钱春玲 胡利兵 刘杜娟

[摘要]目的：探討个体化心理护理干预对口腔颌面部骨折患者负性情绪及生活质量的影响，并分析其相关因素。方法：纳入2017年3月-2020年1月池州市人民医院口腔科收治的口腔颌面部骨折患者106例，按照随机数字表法分为心理护理组和常规护理组，各53例。心理护理组术后在常规护理基础上给予个体化心理护理方式，常规护理组术后采用常规护理方式。分别于出院时、出院3个月采用抑郁自评量表（Self-rating depression scale，SDS）和焦虑自评量表（Self-rating anxiety scale，SAS）评估患者负性情绪状况;采用健康状况调查简表（the MOS item short from health survey，SF-36）评估患者生活质量情况;以SF-36总分中位数为界值，比较两组患者临床资料，采用多因素Logistics回归方程分析影响患者生活质量的相关因素。结果：出院3个月后，心理护理组SF-36总分、情感职能、社会功能、精神健康评分高于常规护理组，SAS、SDS评分低于常规护理组，差异具有统计学意义（P<0.05）。以SF-36总分中位数为界值，对比两组患者临床资料显示，低生活质量组患者在性别、骨折严重程度、出院3个月后SAS、SDS评分、是否给予心理护理干预、面部美观度与高生活质量组比较差异具有统计学意义（P<0.05）。多因素Logistic回归分析显示，颌面部粉碎性骨折（OR=4.815）、女性（OR=4.660）、面部美观度评分越低（OR=0.866）是影响患者生活质量的独立危险因素（P<0.05）;心理护理（OR=0.829）是改善患者生活质量的独立保护因素（P<0.05）。结论：个体化心理护理能够改善口腔颌面部骨折患者的负性情绪，改善生活质量;对于女性、粉碎性骨折以及对面部美观度影响较大的骨折患者的生活质量情况需要临床医生多加关注。

[关键词]个体化心理护理;口腔颌面部骨折;负性情绪;生活质量;美观度;相关性

[中图分类号]R473.78    [文献标志码]B    [文章编号]1008-6455（2021）05-0151-04

The Influence of Individualized Psychological Care on the Negative Emotion and Quality of Life of Patients with Maxillofacial Fractures and

Analysis of Related Factors

QIAN Chun-ling，HU Li-bing，LIU Du-juan

（Department of Stomatology，Chizhou People's Hospital，Chizhou 247000，Anhui，China）

Abstract： Objective  To explore the impact of individualized psychological care on the negative emotion and quality of life of patients with maxillofacial fractures， and analyze the related factors. Methods  A total of 106 patients with maxillofacial fractures admitted to the Department of Stomatology， Chizhou People's Hospital from March 2017 to January 2020 were enrolled and divided into the psychological care group and the routine care group according to the random number table method. The psychological care group adopts individualized psychological nursing method after operation， and the routine care group adopts conventional nursing method after operation. The Self-rating depression scale （SDS） and Self-rating anxiety scale （SAS） were used to assess the patient's negative emotional state at discharge and 3 months after discharge. The MOS item short from health survey （SF-36） was used to evaluate the quality of life. Used the median of the total score of SF-36 as the cutoff value， the clinical data of the two groups of patients were compared， and the multivariate Logistics regression equation was used to analyze the relevant factors affecting the quality of life of the patients. Results  Three months after being discharged from the hospital， the total score of SF-36， emotional function， social function and mental health in the psychological care group were higher than those in the routine care group， and the SAS and SDS scores were lower than those in the routine care group. The differences were statistically significant （P<0.05）. Taked the median of the total score of SF-36 as the cutoff value， comparing the clinical data of the two groups of patients， the patients in the low quality of life group showed that the fracture severity， gender， SAS and SDS scores 3 months after discharge from the hospital， whether to give psychological care intervention， facial There was statistical difference between aesthetics and high quality of life group （P<0.05）. Multivariate logistic regression analysis showed that comminuted maxillofacial fracture （OR=4.815）， female （OR=4.660）， and lower facial aesthetic score （OR=0.866） were independent risk factors affecting the quality of life of patients （P<0.05）. Psychological care （OR=0.829） was an independent protective factor to improve the quality of life of patients （P<0.05）. Conclusion  Individualized psychological care can improve the negative emotions of patients with maxillofacial fractures and improve the quality of life. The quality of life of women， comminuted fractures， and fractures that have a greater impact on facial aesthetics needs to be paid attention to by clinicians.

Key words： individualized psychological care; maxillofacial fractures; negative emotion; quality of life; beauty degree; relevance

口腔颌面部骨折（Maxillofacial fracture，MFF）的术后康复涉及面部美观和口腔功能，与患者的生活质量和心理情绪息息相关。自我形象的改变和对生活的不满意会严重影响患者的情绪变化，导致心理障碍，抑郁症或焦虑症的发生风险增加[1]。现在关于MFF的治疗已不仅仅局限于骨折复位和创伤器官功能的恢复，对于患者心理状态和生活质量的干预也纳入MFF康复领域[2]。由于MFF的术后康复需要较长时间，这就对术后护理提出了更高的要求。……