Effect of Cluster Nursing on Postoperative Efficacy of Patients with Stage Ⅲ and Ⅳ Pressure Ulcer
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摘要:
目的 探讨集束化护理对负压封闭引流（VSD）术联合肌皮瓣移植修复Ⅲ、Ⅳ期压疮患者疗效的促进作用。 方法 采用整群抽样法，选取2019年9月至2021年3月于云南省第一人民医院新昆华医院接受VSD术联合肌皮瓣移植修复Ⅲ、Ⅳ期压疮60例患者为研究对象。采用随机数字表法，将研究对象分为观察组和对照组，对照组给予常规护理，观察组在对照组的基础上给予集束化护理，利用PUSH量表评价创口面积大小、组织类型变化及渗液量变化，比较2组患者愈合时间及治疗有效率。 结果 干预7 d，2组患者PUSH评分比较差异无统计学意义（P > 0.05），干预14 d、21 d时，观察组PUSH评分低于对照组（P < 0.05），观察组各时间点PUSH评分比较差异有统计学意义（P < 0.05），对照组干预14 d与干预21 d比较，差异无统计学意义（P > 0.05）；观察组愈合时间（29.2±8.6）d低于对照组（35.7±13.7）d（P < 0.05）；干预21 d后观察组治疗有效率高于对照组（P < 0.05）。 结论 对VSD术联合肌皮瓣移植修复Ⅲ、Ⅳ期压疮患者实施集束化护理能够有效促进压疮恢复，可在临床实践中推广。 Abstract:Objective To explore the effect of cluster nursing on the curative effect of negative pressure sealing drainage （VSD） combined with myocutaneous flap transplantation in the repair of stage ⅲ and ⅳ pressure ulcer. Methods 60 patients with stage III and IV pressure sores who underwent VSD combined with myocutaneous flap transplantation in xinkunhua Hospital of the first people’s Hospital of Yunnan Province from September 2019 to March 2021 were selected by convenient sampling method. The subjects were randomly divided into observation group and control group. The control group was given routine nursing, and the observation group was given cluster nursing on the basis of the control group. The change of wound area, tissue type and exudation were evaluated by push scale, and the healing time and treatment efficiency of the two groups were compared. Results After 7 days of intervention, there was no significant difference in push score between the two groups （P > 0.05）. At 14 and 21 days of intervention, the push score of the observation group was lower than that of the control group （P < 0.05）. There was significant difference in push score at each time point in the observation group （P < 0.05）. There was no significant difference between the 14 days of intervention and the 21 days of intervention in the control group （P > 0.05）; The healing time in the observation group （29.2 ± 8.6） d was lower than that in the control group （35.7 ± 13.7） d （P < 0.05）; After 21 days of intervention, the effective rate of the observation group was higher than that of the control group （P< 0.05）. Conclusion Cluster nursing for patients with stage III and IV pressure ulcer repaired by VSD combined with myocutaneous flap transplantation can effectively promote the recovery of pressure ulcer and can be popularized in clinical practice. -
表 1 2组患者干预前后PUSH评分比较[（
$\bar x \pm s$ ），分]Table 1. Comparison of push scores between the two groups before and after intervention [（
$\bar x \pm s$ ），points]组别 入院 7 d 14 d 21 d 观察组（n = 30） 10.4 ± 2.7 7.1 ± 2.5 3.8 ± 3.0 2.0 ± 0.8 对照组（n = 30） 10.6 ± 2.9 8.0 ± 2.8 6.0 ± 3.0 4.7 ± 2.6 t −0.276 −1.313 −2.84 −5.436 P 0.784 0.194 0.006* < 0.001* *P < 0.05。 
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表 2 2组患者治疗有效率比较 [n（％）]
Table 2. Comparison of treatment effectiveness between the two groups [n （%）]
组别 愈合 有效 无效 护理有效率 观察组（n = 30） 17（56.7） 12（40.0） 1（3.3） 29（96.7） 对照组（n = 30） 10（33.3） 12（40.0） 8（26.7） 22（73.3） χ2 6.405 P 0.011* *P < 0.05。
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