李杭 李月 刘敏

[摘要]目的：探讨围术期优质护理对手部烫伤瘢痕修复患儿心理情绪及生活质量的影响。方法：选取2017年8月-2018年8月笔者医院收治的手部烫伤瘢痕修复患儿136例，随机分为观察组（n=68）与对照组（n=68）。对照组患儿给予常规护理，观察组给予围术期优质护理。采用总主动活动度测定法（Total active movement， TAM）、功能独立性评分（Functional independence measure，FIM），观察术前3d、术后7d两组患儿生活质量状况;采用Achenbach儿童行为量表（Child behavior checklist，CBCL）、中国幼儿情绪性及社会性发展量表（Emotional and social development scale of Chinese infants，CITSEA），观察两组患儿术前3d、术后7d心理情绪状态。结果：观察组患儿术后7d TAM评级、FIM评分优于本组术前3d，且优于对照组，差异均有统计学意义（P<0.05）;观察组患儿术后7d CBCL量表评分及CITSEA量表阳性率均低于本组术前3d，且低于对照组，差异均有统计学意义（P<0.05）。结论：围术期优质护理可明显提高患儿手部烫伤瘢痕修复术后生活质量，促进其恢复健康心理。

[关键词]围术期优质护理;烫伤;儿童;手部;瘢痕修复;心理情绪;生活质量

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2020）03-0152-04

Abstract： Objective  To explore the effect of perioperative high quality nursing on the psychological and emotional health and quality of life of children with hand scald scar repair. Methods  136 children with hand scalds in our hospital from August 2017 to August 2018 were selected and randomly divided into the observation group （n=68） and the control group （n=68）. The control group was given routine nursing， while the observation group was given high-quality perioperative nursing. And all children were assessed by various scales， including Total Active Movement （TAM）， Functional Independence Measure （FIM）， Achenbach Childrens Behavior Scale （CBCL）， and Chinese Version of Urban Infant-Toddler Social and Emotional Assessment （CITSEA）. The scores of each scale were recorded and compared between groups. Results  The TAM and FIM scores of the observation group on the 7d after operation were better than those of the group before operation 3d， and better than those of the control group， the differences were statistically significant（P<0.05）. The positive rates of CBCL and CITSEA in the observation group on the 7d after operation were lower than those in the group before operation 3d， and lower than those of the control group（P<0.05）. Conclusion  The application of perioperative nursing can significantly improve the quality of life， and promote the recovery of mental health for children after hand scald scar repair.

Key words： perioperative quality care; scald; children; hand; scar repair; psychological emotion; quality of life

手部屬于皮肤暴露部位，在接触高温物体、液体、明火时常发生烫、烧伤。小儿活泼好动，对外界危险感知能力不强，较成人更易发生烫伤意外[1]。并且小儿手部皮肤脆弱，烫伤常为中、重度。烫伤后出现的手部瘢痕增生、瘢痕挛缩并发症，可造成小儿手部功能障碍，影响手部皮肤美观[2]。烫伤产生的疼痛感会给小儿留下心理阴影，表现为长时间不能触碰热源等现象。手部皮肤受损还会使小儿在成长过程中逐渐产生自卑感，出现自我否定及抑郁、悲伤、焦虑情绪，严重影响小儿心理健康。整形外科瘢痕修复手术是临床常用手部烫伤后瘢痕修复法，可矫正手部功能，修复手部皮肤美观[3]。但小儿因年龄小，术前、术中及术后均易发生不同类型意外，如术前小儿因害怕手术严重哭闹，使手术无法正常进行。……