式对亚急性期脑卒中呼吸功能及膈肌功能的影响[J].广西医学, 2019,41(1): 102-104,107. DOI: 10.11675/j.issn.0253-4304.2019.01.26.
[7]	AguilarB, PenmJ, LiuS, et al. Efficacy and safety of transdermal buprenorphine for acute postoperative pain: a systematic review and meta-analysis[J].J Pain, 2023,24(11):1905-1914. DOI: 10.1016/j.jpain.2023.07.001.
[8]	佟琳, 胡晓龙, 张万福, 等. 腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果[J]. 中华烧伤杂志, 2021,37(11): 1048-1053. DOI: 10.3760/cma.j.cn501120-20210204-00050.
[9]	李舒玲,蒋璇,王蓓.自制可调气压外固定胸带在开胸术后的应用[J].护理学杂志,2015,30(6):24-25.DOI: 10.3870/hlxzz.2015.06.024.
[10]	El OakleyRM, WrightJE. Postoperative mediastinitis: classification and management[J]. Ann Thorac Surg,1996,61(3):1030-1036.DOI: 10.1016/0003-4975(95)01035-1.
[11]	袁武,陈剑,程力剑, 等. 改良Robicsek法加双侧胸大肌肌瓣治疗心脏直视术后胸骨裂开[J]. 临床外科杂志,2020,28(12):1129-1131. DOI: 10.3969/j.issn.1005-6483.2020.12.010.
[12]	SchugSA, PalmerGM, ScottDA, et al. Acute pain management: scientific evidence, fourth edition, 2015[J]. Med J Aust, 2016,204(8):315-317. DOI: 10.5694/mja16.00133.
[13]	杨姣, 王玲, 李娜,等.艾司氯胺酮复合麻醉在小儿瘢痕非插管全麻患者超脉冲二氧化碳点阵激光治疗术中的应用及效果观察[J/CD].中华损伤与修复杂志(电子版), 2022, 17(2):119-125. DOI: 10.3877/cma.j.issn.1673-9450.2022.02.005.
[14]	林野,李守军.封闭式持续负压吸引治疗小儿心脏外科手术后累及胸骨的深部切口感染[J].临床小儿外科杂志, 2020,19(9):806-809.DOI: 10.3969/j.issn.1671-6353.2020.09.009.
[15]	朱喆辰,史京萍,王鸣,等.负压封闭引流联合局部浸润麻醉下清创并手术缝合修复胸部正中切口愈合不良的临床应用[J/CD].中华损伤与修复杂志(电子版),2021,16(4):316-321. DOI: 10.3877/cma.j.issn.1673-9450.2021.04.006.
[16]	王芹, 陆昊, 郑闻, 等.呼吸运动锻炼改善COPD患者通气功能及运动耐量效果分析[J].华南预防医学, 2020,46(3):303-305. DOI: 10.12183/j.scjpm.2020.0303.
[17]	刘倩. 开胸手术后患者疼痛的评估及护理干预研究[J]. 中国社区医师, 2018, 34(27): 152-154. DOI: 10.3969/j.issn.1007-614x.2018.27.096.
[18]	李燕如,刘晓芬,李少芳,等. 自控式多功能胸带的研制及其在降低胸部手术患者活动性疼痛中的应用[J].护理学报, 2019,26(20):74-77. DOI: 10.16460/j.issn1008-9969.2019.20.074.
[19]	赵培,郭员志,张一帆, 等. 改良多头腋胸带改善乳腺癌病人术后皮下积液的效果[J]. 护理研究, 2020, 34(10): 1841-1843. DOI: 10.12102/j.issn.1009-6493.2020.10.036.
[20]	胡晓龙,张万福,韩飞,等.医用皮肤减张闭合器在胸骨切开术后裂开手术治疗中的应用效果[J/CD].中华损伤与修复杂志(电子版),2021, 16(1):39-43. DOI: 10.3877/cma.j.issn.1673-9450.2021.01.007.
[21]	兰怀,王镇龙,罗娜,等. 全胸腔镜下心脏手术新型胸衣的设计与应用研究[J]. 中国胸心血管外科临床杂志,2021,28(7):837-840. DOI: 10.7507/1007-4848.202007032.
[22]	张万福, 徐婧, 张敬群, 等. 胸骨切开术后继发伴胸骨骨髓炎和/或纵隔炎创面的围手术期处理及其临床效果[J]. 中华烧伤与创面修复杂志, 2024, 40(2): 151-158. DOI: 10.3760/cma.j.cn501225-20231028-00141.

下载: 全尺寸图片幻灯片

1 术后拆线时常规胸带组与盔甲式胸带组行胸骨裂开修复术患者呼吸运动导致伤口缝线切割长度。1A.常规胸带组患者；1B.盔甲式胸带组患者，图1B缝线切割长度短于图1A

下载: 全尺寸图片幻灯片

2 胸骨裂开患者修复术后使用盔甲式胸带的效果。2A.术前胸骨外露；2B.术后应用盔甲式胸带固定；2C.术后6个月，伤口恢复良好

下载: 全尺寸图片幻灯片

表1 2组行胸骨裂开修复术患者一般资料比较

表1. Comparison of general data between two groups of patients after sternal dehiscence repair surgery

组别	例数	性别（例）		年龄（岁， x ¯ ± s ）	心功能分级（例）				吸烟史（例）		糖尿病史（例）		创面分型（例）
组别	例数	男	女	年龄（岁， x ¯ ± s ）	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	有	无	有	无	Ⅰ型	Ⅱa型	Ⅱb型
常规胸带组	11	9	2	56±7	2	3	5	1	9	2	8	3	1	6	4
盔甲式胸带组	12	9	3	55±7	2	4	4	2	10	2	9	3	1	6	5
统计量值		—		t=0.28	Z=0.06				—		—		Z=0.24
P值		>0.999		0.786	0.948				>0.999		>0.999		0.810
注：常规胸带组患者佩戴常规胸带，盔甲式胸带组患者佩戴盔甲式胸带；“—”表示无此项

下载: 导出CSV

表2 2组行胸骨裂开修复术患者术后各时间点疼痛强度评分比较（分， x ¯ ± s ）

表2. Comparison of the pain intensity scores between two groups of patients who underwent sternal dehiscence repair surgery at each time point after surgery

组别	例数	6 h	24 h	48 h	72 h
常规胸带组	11	7.6±1.2	6.4±0.9	5.6±0.8	4.1±0.7
盔甲式胸带组	12	5.5±1.3	4.7±1.2	3.8±1.0	2.6±0.9
t值		15.07	14.70	13.66	11.03
P值		<0.001	<0.001	<0.001	<0.001
注：常规胸带组患者佩戴常规胸带，盔甲式胸带组患者佩戴盔甲式胸带；处理因素主效应， F=614.89， P<0.001；时间因素主效应， F=19.85， P<0.001；两者交互作用， F=14.70， P<0.001