CAJ | 학술논문

目的：探讨截肢术后残端皮瓣坏死合并感染应用负压封闭引流的护理方法，为临床应用提供参考依据。方法2012年3月－2014年2月骨科对15例截肢术后残端皮瓣坏死合并感染的患者应用负压封闭引流技术，护理上重点做好负压封闭引流护理、患肢疼痛护理、心理护理和营养支持。结果通过对负压封闭引流患者精心的治疗与护理，避免了因护理操作不当引起的再次感染，提高了护理的安全性；负压封闭引流5～7d后，揭除敷料时，有13例患者创面细菌培养呈阴性，无坏死组织残留，肉芽组织生长较好，行植皮术后愈合良好，2例患者更换二次负压封闭引流后，经过5～7d后，创面细菌培养呈阴性，无大量渗液集聚并可见新鲜肉芽组织，行植皮术后患者痊愈；15例患者无1例发生深部感染及骨髓炎等并发症。结论截肢术后残端皮瓣坏死合并感染患者应用负压封闭引流时，护理人员应密切观察引流情况，以保证有效引流，防止引流管道堵塞的发生，同时做好患肢疼痛护理、心理护理和营养支持，为二期植皮手术的顺利进行奠定良好基础，提高护理满意度。
목적：탐토절지술후잔단피판배사합병감염응용부압봉폐인류적호리방법，위림상응용제공삼고의거。방법2012년3월－2014년2월골과대15례절지술후잔단피판배사합병감염적환자응용부압봉폐인류기술，호리상중점주호부압봉폐인류호리、환지동통호리、심리호리화영양지지。결과통과대부압봉폐인류환자정심적치료여호리，피면료인호리조작불당인기적재차감염，제고료호리적안전성；부압봉폐인류5～7d후，게제부료시，유13례환자창면세균배양정음성，무배사조직잔류，육아조직생장교호，행식피술후유합량호，2례환자경환이차부압봉폐인류후，경과5～7d후，창면세균배양정음성，무대량삼액집취병가견신선육아조직，행식피술후환자전유；15례환자무1례발생심부감염급골수염등병발증。결론절지술후잔단피판배사합병감염환자응용부압봉폐인류시，호리인원응밀절관찰인류정황，이보증유효인류，방지인류관도도새적발생，동시주호환지동통호리、심리호리화영양지지，위이기식피수술적순리진행전정량호기출，제고호리만의도。
OBJECTIVE To explore the application of vacuum sealing drainage in nursing care of the amputation pa‐tients with postoperative skin flap necrosis complicated with infections so as to provide guidance for clinical appli‐cation .METHODS The vacuum sealing drainage technique was applied in 15 amputation patients with postoperative skin flap necrosis complicated with infections who were treated in the orthopedics department from Mar 2012 to Feb 2014 ,focusing on the nursing care including the vacuum sealing drainage care ,limb pain nursing ,psychologi‐cal nursing ,and nutrition support .RESULTS Through the meticulous treatment and nursing ,the recurrent infec‐tions due to nursing procedures were prevented and the nursing safety was improved .The wound specimens were cultured negative in 13 patients when the dressing were removed after the vacuum sealing drainage was carried out for 5 to 7 days ,no necrotic tissues remained ,and granulation tissues grew well ,and the patients got good postop‐erative healing after skin grafting .The wound specimens were cultured negative in 2 patients after the second vacu‐um sealing drainage was performed for 5 to 7 days ,without large volume of exdudates gathered ,the newly grown granulation tissues visible ,and the patients were cured after the skin grafting .The complications such as deep in‐fections and osteomyelitis did not occur in any of the 15 patients .CONCLUSION As the vacuum sealing drainage is applied for the amputation patients with postoperative skin flap necrosis patients complicated with infections ,it is necessary for the nursing staff to pay close attention to the condition of drainage to ensure the effective drainage and prevent the blockage of drainage tubes and carry out the limb pain nursing ,psychological nursing ,and nutri‐tion support so as to lay foundation for the phase Ⅱ skin grafting and improve the satisfaction with the nursing .