刘艳 刘君君 王玉英 汤远艳

[摘要]目的 觀察临床护理康复路径在成人大面积烧伤患者康复中的应用效果。方法 选取2017年10月～2018年12月我院收治的90例成年大面积烧伤患者，根据随机数字表法分为两组，每组各45例，对照组采用常规护理措施干预，观察组采用临床护理康复路径干预。比较两组的住院时间、住院费用，比较两组健康知识知晓程度、治疗满意度、烧伤创面瘢痕情况及干预后生活质量，比较两组干预前后负面情绪变化。结果 两组干预后体像评分比较，差异无统计学意义（P>0.05），但观察组其他生活质量评分均高于对照组，差异有统计学意义（P<0.05）;观察组住院时间短于对照组，住院费用少于对照组，温哥华瘢痕量表（VSS）评分低于对照组，而满意度和健康知识知晓评分高于对照组，差异均有统计学意义（P<0.05）;两组干预前汉密尔顿焦虑量表（HAMA）各因子评分比较，差异无统计学意义（P>0.05），对照组干预前后HAMA比较，差异无统计学意义（P>0.05），观察组干预后HAMA各因子评分低于干预前及对照组，差异有统计学意义（P<0.05）。结论 临床护理康复路径可明显提高成人大面积烧伤患者满意度和健康知识知晓度，显著改善创面瘢痕、生活质量及负面情绪，同时还可缩短住院时间和减少住院费用。

[关键词]临床护理康复路径;大面积烧伤;康复;生活质量

[中图分类号] R473.6          [文献标识码] A          [文章编号] 1674-4721（2020）7（c）-0245-04

Application effect of clinical nursing rehabilitation pathway in rehabilitation of adult patients with large area burns

LIU Yan   LIU Jun-jun▲   WANG Yu-ying   TANG Yuan-yan

Department of Outpatient， the Chest Hospital of Jingzhou City， Hubei Province， Jingzhou   434000， China

[Abstract] Objective To observe the application effect of clinical nursing rehabilitation pathway in rehabilitation of adult patients with large area burns. Methods A total of 90 adult patients with extensive burn which admitted to our hospital from October 2017 to December 2018 were selected and divided into two groups according to random number table method， 45 cases in each group. The control group received routine nursing intervention， and the observation group received clinical nursing rehabilitation intervention. The hospital stay time and hospital expenses of the two groups were compared， and the health knowledge， treatment satisfaction， burn wound scar status and post-intervention quality of life of the two groups were compared. The negative emotional changes of the two groups before and after intervention were compared. Results There was no significant difference in body image score between the two groups after intervention （P>0.05）， but the other quality of life scores in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. The hospital stay in the observation group was shorter than that in the control group， the hospitalization cost was less than that in the control group， the vancouver scar scale （VSS） score was lower than that in the control group， and the satisfaction and health knowledge awareness scores were higher than those in the control group， the differences were statistically significant （P<0.05）. There was no significant difference in Hamilton anxiety scale （HAMA） score between the two groups before intervention （P>0.05）. There was no significant difference in the comparison of the control group before and after the intervention （P>0.05）. The scores of the HAMA factors in the observation group were lower than those of before the intervention and the control group， the difference were statistically significant （P<0.05）. Conclusion The clinical nursing rehabilitation pathway can significantly improve the satisfaction and health knowledge of adult patients with large area burns， significantly improve wound scar， quality of life and negative emotions， shorten the length of hospitalization and reduce the cost of hospitalization.

[Key words] Clinical nursing rehabilitation pathway; Extensive burns; Rehabilitation; Quality of life

成人大面积烧伤患者创面常需数月至半年时间方可愈合，但为有效改善肢体生理功能、减轻瘢痕挛缩症状需采取更长时间的康复训练。如何制订科学合理且行之有效的康复措施是医务人员关注的焦点和难题[1]。由于存在医疗费用昂贵、文化程度差异、院外康复缺乏医护人员支持和指导等，较多患者难以达到理想的康复效果，而明显增加患者致残率和降低生活质量[2]。临床路径是针对某种疾病建立诊断和治疗模式，有程序化、规范化、标准化等特点，整个模式以循证医学证据及相关指南为指导，可有效促进医疗诊治及护理水平显著性提高[3]。本研究将……