提升燒傷中心護理人員口腔癌顯微游離皮瓣手術病人異常組織辨識正確率

Project for Improving Nursing Staff' Identification of Abnormal Tissue in Patients with Oral Cancer Undergoing Microsurgical Free Flap in a Burn Center

陳湘君(Hsiang-Chun Chen) ； 黃佩芳(Pey-Fang Hwang) ； 洪美慧(Mei-Hui Hung) ； 張峰玉(Fung-Yu Chang) ； 張碧華(Pi-Hua Chang)

《榮總護理》 34卷3期 (2017/09) Pp. 248-255

https://doi.org/10.6142/VGHN.34.3.248

摘要

口腔癌顯微游離皮瓣手術病人因術後需密切監測皮瓣組織循環，故轉入燒傷中心治療。本單位2013年皮瓣手術成功率93.5%，分析原因為護理人員對術後皮瓣異常組織辨識正確率僅66.7%，導致延遲入手術室行血管探查術。專案目的為提升燒傷中心護理人員口腔癌顯微游離皮瓣手術病人異常組織辨識正確率，促進皮瓣組織癒合。現況分析發現護理人員照護知識不足、皮瓣監測儀器不足、無皮瓣監測照護準則及分層呼叫機制繁瑣，造成組織辨識正確率低，透過交接班後雙人共同辨識機制及拍照記錄、舉辦皮瓣監測護理在職教育、添購皮瓣監測儀器、制定標準流程、製作監測技術評核單並每月稽核及修改醫師呼叫機制進行改善。執行後，組織辨識正確率提升至99.5%，皮瓣手術成功率亦達99.4%。建議將顯微游離皮瓣組織辨識流程製作技術光碟，並平行推廣至全院，培養護理人員皮瓣組織異常辨識能力，以提升顯微游離皮瓣手術成功率。

關鍵字

口腔癌 ； 顯微游離皮瓣手術 ； 組織辨識

並列摘要

Patients with oral cancer undergoing microsurgical free flap reconstruction often need to be transferred to burn centers to monitor flap tissue perfusion. However, in 2013, the success rate of free flap surgery was 93.5% because the rate of abnormal tissue identification was only 66.7%. Identified relevant risk factors include (1) poor nursing knowledge, (2) lack of monitoring equipment, (3) lack of a flap monitoring standard, and (4) inadequate interteam communication. We designed a microsurgical free flap education program, in which both shift nurses checked and photographed flap tissue after their shift. We also incorporated additional monitoring equipment, developed a standard process, and changed the call mechanism. After project completion the abnormal tissue identification rate had increased to 99.5%. After this rate had been maintained for 1year, the surgery success rate had increased to 99.4%. We suggest that monitoring standard processes should be recorded to DVD and extended to other units.

並列關鍵字

oral cancer ； microsurgical free flap ； tissue identification

參考文獻

林文淑、龔文娟（2014）‧照顧一位接受顯微皮瓣移植手術病人之護理經驗‧馬偕護理雜誌，8（2），51-60。

曾光毅、曾嵩智（2011）‧現階段口腔癌的預防與治療‧家庭醫學與基層醫療，26（5），215-224。

American Cancer Society (2016, April, 22). Learn about oral cavity and oropharyngeal cancer. Retrieved from http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/index

Jeremic, J. V., & Nikolic, Z. S. (2015). Versatility of radial forearm free flap for intraoral reconstruction. Srpski Arhiv Za Celokupno Lekarstvo, 143(5-6), 256-260.

O'Neill, J. K., Greenwood, A. J., & Khan, U. (2010). A survey of UK units and a suggested protocol for free flap reconstruction of the lower limb: Follow-up and management in the first postoperative week. Journal of Reconstructive Microsurgery, 26(9), 601-606.