头颈组织瓣修复术后患者症状报告特点的调查研究

目的 :调查头颈组织瓣修复术后住院治疗期间患者自我报告的症状特点,为后续症状负担研究提供理论依据。方法 :便利抽取2017年9—11月行组织瓣移植的术后患者,每日收回患者以书写形式报告的各种症状与不舒服,并进行内容分析,以症状种类饱和为观察终止点。结果:共纳入31位患者。症状以疼痛、不舒适、呼吸困难、入睡困难、热/多汗和口干为代表,占报告症状的29.0%以上。有67.7%的患者合并出现了3个以上的症状,其中最多见的合并为5个(16.1%)和4个(12.9%)种类,一名患者最多合并出现10个种类不适症状。不同人口学特征、软硬组织瓣种类及组织瓣是否血管化的患者报告的症状数量比较,差异无统计学意义(P>0.05)。结论 :头颈部组织瓣移植修复术后患者自我报告的症状种类多样,且比较集中在少数症状。     

头颈肿瘤游离组织瓣移植修复术后血管危象的早期观察与护理

目的分析头颈肿瘤游离组织瓣移植修复术后发生血管危象的主要因素,探讨护理应对措施。方法对2001年3月至2009年1月期间119例在我科完成游离组织瓣移植修复手术的病例进行分析,总结头颈肿瘤游离组织瓣移植修复手术护理经验,并针对临床观察中遇到的问题、观察难点提出血管危象早期变化特点及临床应对措施。结果119例患者中9例发生血管危象,7例抢救成功,1例抢救失败,1例放弃。结论早期发现血管危象,尽早采取及时有效的处理措施是挽救血管危象唯一有效的方法。进一步提高临床护理的观察能力,早期发现血管危象并进行及时有效的处理,是提高游离组织瓣移植成功率的关键。     

头颈癌术后留置气管套管患者症状群与前哨症状的调查研究

目的了解头颈癌术后留置气管套管患者症状群, 识别不同症状群的前哨症状。方法采用便利抽样法, 选取2020年6月—2021年12月于郑州大学附属肿瘤医院(河南省肿瘤医院)头颈甲状腺外科住院行手术治疗的197例头颈癌患者为研究对象, 于术后第7天采用一般资料问卷、安德森症状评估量表-头颈部进行问卷调查, 应用探索性因子分析提取症状群, 采用Apriori关联分析法识别症状群内的前哨症状。结果头颈癌术后留置气管套管患者存在4个症状群, 分别为头颈癌-特异性症状群、疼痛-消化道症状群、发声/吞咽障碍症状群和疲乏-睡眠-情绪症状群, 口腔和咽喉黏液是头颈癌-特异性症状群的前哨症状, 恶心是疼痛-消化道症状群的前哨症状, 麻木和针刺感是发声/吞咽障碍症状群前哨症状, 悲伤难过是疲乏-睡眠-情绪症状群的前哨症状。结论头颈癌术后留置气管套管患者存在症状较多, 组合成症状群, 且各症状群内存在前哨症状, 提示医务工作者应该将前哨症状作为症状群管理的切入点, 以达到有效管理症状的目的。     

带蒂肌皮瓣修复头颈组织缺损术后的护理

1983年12月～1999年11月,共完成带蒂胸大肌肌皮瓣等组织瓣修复头颈缺损手术165例,组织瓣全部成活率89.09%,部分成活率9.6%.除加强口腔护理、鼻饲和心理护理、功能训练外,必须重点观察皮瓣的颜色、温度和毛细血管充盈状况,做好头颈缺损修复术后的护理,是手术成功的关键环节之一.     

头颈肿瘤手术缺损的修复方法

头颈部肿瘤切除后多数需要利用自体组织进行修复,在目前众多的修复手段当中如何选用合适的组织瓣,达到创面及时愈合,同时恢复外形和功能是耳鼻咽喉头颈外科医生共同关注的难题,本文就相关的问题进行阐述。     

胸廓内动脉穿支皮瓣修复头颈肿瘤术后颈前组织缺损患者的围术期护理

目的：探讨胸廓内动脉穿支皮瓣修复头颈肿瘤术后颈前组织缺损患者围术期护理。方法回顾2012年3月—2013年8月耳鼻咽喉头颈外科收治的9例胸廓内动脉穿支皮瓣修复头颈肿瘤术后颈前组织缺损过程中所采用的护理措施、护理方法,归纳总结胸廓内动脉穿支皮瓣修复头颈肿瘤术后颈前组织缺损护理常规。结果随访2～16个月,本组患者皮瓣全部成活,无一例并发症发生,皮瓣外形满意,无需二次手术修补皮瓣。结论胸廓内动脉穿支皮瓣术后给予严密观察与精心护理,可提高皮瓣成活率,提高患者生存质量。     

口腔颌面部组织瓣修复术后口腔护理方法的研究

目的 研究改良口腔护理法在口腔颌面部组织瓣修复术后患者康复过程中的作用与效果观察.方法 将67例进行口腔颌面部组织瓣修复术的患者,随机分为实验组34例和对照组33例.实验组采用改良口腔护理法,对照组采用传统方法.观察2组的口腔清洁程度、患者舒适度、患者疼痛程度、术区红肿、组织瓣缝线处分泌物情况.结果 观察组在减轻患者术区疼痛、增加口腔清洁程度、减轻口臭、减轻组织瓣移植区分泌物及局部水肿方面与对照组有显著性差异(P＜0.05).结论 用改良法对口腔颌面部组织瓣修复术后患者进行口腔护理,可有效地预防口腔感染,增加舒适度,促进患者康复.     

口腔颌面部组织瓣修复术后口腔护理方法的研究

目的研究改良口腔护理法在口腔颌面部组织瓣修复术后患者康复过程中的作用与效果观察。方法将67例进行口腔颌面部组织瓣修复术的患者,随机分为实验组34例和对照组33例。实验组采用改良口腔护理法,对照组采用传统方法。观察2组的口腔清洁程度、患者舒适度、患者疼痛程度、术区红肿、组织瓣缝线处分泌物情况。结果观察组在减轻患者术区疼痛、增加口腔清洁程度、减轻口臭、减轻组织瓣移植区分泌物及局部水肿方面与对照组有显著性差异（P〈0.05）。结论用改良法对口腔颌面部组织瓣修复术后患者进行口腔护理,可有效地预防口腔感染,增加舒适度,促进患者康复。     

基于患者角度的引导组织再生术疗效分析

目的从患者角度评估引导组织再生术(GTR)与单纯翻瓣刮治术治疗牙周骨内缺损的临床疗效。方法选取40例牙周炎重度垂直骨吸收的患牙,随机平均分为翻瓣术组及GTR组,采用问卷调查的方式记录患者感知的术后反应并记录局部组织的愈合情况。结果局部疼痛、龈组织水肿及牙根面敏感为患者主诉的常见术后反应,两组差异无显著性。术后创口的裂开GTR组显著高于翻瓣组,两组后期的疗效未见有显著性差异,1年后两组患者对所取得的临床效果均较为满意。结论与单纯翻瓣术相比,引导组织再生术中膜的植入治疗牙周骨内缺损并不会加重组织的术后反应,对牙周组织术后的早期愈合无明显影响。     

腺样体肥大患者的临床特征及咽喉反流与病情严重程度的相关性分析

目的分析腺样体肥大(adenoid hypertrophy,AH)患者的临床表现及病理学特征,观察咽喉反流与其病情严重程度的相关性。方法选取广东中山小榄人民医院2020年6月—2021年6月收治的接受手术治疗的AH患者150例。根据患者鼻腔中腺样体堵塞情况,将其分为轻度组(50例,腺样体堵塞后鼻孔1/3的位置)、中度组(50例,腺样体堵塞后鼻孔1/2的位置)和重度组(50例,腺样体堵塞后鼻孔2/3及以上的位置)3组,分析3组患者的临床特点。采用咽喉反流症状指数量表(RSI)、咽喉反流体征量表(RFS)比较3组患者咽喉反流情况,经Spearman系数分析RFS、RSI与AH患者病情严重程度的相关性。结果重度AH患者的免疫组化结果呈强阳性,临床多伴有严重鼻塞、打鼾症状,中度、轻度组的免疫组化阳性表达较弱、症状较轻;重度组患者的RSI、RFS评分均高于中度组、轻度组,差异有统计学意义(P<0.05);Spearman相关性分析显示,RFS、RSI评分越高,AH患者病情越严重,咽喉反流程度与腺样体肥大分级密切相关[r₍(轻度与1级、2级、3级、4级))=0.472、...     

癌性疼痛的控制及护理

目的：探讨癌症患者疼痛及护理对策。方法：对100例癌症患者采用线性视觉模拟评估疼痛的程度。结果：本组100例,75例得到有效控制,24例未能得到有效控制。其中轻度疼痛占43.9%,中度疼痛占40.1%,重度疼痛占16.0%。在重度疼痛中,强阿片类药物应用仅达52.1%,在中度疼痛中,弱阿片类药物应用仅达52.2%。结论：实施心理护理、疼痛控制、营养支持等优质护理是改善患者生活质量,延长寿命的关键。     

Nimesulide for the treatment of painful inflammatory process in the ear, nose and throat areas: a double-blind controlled study with benzydamine

Nimesulide, 4-nitro-2-phenoxymethanesulphonanilide, a new non-steroidal anti-inflammatory drug endowed with potent anti-inflammatory, analgesic and antipyretic activities, was tested at a daily dose of 200 mg b.i.d. against Benzydamine on a double-blind basis, in a randomized trial with fifty out-patients suffering from inflammatory ear, nose and throat diseases (otitis media, sinusitis, rhinitis). Nimesulide treatment brought about an immediate and significant improvement in over-all pain, exudation, oedema and headache and produced a rapid lowering in body temperature. The recovery was more rapid and significant in patients with Nimesulide than in those with Benzydamine. The signs and symptoms under consideration reached almost complete resolution within the set treatment-period of 10 days. Clinical tolerability of Nimesulide was better than that of Benzydamine: one case of moderate gastric pyrosis and drowsiness was complained of by the Nimesulide-treated patients versus eleven cases of gastro-intestinal discomfort, mouth dryness, and/or drowsiness which were complained of by the Benzydamine-treated patients.     

Migraine headaches and pain with neuropathic characteristics: Comorbid conditions in patients with multiple sclerosis

We conducted a postal survey to assess the prevalence and characteristics of neuropathic pain and migraine in a cohort of multiple sclerosis (MS) patients. Of the 1300 questionnaires sent, 673 could be used for statistical analysis. Among the respondents, the overall pain prevalence in the previous month was 79%, with 51% experiencing pain with neuropathic characteristics (NCs) and 46% migraine. MS patients with both migraine and NC pain (32% of the respondents) reported more severe pain and had lower health-related quality of life than MS patients with either migraine or NC pain. Pain intensity in MS patients with migraine was moderate (6.0 ± 0.1). Migraine was mostly episodic, but headaches were occurring on ?15 days per month in 15% of those with migraine. MS patients with migraine were younger and had shorter disease durations than those with NC pain. NC pain was most often located in the extremities, back and head, and was frequently described as tingling and pins-and-needles. The intensity of NC pain was low to moderate (4.9 ± 0.1), but positively correlated with the number of painful body sites. Nonetheless, patients with NC pain were more disabled (with a higher Expanded Disability Status Scale and pain interference index) than patients with migraine. Migraine, but not NC pain, was associated with age, disease duration, relapsing-remitting course, and interferon-beta treatment. This suggests that NC pain and migraine are mediated by different mechanisms. Therefore, pain mechanisms that specifically operate in MS patients need to be characterized to design optimal treatments for these individuals.     

Incidence of Headache and Severity of Head Injury

The relationship between the incidence of post-traumatic headache and the severity of head injury has been a controversial issue. The milder the head injury, the more frequently severe headache is noted as a symptom. To investigate this relationship, 121 civilians were investigated using simplified classifications of the grade of headache, type of injury (mild or severe), cervical X-ray and head CT findings, and clinical history. All the subjects were claiming compensation for work-related injuries. In the mildly injured group, 46/64 patients complained of severe headache, while only 19/57 had severe headache in the severely injured group (p < 0.001). Abnormal findings on the cervical X-ray films including degenerative changes were more frequent in the severe headache group (p < 0.02). CT abnormalities correlated positively with the severity of head injury (p < 0.001), but showed an inverse relationship with the incidence of headache (p < 0.01). Mentally impaired patients also complained of headache less frequently (p < 0.01). On the basis of these results, possible organic mechanisms related to the pathogenesis of post-traumatic headache are discussed.     

背侧横行带蒂岛状包皮内板转移术矫治中重型隐匿阴茎

目的探讨背侧横行带蒂岛状包皮内板转移术矫治中、重型隐匿阴茎的临床应用。方法回顾性分析我院2010年9月至2011年6月收治的34例采用背侧横行带蒂岛状包皮内板转移术矫治的中、重型隐匿阴茎患者的临床资料及其术后1周、3周、3个月和6个月复查时皮瓣存活及阴茎外形情况。结果本组全部病例均顺利完成手术。术后32例皮瓣存活良好,2例内板部边缘小片缺血坏死,约1个月后自行修复形成接近正常的皮肤外观。阴茎皮肤和皮瓣肿胀在术后1～3周基本消退,末见慢性水肿形成。全部病例阴茎外显良好,无回缩,无皮肤缩窄环。14例皮瓣外观接近正常阴茎皮肤,皮瓣-皮肤交界部痕迹不明显,15例皮瓣内板部与阴茎皮肤外观差异明显但阴茎整体外观轮廓良好,5例可见内板与阴茎皮肤交界部轻度线状凹陷瘢痕。结论采用背侧横行带蒂岛状包皮内板转移术矫治中、重型隐匿阴茎可以充分保留局部皮肤材料、充分矫正包皮狭窄环、获得并维持良好阴茎显露,阴茎外观良好,少数病例存在较明显的皮肤异质性问题。     

指背神经及其伴行血管为蒂的岛状皮瓣的解剖与临床应用

目的　探讨指腹软组织缺损新手术方法的解剖学依据及其临床应用。方法　观察 2 0只手的指背神经、指背动脉和指背动脉网在指背的分布 ,并应用于 16例指腹缺损的修复。结果　临床应用于 16例16指 ,皮瓣面积 18mm× 12mm～ 30mm× 2 1mm ,皮瓣全部成活。结论　皮瓣面积大 ,手术简单 ,不影响手指血供 ,感觉好 ,有较高应用价值。     

Assessment of pain during head and neck irradiation

Radiation therapy for patients with head and neck malignancies frequently results in painful mucositis, which is usually poorly controlled with standard analgesics or topical anesthetics. To better understand the temporal development of radiation-induced pain and the effects of this pain on activities of daily living, 14 patients undergoing radiation therapy for a newly diagnosed head and neck malignancy completed daily pain diaries during the course of irradiation. All patients developed painful mucositis, usually beginning during the second or third week of radiation. Despite the use of analgesics/anesthetics, pain was rated as moderate or severe on 37% of treatment days and was noted to be constant or present throughout most of the day on 58% of treatment days. Eating and sleep disturbances related to pain occurred on 55% and 34% of treatment days, respectively. Eight patients had greater than a 2-kg weight loss. Radiation induces a predictable pattern of pain and comorbidity, which may be amenable to earlier and more aggressive analgesic treatment.     

Side effects of morphine patient-controlled analgesia and meperidine patient-controlled analgesia: a follow-up of 500 patients.

Many physicians, Certified Registered Nurse Anesthetists (CRNAs), and registered nurses have the clinical impression that either morphine sulfate or meperidine hydrochloride is a better drug to control postoperative pain. In this study, we evaluated pain relief and side effects for these two drugs to assess their potential differences. CRNAs conducted a structured interview of 500 female patients 24 hours after major gynecologic, urologic, or breast surgery. Patients' responses on 4-point scales of none, mild, moderate, and severe were collected for pain intensity, degree of nausea, severity of vomiting and itchiness, and degree of sedation experienced since the operation. There were 91 patients who received morphine patient-controlled analgesia (PCA) and 409 patients administered meperidine PCA. No statistically significant differences for pain intensity, degree of nausea, severity and incidence of vomiting, or degree of sedation were found. However, a significant difference was found in the incidence rates of mild itchiness, which occurred more frequently in the morphine PCA group (P less than .001). Patients vomited more often after vaginal hysterectomy than patients having laparotomy, major oncology, or tuboplasty surgeries (P less than .05), and vaginal repair patients reported more vomiting than patients having major oncology or tuboplasty surgeries. Clinical impressions that either morphine or meperidine should be the preferred treatment for patients following gynecologic operations was not found by a 24-hour review of 500 patients for pain relief and side effects. Although mild itchiness occurred more frequently in the morphine PCA group, treatment was rarely necessary.