皮瓣移植术后皮瓣区“五点温度”变化与皮瓣血供和预后的相关性研究  

Correlation between the changes of the"five-point temperature"in the flap area and the blood supply and prognosis after flap transplantation

作　　者：朱玉玲 蒋琪霞 祝文君 朱思文 李秀芸 谢郝婷 王华军 王金金 ZHU Yuling;JIANG Qixia;ZHU Wenjun;ZHU Siwen;LI Xiuyun;XIE Haoting;WANG Huajun;WANG Jinjin(Department of Burns and Plastic Surgery,General Hospital Eastern Theater Command of PLA,Nanjing,210002,China)

机构地区：[1]南京医科大学金陵临床医学院(东部战区总医院)烧伤整形科,南京市210002 [2]云南省红河州第一人民医院伤口造口治疗中心

出　　处：《中国护理管理》2025年第1期140-144,共5页Chinese Nursing Management

基　　金：全军卫勤创新课题(20WQ027);东部战区总医院院内课题(22HLZX3)。

摘　　要：目的:分析皮瓣移植术后皮瓣温度变化规律与皮瓣血供和预后的关系,以及时发现皮瓣血运障碍,降低并发症发生率,提高护理质量,改善患者预后。方法:纳入2021年12月至2023年12月住院的65例接受皮瓣手术的患者。术后第1天起,每2小时一次,连续5天观察皮瓣“五点温度”、毛细血管反应、皮瓣颜色,记录皮瓣血运情况、患者住院时间和预后。结果:患者术后1~5天“五点温度”由(35.87±0.48)℃上升至(36.20±0.18)℃。11例(16.9%)患者术后发生血管危象,其中静脉危象7例(10.8%)、动脉危象4例(6.2%)。相关性分析显示,术后1~3天“五点温度”与血管危象(r=-0.621、-0.523、-0.462,均P<0.001)及皮瓣坏死(r=-0.492、-0.649、-0.739,均P<0.001)呈负相关。血供正常组术后皮瓣一期愈合,住院时间为(24.24±10.97)天;静脉危象组经处理后皮瓣成活,住院时间为(39.00±11.51)天;动脉危象组皮瓣坏死需要再次手术,住院时间为(52.33±14.30)天。三组住院时间比较差异有统计学意义(P<0.001)。结论:术后1~5天皮瓣“五点温度”逐渐升高。当术后1~3天皮瓣温度低于36.05℃时,需要警惕血管危象发生,低于35.70℃时需要警惕皮瓣坏死。准确监测皮瓣温度对早期发现并处理血管危象、皮瓣坏死及改善皮瓣预后极为重要。Objective:To analyze the relationship between the temperature changes of the flap after flap transplantation,blood supply,and prognosis,in order to timely detect skin flap blood flow disorders,reduce the incidence of complications,improve nursing quality,and improve patient prognosis.Methods:Sixty-five hospitalized flap transplantation patients were included from December 2021 to December 2023.Starting from the first postoperative day,the"five-point temperature"of the flap,capillary response,and flap color were observed every 2 hours for 5 consecutive days.The flap's blood supply,hospitalization duration,and prognosis were recorded.Results:The"five-point temperature"on postoperative days 1 to 5 were from 35.87±0.48°C to 36.20±0.18°C.Vascular crises occurred in 11 patients(16.9%),with 10.8%(n=7)experiencing venous crises and 6.2%(n=4)arterial crises.Correlation analysis showed that the"five-point temperature"on postoperative days 1 to 3 was negatively correlated with vascular crises(r=-0.621,-0.523,-0.462;all P<0.001)and flap necrosis(r=-0.492,-0.649,-0.739;all P<0.001).In the normal blood supply group,the flaps achieved primary healing with an average hospital stay of 24.24±10.97 days.In the venous crisis group,the flaps survived after treatment,with an average hospital stay of 39.00±11.51 days.In the arterial crisis group,the flaps experienced necrosis requiring additional surgery,with an average hospital stay of 52.33±14.30 days.The differences in hospital stay among the three groups were significant(P<0.001).Conclusion:The"five-point temperature"of the flap gradually increased from postoperative days 1 to 5.If the temperature is below 36.05°C on days 1 to 3,vascular crisis should be suspected,and if it is below 35.70°C,flap necrosis should be suspected.Therefore,accurately monitoring flap temperature is crucial for the early detection and management of vascular crises and necrosis,as well as for improving flap prognosis.

关 键 词：皮瓣移植 温度测量 非接触式红外线测温仪 血管危象 皮瓣血供 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]