毛栋玲　熊莹帆　安维娟

[摘要]目的：探討阶段性护理在调Q激光治疗黄褐斑围术期的应用价值。方法：回顾性分析笔者医院2019年1月-2019年12月调Q激光治疗黄褐斑的188例患者的临床资料，依照护理干预方式，将采用常规护理干预的患者93例纳入对照组，将采用阶段性护理干预的患者95例纳入观察组，比较两组患者创面愈合情况、疼痛状态、心理状态及护理满意度情况。结果：观察组红斑持续时间均短于对照组，随访2个月色素沉着面积也小于对照组，差异有统计学意义（P<0.05）。观察组术后15min、30min、1h VAS评分低于对照组，差异有统计学意义（P<0.05）;两组术后2h VAS评分比较差异无统计学意义（P>0.05）。观察组干预后心理困扰、SAS、SDS评分低于对照组，差异有统计学意义（P<0.05）。观察组对治疗环境、服务态度、护理沟通、心理护理、健康宣教的满意度分别为96.84%、96.84%、95.79%、93.68%、94.74%高于对照组的89.25%、87.10%、86.02%、83.87%、78.49%，差异有统计学意义（P<0.05）。结论：阶段性护理有利于加快调Q激光治疗黄褐斑术后创面恢复，减轻色素沉着及术后疼痛，改善患者心理状态，提高护理满意度。

[关键词]黄褐斑;调Q激光;围术期;阶段性护理;应用价值

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2021）10-0171-04

Application Value of Staged Nursing in Perioperative Chloasma Treated with Q-switched Laser

MAO Dong-ling1，XIONG Ying-fan2，AN Wei-juan3

（1.Department of Laser Cosmetology;2.Department of Neurosurgery;3.Department of Pediatrics，the Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University，Shanghai 201900，China）

Abstract： Objective  To explore the application value of staged nursing in perioperative chloasma treated with Q-switched laser. Methods  The clinical data of 188 chloasma patients who were treated with Q-switched laser in the hospital from January to December 2019 were retrospectively analyzed. According to different nursing intervention methods， 93 cases who were given routine nursing intervention were included in the control group， while another 95 cases who were given staged nursing intervention were included in the observation group. The wound healing， pain status， psychological status and nursing satisfaction were compared between the two groups. Results  The duration of erythema in the observation group was shorter than that in the control group， the difference was statistically significant （P<0.05）. After 2 months of follow-up， the pigmentation area of the observation group was also smaller than that of the control group （P<0.05）. The VAS scores of the observation group at 15min， 30min and 1h after operation were lower than those of the control group （P<0.05）. There was no significant difference in VAS score at 2h after operation between the two groups （P>0.05）. After intervention， the scores of psychological distress， SAS and SDS in the observation group were lower than those in the control group （P<0.05）. The satisfaction of the observation group with the treatment environment， service attitude， nursing communication， psychological nursing and health education were 96.84%， 96.84%， 95.79%， 93.68% and 94.74% respectively， which was higher than those of the control group （89.25%， 87.10%， 86.02%， 83.87% and 78.49%， P<0.05）. Conclusion  Staged nursing is beneficial to accelerate postoperative wound recovery of chloasma patients treated with Q-switched laser， reduce pigmentation， relieve postoperative pain， improve patients' psychological status and increase nursing satisfaction.

Key words： chloasma; Q-switched laser; perioperative period; staged nursing; application value

黄褐斑是皮肤科常见疾病类型，属于获得性色素增加皮肤疾病。黄褐斑主要分布部位为面颊部，可累及肩、颈、手背等部位，对患者容貌造成一定的影响，甚至可以影响到患者的心理健康[1]。临床上黄褐斑患者并无明显的主观症状，大多数学者认为黄褐斑的发生和发展与妊娠、日晒、口服避孕药、酒精中毒、肝功能紊乱等诸多因素有关。另，雌激素水平紊乱对疾病影响极大，因此女性发病率高于男性[2]。调Q激光是现代高科技激光技术，基本原理为光致爆破，通过毫秒、微秒超脉冲时间，瞬间穿透皮肤表皮，到达皮肤真皮与深层，使色素颗粒在瞬间被粉碎[3]。临床认为，激光治疗期间配合以有效的护理措施具有重要价值。阶段性护理是指依照患者疾病所处阶段，根据患者具体情况，以时间作为干预链条，进行细致划分，针对性采取不同的护理干预措施以满足患者不同阶段的不同需求，帮助患者早日康复[4]。……