高佳丽　陈晓娟

[關键词]烧伤植皮;疼痛;心里困扰;应对方式;生活质量

[中图分类号]R622+.1    [文献标志码]B    [文章编号]1008-6455（2021）12-0152-04

Application of Whole-Course Programmed Pain Management Combined with Positive Suggestive Incentive Intervention in Patients with Burns Undergoing Skin Grafting

GAO Jia-li，CHEN Xiao-juan

[Department of Plastic Surgery（Department of Burn），West China Hospital，Sichuan University/West China School of Nursing，Chengdu 610044，Sichuan，China]

Abstract： Objective  To observe the application effect of whole-process programmed pain management combined with positive suggestive incentive intervention on patients with burns undergoing skin grafting. Methods  Totally 108 cases of patients with burns undergoing skin grafting in our hospital were selected as the research subjects. According to the random number table method， the patients were divided into observation group and control group according to the random number table method， with 54 cases in each group. Observation group was given routine nursing for burn patients with skin grafting， and control group was additionally given whole-course programmed pain management and positive suggestive incentive intervention nursing. The perioperative pain status， changes of psychological states， coping styles and quality of life before and after intervention were compared between the two groups. Results  1 day after operation， the difference in VAS scores between the two groups was not statistically significant （P>0.05）; after 3d and 7d after operation， the VAS scores of the two groups were significantly lower than that on the first day after surgery， and the difference was statistically significant. The decrease was more significant on the 7th day than on the 3rd day after the operation， and the decrease was more obvious in the observation group （P<0.05）. After 1 month of intervention， the Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale （HAMD） and Mental Distress Scale （DM） scores were significantly reduced in the two groups （P<0.05）. In the Jalowies Coping Style Scale， the scores of positive coping styles were significantly increased （P<0.05）， and scores of negative coping styles were significantly decreased （P<0.05）， and the comparison between the above-mentioned index groups was significantly different after intervention （P<0.05， Three months later， the scores of GQOLI-74 in the two groups were significantly increased， and the contrast between the groups was significantly different after the intervention （P<0.05）. Conclusion  Whole-process programmed pain management combined with positive suggestive incentive intervention can effectively alleviate the perioperative pain status，reduce the postoperative adverse emotions， improve the coping styles， and promote the quality of life of burn patients undergoing skin grafting.

Key words： burns with skin grafting; pain; psychological distress; coping styles; quality of life

烧伤是由于机体受到热力灼伤皮肤而导致的特殊性疾病，往往伴随着剧烈的灼痛感，其疼痛程度往往与烧伤面积、烧伤深度、病情进展等因素相关，具有发病急、恢复周期长、疼痛感强烈等特点[1]。临床上深度烧伤患者常采取植皮手术进行治疗，然手术过程中创面削痂、植皮、术后愈合等会引起患者术后剧烈疼痛，加之烧伤带来的身体残缺，患者术后易产生焦虑、抑郁、心理困扰等负面情绪，继而降低患者治疗信心，甚至中断治疗，不利于术后康复[2-3]。因此加强对烧伤患者围术期疼痛管理及心理护理是临床护理的重点。全程程序化疼痛管理是针对临床疼痛反应的转型護理措施，通过合理评估患者病情及引起疼痛的相关风险因素，制定针对性护理措施，以缓解治疗及康复过程的疼痛症状，减轻患者治疗负担，目前该方法已应用于多种疾病治疗中[4]。正性暗示激励干预是一种新型心理护理模式，是指护理人员通过鼓励、肯定等积极的暗示性语言、动作、行为等，缓解患者紧张、焦虑等不良情绪，提高其治疗信心[5]。研究表明，围术期实施正性暗示语言干预，可改善患者心理状态，降低手术应激反应，改善预后[6]。本研究拟通过对笔者医院烧伤植皮患者实施全程程序化疼痛管理联合正性暗示激励干预，以探讨其对疼痛、心理困扰及生活质量的影响，为临床护理提供参考，报道如下。……