李虹437300湖北省赤壁市人民醫(yī)院

化膿性闌尾炎術(shù)后切口感染的預(yù)防及護(hù)理措施

李虹
437300湖北省赤壁市人民醫(yī)院

目的：探討化膿性闌尾炎術(shù)后切口感染的預(yù)防及護(hù)理措施。方法：2012年12月-2013年12月收治闌尾炎手術(shù)患者200例，按照隨機(jī)分配的原則分為治療組和對(duì)照組，每組100例。對(duì)照組采用常規(guī)的手術(shù)方法和護(hù)理措施，而治療組手術(shù)后采用大量生理鹽水對(duì)腹腔以及切口進(jìn)行沖洗，手術(shù)后放置引流管，且護(hù)理措施在常規(guī)護(hù)理基礎(chǔ)上加強(qiáng)對(duì)患者切口的護(hù)理，對(duì)比兩組患者的臨床效果。結(jié)果：經(jīng)過(guò)護(hù)理后，治療組手術(shù)后切口感染率顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療組住院時(shí)間以及護(hù)理滿意度顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論：闌尾炎手術(shù)后采用生理鹽水沖洗切口及腹腔，且放置引流管，對(duì)患者進(jìn)行精細(xì)的護(hù)理，能夠降低切口感染發(fā)生率和患者住院時(shí)間，提高患者的護(hù)理滿意度，值得在臨床上推廣應(yīng)用。

化膿性闌尾炎；切口感染；護(hù)理；臨床效果

化膿性闌尾炎在臨床上屬于一種比較常見(jiàn)的腹部感染性疾病，主要是因?yàn)榛撔源竽c桿菌合并厭氧菌感染，導(dǎo)致患者的闌尾出現(xiàn)化膿或者穿孔，容易導(dǎo)致患者腹腔或者切口感染，因此該疾病的主要的并發(fā)癥是切口感染［1］。導(dǎo)致患者出現(xiàn)切口感染的因素比較多，例如患者的年齡、性別、切口的長(zhǎng)度和形狀、手術(shù)時(shí)間等?；颊甙l(fā)生切口感染后，需要經(jīng)過(guò)長(zhǎng)時(shí)間的治療才能夠愈合，且導(dǎo)致患者的住院時(shí)間增加，即增加了患者經(jīng)濟(jì)負(fù)擔(dān)，又加重了護(hù)理人員的工作負(fù)擔(dān)［2］。因此如何預(yù)防患者切口感染和縮短住院時(shí)間、提高患者的滿意度成為了醫(yī)院需要解決的問(wèn)題。本文主要探討分析化膿性闌尾炎術(shù)后切口感染的預(yù)防及護(hù)理措施，現(xiàn)報(bào)告如下。

資料與方法

2012年12月-2013年12月收治行闌尾炎手術(shù)患者200例，將所有入選的患者按照隨機(jī)分配的原則分為治療組和對(duì)照組，每組患者100例。治療組中，男65例，女35例，年齡18.5～67.5歲，平均（42.3±6.5）歲；對(duì)照組中，男63例，女37例，年齡19.2～68.4歲，平均（41.9±7.2）歲。兩組患者在年齡、性別等一般臨床資料差異無(wú)統(tǒng)計(jì)學(xué)意義（＞0.05），組間具有可比性。

治療方法：對(duì)照組采用傳統(tǒng)的手術(shù)方法，而治療組在手術(shù)后采用大量的溫生理鹽水反復(fù)沖洗患者的腹腔，然后利用吸引器將沖洗液吸引干凈，經(jīng)過(guò)3次左右的反復(fù)沖洗后，縫合腹膜，然后采用生理鹽水對(duì)切口進(jìn)行沖洗，這樣能夠最大限度的降低切口細(xì)菌的密度，手術(shù)后放置引流管，將切口縫合。手術(shù)后給予對(duì)照組常規(guī)的護(hù)理方法：①向患者講解宣傳化膿性闌尾炎的相關(guān)知識(shí)；②對(duì)患者進(jìn)行心理護(hù)理：護(hù)理人員及時(shí)同患者進(jìn)行有效的溝通和交流，對(duì)患者進(jìn)行心理疏導(dǎo)，減少不良情緒滋生；③對(duì)患者的日常飲食進(jìn)行指導(dǎo)，指導(dǎo)患者進(jìn)行適當(dāng)?shù)拇蚕逻\(yùn)動(dòng)，減少粘連性腸梗阻的發(fā)生率；④時(shí)刻觀察患者手術(shù)切口的情況，是否愈合、是否出現(xiàn)紅腫、波動(dòng)等，定時(shí)對(duì)切口進(jìn)行消毒和更換敷料；⑤定時(shí)觀察患者的體溫以及血象的變化，發(fā)現(xiàn)異常及時(shí)通知醫(yī)生進(jìn)行再次治療。對(duì)于治療組患者手術(shù)后的護(hù)理，除了進(jìn)行和對(duì)照組一樣的常規(guī)護(hù)理外，重點(diǎn)加強(qiáng)對(duì)患者切口引流的護(hù)理，主要包括：①觀察患者的引流管是否暢通，是否發(fā)生異常，例如阻塞、扭曲、脫出等現(xiàn)象；②對(duì)于敷料滲出液體的顏色、多少以及性質(zhì)進(jìn)行密切的觀察，如果發(fā)現(xiàn)引流不正常后立即進(jìn)行處理，在特殊的情況下需要對(duì)引流管進(jìn)行更換，如果引流發(fā)生不暢，容易導(dǎo)致血液和組織液發(fā)生積聚，從而增加了細(xì)菌生長(zhǎng)繁殖的可能性，最后導(dǎo)致患者發(fā)生切口的感染；③要根據(jù)患者引流液的多少以及性質(zhì)等，確定引流管的拔管時(shí)間，一般患者拔管時(shí)間在手術(shù)后5d左右，如果發(fā)生特殊情況，引流管需要延長(zhǎng)1周后拔出。

Prevention and nursing m easures exp loration of the incision in fection prevention postoperative of suppurative appendicitis

Li Hong
The People'sHospitalofChibiCity，HubeiProvince 437300

Objective：To explore the prevention and nursing measures of the incision infection postoperative of suppurative appendicitis.Methods：200 cases of patients with appendicitis surgery from December 2012 to December 2013 were randomly divided into the treatment group and the control group，according to the principle of distribution，with 100 cases in each group.The control group were treated with routine operation methods and nursing measures，and the abdominal cavity and incision were washed with a lotof physiological saline after the operation and the drainage tubes were placed after the surgery in the treatment group，and nursing measures on the incision of patients were strengthen on the basis of conventional nursing care.We compared the clinical effects of the two groups.Results：After nursing care，the incision infection rate of the treatment group was significantly lower than that of the control group，and there was significant difference（P＜0.05）.The hospitalized time and nursing satisfaction of the treatment group were significantly superior to that of the control group，and there were significant differences（P＜0.05）.Conclusion：Washing the abdominal cavity and incision with a lotof physiological saline，the placementof the drainage tubes after the surgery and meticulous care can reduce the incidence of incision infection and hospitalized time，and improve nursing satisfaction，which isworthy of popularization and application in clinic.

Suppurative appendicitis；Incision infection；Nursing；Clinicaleffect

10.3969/j.issn.1007-614x.2015.1.89