Abstract:

Objective　To study the clinical application value of perioperative nursing management strategies in the treatment of congenital microtia (CM) patients with delayed retroauricular flap combined with autogenous costal cartilage stereoscopic scaffold for external ear reconstruction. Methods　It was a randomized controlled trial. A total of 108 CM patients admitted to Hunan Provincial People's Hospital from January 2018 to January 2021 were selected as the objects. They were divided into a control group (54 cases) and a management group (54 cases) with the random number table method. In the control group, there were 33 females and 21 males, aged (13.81±2.13) years. In the management group, there were 34 females and 20 males, aged (14.15±2.42) years. All the patients underwent external ear reconstruction with delayed retroauricular flap and autologous costal cartilage stereoscopic scaffold. Among them, the control group received routine nursing management measures in the perioperative management, while the management group received comprehensive nursing mode including behavior guidance, emotional relief, and other nursing management. The patients' general data (including gender and age), anxiety, pain, quality of life, and satisfaction after intervention were compared under different perioperative nursing strategies. χ² test and t test were used. Results　The satisfaction of humanistic care [94.44% (51/54)], index management [98.15% (53/54)], and follow-up effect [96.30% (52/54)] in the management group were all higher than those in the control group [81.48% (44/54), 85.19% (46/54), and 83.33% (45/54)] (χ²=4.285, 5.939, and 4.960; all P<0.05). After intervention, the scores of Self-rating Anxiety Scale (SAS) [(37.98±3.39) points], Hamilton Anxiety Scale (HAMA) [(8.22±1.25) points], and Visual Analogue Scale (VAS) [(1.13±0.15) points] in the management group were lower than those in the control group [(45.21±3.45) points, (11.78±1.33) points, and (1.41±0.31) points] (t=10.984, 14.333, 5.975; all P<0.001). The incidence of redness and swelling, infection, and other adverse reactions in the management group [5.56% (3/54)] was lower than that in the control group [18.25 (10/54)] (χ²=4.285, P<0.05). The scores of all dimensions of quality of life of the management group after intervention were lower than those of the control group (all P<0.001). Conclusion　For CM patients, the application of perioperative comprehensive nursing management strategies can improve the patients' satisfaction on postoperative rehabilitation effect, relieve their psychological negative emotions, and improve their quality of life.

Key words:

Congenital microtia, Delayed retroauricular flap, Autogenous costal cartilage stereoscopic scaffold, External ear reconstruction, Perioperative nursing management

摘要：

目的　研究先天性小耳畸形（congenital microtia，CM）患者行耳后延迟皮瓣联合自体肋软骨立体支架法外耳再造术中围手术期护理管理的临床应用价值。方法　本研究为随机对照试验。选取湖南省人民医院在2018年1月至2021年1月期间收治的CM患者108例为对象，在随机数字表法下，将其随机分为对照组（54例）与管理组（54例）。对照组女33例，男21例，年龄（13.81±2.13）岁；管理组女34例，男20例，年龄（14.15±2.42）岁。所有患者均接受耳后延迟皮瓣加自体肋软骨立体支架法外耳再造术治疗方案。其中，对照组在围手术期管理中仅实施常规护理管理措施，而管理组则实施包括行为指导、情绪疏理等护理管理的综合性护理模式。比较围手术期不同护理策略下的患者一般资料（包括性别及年龄等），焦虑、疼痛、生活质量，以及干预后的满意度等情况。采用χ²检验、t检验。结果　管理组的人文关怀满意度［94.44%（51/54）］、指标管理满意度［98.15%（53/54）］、随访效果满意度［96.30%（52/54）］对比对照组［81.48%（44/54）、85.19%（46/54）、83.33%（45/54）］均更高（χ²=4.285、5.939、4.960，均P<0.05）。管理组干预后的焦虑自评量表（SAS）［（37.98±3.39）分］、汉密尔顿焦虑量表（HAMA）［（8.22±1.25）分］、视觉模拟疼痛评分量表（VAS）评分［（1.13±0.15）分］与对照组［（45.21±3.45）分、（11.78±1.33）分、（1.41±0.31）分］对比均更低（t=10.984、14.333、5.975，均P<0.001）。管理组红肿、感染等不良反应发生率［5.56%（3/54）］与对照组［18.25（10/54）］对比更低（χ²=4.285，P<0.05）。管理组干预后的生活质量各维度评分均低于对照组（均P<0.001）。结论　对于CM患者而言，围手术期综合性护理管理措施的运用可提升患者对术后康复效果的满意度，缓解手术患者的心理负性情绪，提升患者的生活质量。

关键词:

先天性小耳畸形, 耳后延迟皮瓣术, 自体肋软骨立体支架法, 外耳再造术, 围术期护理管理