任琳洁 吴直惠 黄建琼

[摘要]目的：探索正念减压训练对重度烧伤患者治疗依从性及生活自理能力的影响。方法：选取2018年2月-2019年2月笔者科室收治的140例重度烧伤患者，按照双盲抽签法将患者分为观察组70例，对照组70例。对照组仅给予常规性护理和一般性访视，观察组在对照组的基础上给予正念减压训练。比较评价两组患者在治疗前后伤残接受度量表（Acceptance of disability scale，AODS）、抑郁自评量表（Self-rating depression scale，SDS）、社交回避及苦恼量表（Social avoidance and distress scale，SADS）、焦虑自评量表（Self-rating anxiety scale，SAS）、生活自理能力评定量表（Activity of daily living Scale，ADL）以及依从性得分。结果：经临床干预治疗后，观察组患者的AODS评分显著升高且高于对照组，SADS评分显著下降且相比对照组更低，差异均有统计学意义（P<0.05）。观察组SDS及SAS评分均下降且低于对照组，ADL评分及依从性均高于对照组，差异均有统计学意义（P<0.05）。结论：正念减压训练可有效提高患者对自我伤残的接受能力、临床依从性以及生活自理能力;同时降低其社交回避及苦恼、焦虑、抑郁等不良情绪，值得临床推广和使用。

[关键词]重度烧伤;正念减压训练;伤残接受度;社交回避及苦恼;焦虑;抑郁;生活自理能力;依从性

[中图分类号]R473.6    [文獻标志码]B    [文章编号]1008-6455（2020）07-0165-04

Abstract： Objective  To explore the effect of mindfulness-based stress reduction on the treatment compliance and self-care ability of severely burned patients. Methods  140 patients with severe burn admitted in our department from February 2018 to February 2019 were divided into the observation group （70 cases） and the control group （70 cases）. The control group was only given routine nursing and follow-up visit， and the observation group was given mindfulness-based stress reduction on the basis of the control group. The acceptance of disability scale （AODS）， self-rating depression scale （SDS）， social avoidance and distress scale （SADS）， self-rating anxiety scale （SAS）， activity of daily living scale （ADL） and compliance scores were compared before and after treatment. Results  After clinical intervention， the AODS score of the observation group was significantly higher than that of the control group， and the sads score was significantly lower than that of the control group， the differences were statistically significant（P<0.05）. The scores of SDS and SAS in the observation group were lower than those in the control group， and ADL scores and compliance were higher than those in the control group（P<0.05）.  Conclusion  Mindfulness-based stress reduction can effectively improve the patients' ability of self handicapping acceptance， clinical compliance and self-care ability， and reduce their social avoidance， distress， anxiety， depression and other adverse emotions. it is worthy of clinical application.

Key words： severe burn; mindfulness-based stress reduction; disability acceptance; social avoidance and distress; anxiety; depression; self-care ability; compliance

重度烧伤是一种灾难性的、突发性的疾病，患者体表受损面积大，虽然随着治疗技术的进步，该病治愈率有所提高，但创面愈合后仍会遗留不同程度的色素沉积或形成瘢痕。患者在长期的治疗过程中除了面对疼痛和高昂的医疗费用[1]外，还要面临其外表改变所导致的一系列反应，如对自身容貌伤残的焦虑、抑郁、社交恐惧等，甚至会产生自杀倾向[2]。这些消极的心理问题可严重影响患者的生存质量及预后治疗。据调查，有一半以上的重度烧伤的患者在出院后面临上述问题，这是由于患者心理上存在的灾难后应激状态所导致的[3-4]。因此，临床有必要寻找一种可以缓解改善这种症状的治疗手段。……