符小玉 陈小芬 林白浪

[摘要] 目的 探讨创面治疗师临床常规及其路径规范化探索及治疗。 方法 选取2015年11月～2017年10月中南大学湘雅医学院附属海口医院伤口造口中心接收诊治的压疮、急性挫擦伤、慢性伤口创面的患者260例作为研究对象，按照随机数字表法分为对照组和研究组，每组各130例;其中对照组患者采取常规治疗方法，研究组患者应用临床路径管理进行治疗，比较两组患者的临床治疗效果、患者治療后不良反应的发生情况、患者满意率和患者投诉率等情况以及皮肤生活质量的变化。 结果 研究组患者的总有效率显著高于对照组（P < 0.05）;研究组患者治疗后不良反应的总发生率明显低于对照组，差异有统计学意义（P < 0.05）;治疗后研究组患者满意率显著高于对照组（P < 0.05），投诉率显著低于对照组（P < 0.05）;治疗前研究组和对照组患者的皮肤生活质量比较，差异无统计学意义（P > 0.05）;治疗后两组患者皮肤生活质量均有改善，研究组心理、生理、人际交往、社会活动以及家庭等评分明显优于对照组，差异有统计学意义（P < 0.05）。 结论 对压疮、急性挫擦伤以及慢性伤口创面的患者应用临床常规及其路径的治疗方案，有效率较高，能够有效降低患者不良反应的发生率，减少患者的投诉，缓和医患关系，同时提高患者的皮肤生活质量，值得推广使用。

[关键词] 创面治疗;临床路径;规范化;治疗

[中图分类号] R197.3          [文献标识码] A          [文章编号] 1673-7210（2019）01（c）-0163-04

[Abstract] Objective To explore the clinical routine of wound therapists and the standardization of their paths and treatment. Methods From November 2015 to October 2017， 260 patients with pressure ulcers， acute contusion and abrasion， and chronic wound admitted to the wound stomatology center of Haikou Hospital Affiliated to Xiangya Medical College of Central South University were selected as the research objects. According to the random number table method， they were divided into control group and research group， with 130 cases in each group. The patients in the control group were treated with conventional treatment methods， and the patients in the study group were treated with clinical pathway management. The clinical treatment effect， the occurrence of adverse reactions after treatment， the satisfaction rate of the patients and the complaint rate of the patients， as well as the changes of the skin quality of life of the two groups were compared. Results The total effective rate of the study group was significantly higher than that of the control group （P < 0.05）. The total incidence of adverse reactions in the study group was significantly lower than that in the control group， the difference was statistically significant （P < 0.05）. After treatment， the satisfaction rate of patients in the study group was significantly higher than that in the control group （P < 0.05）， and the complaint rate was significantly lower than that in the control group （P < 0.05）. There was no statistically significant difference in skin quality of life between the pre-treatment study group and the control group （P > 0.05）. After treatment， the skin quality of life was improved in both groups， the study group was significantly superior to the control group in scores of psychology， physiology， interpersonal communication， social activities and family， with statistically significant differences （P < 0.05）. Conclusion The application of clinical routine and its pathological treatment for patients with pressure ulcers， acute contusions and chronic wounds has a high efficiency， which can effectively reduce the incidence of adverse reaction symptoms， reduce the patient′s complaint， alleviate doctor-patient relationships，and improve the quality of life of the patient's skin， it is worth promoting.

[Key words] Wound healing; Clinical pathway; Standardization; Treatment

临床路径是一种全新的、标准化管理模式，具有质量好、效益高的优势，其目标是改进现代管理的质量，让患者减少支付无效的医疗费用，让患者对医疗的效果更加满意。临床路径会根据一种特定的疾病制订一套标准的治疗方法和流程[1]，其中考虑医疗质量和成本，包括所有的治疗以及康复的过程。常备应用于治疗压疮、急性挫擦伤、慢性伤口创面。应用不同的治疗方案，最后留下的瘢痕是不同的，且选择手术进行的时机十分重要。实施临床路径的目的是降低医疗成本、提高医疗服务质量以及将医疗行为达到标准化。……