杨晨鹤 张静慧 郭利丽

[摘要]目的：分析早期康復锻炼联合情志护理对上肢重度烧伤后整形植皮患者肢体功能恢复及心理重建的影响。方法：回顾性分析2017年5月-2019年5月于笔者医院接受整形植皮治疗的89例重度上肢烧伤患者临床资料，按照是否给予情志护理分为联合组（n=45）和对照组（n=44）。收集各组临床资料，比较术后各时间段创面疼痛评分（Visual analogue scale，VAS）、美观满意度评分[采用数字评分系统（Navy standardized score，NSS）评估]、抑郁（Self-rating depression scale，SDS）及焦虑评分（Self-rating anxiety scale，SAS）、活动度及并发症发生情况。结果：两组术后第1天VAS评分比较差异无统计学意义（P>0.05）;联合组术后第3周、第5周VAS评分较对照组低，第5周NSS评分较对照组高，差异有统计学意义（P<0.05）。护理前两组SAS及SDS评分比较差异无统计学意义（P>0.05）;联合组术后第3周SAS及SDS评分均有所下降，且低于对照组，差异有统计学意义（P<0.05）。联合组术后第3周背伸ROM、掌屈ROM、旋前ROM、旋后ROM均优于对照组，差异有统计学意义（P<0.05）;术后第12周两组间比较差异无统计学意义（P>0.05）。联合组术后并发症发生率为（6.67%）较对照组（25.00%）低，差异有统计学意义（P<0.05）。结论：采用情志护理联合早期康复锻炼对上肢重度烧伤整形植皮患者进行干预，可显著改善其不良心理及疼痛，促进关节功能恢复，值得临床推广。

[关键词]重度烧伤;情志护理;早期康复锻炼;疼痛;肢体功能;美观度;抑郁;焦虑

[中图分类号]R473.6    [文献标志码]B    [文章编号]1008-6455（2021）03-0167-04

Effect of Early Rehabilitation Exercise Combined with Emotional Nursing on Limb Function Recovery and Psychological Reconstruction of Patients with Upper Limb Severe Burn after Plastic Skin Grafting

YANG Chen-he1，ZHANG Jing-hui2，GUO Li-li2

（1.Department of Reproductive Medicine;2.Department of Pediatrics，Qinhuangdao First Hospital，Qinhuangdao 066000，Hebei，China）

Abstract： Objective  To analyze the effects of early rehabilitation exercise combined with emotional nursing on the recovery of limb function and psychological reconstruction in patients with upper extremity burn after plastic skin grafting. Methods  The clinical data of 89 patients with severe burns of upper limbs treated with plastic skin grafting in our hospital from May 2017 to May 2019 were retrospectively analyzed. According to whether they were treated with emotional nursing，they were divided into the combined group （n=45） and the control group （n=44）. The clinical data of each group were collected to compare the wound pain （Visual analogue scale， VAS）， aesthetic satisfaction （Navy standardized score，NSS）， psychological state （Self-rating depression scale， SDS; Self-rating anxiety scale，SAS）， activity and complications in the postoperative periods. Results  There was no significant difference in VAS score between the two groups on the first day after operation（P>0.05）. The VAS score of the combined group was lower than those of the control group at 3 and 5 weeks after operation， and the NSS score was higher than those of the control group at 5 weeks after operation， the differences were statistically significant（P<0.05）. There was no significant difference in SAS and SDS scores between the two groups before nursing（P>0.05）. After 3 weeks of nursing， SAS and SDS scores of the combined group decreased， and were lower than those of the control group（P<0.05）. At 3 weeks of nursing， the ROM of back extension， palm flexion， pronation and supination in the combined group were better than those in the control group（P<0.05）. There was no significant difference between the two groups at 12 weeks after operation（P>0.05）. The incidence of postoperative complications in the combined group （6.67%） was lower than that in the control group （25.00%， P<0.05）. Conclusion  Emotional nursing combined with early rehabilitation exercises to intervene the patients with plastic skin grafting after severe burns of upper limbs，which can significantly improve their unhealthy psychology and pain， promote joint function recovery， which is worthy of clinical promotion.

Key words： severe burn; emotional nursing; early rehabilitation exercise; pain; limb function; aesthetics; depression; anxiety

近年来，上肢重度烧伤率呈上升趋势[1]，对烧伤后治疗及护理成为临床关注的重点。植皮手术是针对皮肤问题的一种美容手术，可通过取一块自身健康皮肤覆盖修复区域[2]。整形植皮手术为临床治疗上肢重度烧伤常用方法，效果可靠[3]。为避免植皮部位受压，术后患者存在肢体活动受限，因此术后早期康复锻炼有重要意义。但由于伤口存在缝合印記，取皮部位易遗留瘢痕，可对美观度造成一定影响，同时患者在受到疼痛等影响时可产生焦虑、抑郁等多种心理问题，导致术后康复依从性较差，故开展康复锻炼还需重视心理护理的作用[4]。情志……