乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2023.21.001

摘要/Abstract

摘要： 目的构建乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案并评价其应用效果，为临床实践提供参考。方法检索国内外数据库获取相关文献，初步构建乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案，于2022年10月—2023年1月采用德尔菲法进行3轮专家函询，确定方案最终内容。选取2022年1月—12月在浙江省某三级甲等医院接受腹壁下动脉穿支皮瓣乳房重建的21例患者作为对照组，接受常规护理；选取2023年1月—9月的28例患者作为试验组，实施该方案并评价应用效果。结果共15名专家完成3轮函询。第3轮函询中，一、二、三级指标重要性的肯德尔和谐系数分别为0.347、0.388、0.200（P<0.01），各指标的变异系数为0~0.224；最终构建的方案包括3项一级指标、18项二级指标、67项三级指标；试验组皮瓣并发症的发生率低于对照组，但差异无统计学意义（χ²=1.675，P=0.196）。结论该研究构建的乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案初步应用于临床，具有较好的科学性、可靠性、实用性，可为临床护理提供参考依据。

关键词: 乳腺肿瘤, 腹壁下动脉穿支皮瓣, 乳房成形术, 围手术期护理

Abstract:

Objective To construct a perioperative management program for breast reconstruction with deep inferior epigastric perforator flap with breast cancer，and to provide references for clinical practice. Methods The databases at home and abroad were searched to obtain the relevant literature，and the perioperative management program of breast reconstruction with inferior epigastric artery perforator flap for breast cancer was preliminarily constructed. 3 rounds of expert inquiries were conducted by Delphi method from October 2022 to January 2023 to determine the final content of the program. 14 patients who received breast reconstruction with deep inferior epigastric perforator flap in a tertiary hospital in Zhejiang Province from January to May in 2023 were selected as application subjects to implement the modified program and evaluate the clinical effect. Results A total of 15 experts completed 3 rounds of consultation. In the third round of consultation，the Kendall’s concordance coefficient of the importance of the first-level indicators was 0.347（P<0.05）；the Kendall’s concordance coefficients of the importance of the second and third-level indicators were 0.388 and 0.200（P<0.001）；the coefficient of variation of each indicator was 0~0.224. The final program included 3 first-level indicators，18 second-level indicators and 67 third-level indicators. The incidence of flap complications in 14 patients decreased by 11.9%. Conclusion The perioperative management program of breast reconstruction with deep inferior epigastric perforator flap for breast cancer is preliminarily applied in clinical practice，which is scientific，reliable and practical，and it can provide references for clinical nursing.

Key words: Breast Neoplasms, Deep Inferior Epigastric Perforator Flap, Mammaplasty, Perioperative Nursing

李英, 喻晓芬, 梅晓凤, 张露飞. 乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(21): 2565-2574.

LI Ying, YU Xiaofen, MEI Xiaofeng, ZHANG Lufei. Construction and application of a perioperative management program of breast reconstruction with deep inferior epigastric perforator flap in patients with breast cancer[J]. Chinese Journal of Nursing, 2023, 58(21): 2565-2574.

图/表 3

表1 3轮专家函询的肯德尔和谐系数

Table 1 The Kendall’s concordance coefficient of the 3 rounds

表2 乳腺癌患者腹壁下动脉穿支皮瓣乳房重建围手术期护理方案

Table 2（Continued） Perioperative management program for breast reconstruction with deep inferior epigastric perforator flap for breast cancer

表3 两组一般资料的比较[例(百分比, %)]

Table 3 Comparison of general data between the 2 groups[ case(percent, %) ]

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