钟莉 刘静 周晓倩

[摘要]目的：分析治療与康复一体化模式结合心理疏导在烧伤患者中的应用效果。方法：选取2016年3月-2019年4月笔者医院收治的烧伤患者164例，按照随机数表法分为两组，两组患者均接受烧伤后常规治疗，观察组采取治疗与康复一体化结合心理疏导模式进行干预，对照组接受常规康复治疗及健康宣教，比较两组视觉模拟评分法评分（Visual ananlogue scoring，VAS）及瘢痕指数（Scar index，SI），采用汉密尔顿焦虑量表（Hamilton depression scale，HAMD）和汉密尔顿抑郁量表（Hamilton depression scale，HAMD）对患者干预后的焦虑抑郁程度进行评分，采用巴式量表（Barthel index）、简明烧伤健康量表（Burn specific health scale，BSHS-A）对患者的日常生活活动能力、生活质量进行系统性评价。结果：观察组VAS评分、SI、创面愈合时间、HMAD评分、HAMA评分均显著低于对照组，差异有统计学意义（P<0.05）;观察组Barthel评分、BSHS-A评分显著高于对照组，差异有统计学意义（P<0.05）;观察组并发症发生率与对照组比较差异无统计学意义（P>0.05）。结论：烧伤患者实施治疗与康复一体化结合心理疏导护理模式能减轻疼痛，加速创面愈合，减少瘢痕增生，降低抑郁焦虑等负面情绪，提高日常生活能力和生活质量。

[关键词]治疗与康复一体化护理模式;心理疏导;烧伤;生活质量;焦虑;抑郁

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2021）06-0174-03

Application of Treatment and Rehabilitation Integrated Nursing Mode Combined with Psychological Counseling in Burn Patients

ZHONG Li，LIU Jing，ZHOU Xiao-qian

（Department of Plastic and Burn Surgery，West China Hospital，Sichuan University，Chengdu 610000，Sichuan，China）

Abstract： Objective  To analyze the application effect of treatment and rehabilitation integrated nursing mode combined with psychological counseling in burn patients. Methods  A total of 164 burn patients treated in the hospital between March 2016 and April 2019 were selected and randomly divided into two groups. Both groups received conventional post-burn treatment. The observation group received treatment and rehabilitation integrated nursing mode combined with psychological counseling， while the control group received conventional rehabilitation treatment and health education. The Visual analogue scale （VAS） scores and Scar index （SI） of the two groups were compared. The Hamilton anxiety scale （HAMA） and Hamilton depression scale （HAMD） were used to evaluate anxiety and depression degree. Meanwhile， Barthel index and the Burn specific health scale （BSHS-A） were used to systematically evaluate the patients activities of daily living and quality of life. Results  The VAS score， SI， wound healing time， HMAD score and HAMA score of the observation group were significantly lower than those of the control group， and the differences were statistically significant（P<0.05）. The Barthel scores and BSHS-A scores were significantly higher than those of the control group （P<0.05）. There was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion  The treatment and rehabilitation integrated nursing mode combined with psychological counseling for burn patients can relieve pain， accelerate wound healing， inhibit scar hyperplasia， alleviate depression and anxiety， and improve activities of daily living and quality of life.

Key words： treatment and rehabilitation integrated nursing mode; psychological counseling; burn; quality of life; anxiety; depression

烧伤是指由火焰、热液、激光等所造成的皮肤及黏膜损伤，深度烧伤患者可累及肌肉、骨骼[1]。近年来随着我国烧伤救治水平的不断提升，烧伤治愈率可达95%[2]。随着生物医学模式逐步向生物-心理-社会医学模式的转变，烧伤患者创面愈合后遗留的瘢痕、躯体残损及心理问题引起重点关注。由于我国的烧伤康复医学起步较晚，既往临床治疗和护理的重点在于创面愈合和防止感染，对康复护理和创面预后效果的重视程度较低，造成部分患者愈合后伴随着增生性瘢痕及功能障碍，严重影响其生活质量[3]。……