Clinical application effect of sequential nursing on the management of new skin on face and neck after deep burns
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摘要:
目的 探讨序贯式护理在面颈部深度烧伤后新生皮肤的管理中的临床应用效果。 方法 采用回顾性病例对照研究方法。陆军军医大学（第三军医大学）第一附属医院2019年1—12月收治109例符合入选标准的面颈部深度烧伤创面愈合后1周内患者，将1—6月收治的采用综合治疗+常规护理的55例患者纳入常规护理组，其中男27例、女28例，年龄21~65（40±17）岁；将7—12月收治的采用综合治疗+序贯式护理的54例患者纳入序贯护理组，其中男29例、女25例，年龄18~57岁（37±11）岁。统计2组患者首次治疗（以下简称治疗）前及治疗3个月、6个月、1年温哥华瘢痕量表（VSS）中色泽、血管分布、柔软度、厚度评分和VSS总分及四项目瘙痒量表（FIIQ）中瘙痒对睡眠的影响评分及FIIQ总分，治疗1年的治疗有效率和患者对治疗效果的满意度及治疗期间的不良反应发生情况。对数据行独立样本t检验、Mann-Whitney U检验、χ2检验。 结果 2组患者治疗前VSS中的色泽、血管分布、柔软度、厚度评分及VSS总分均相近（P>0.05）。序贯护理组患者治疗3个月VSS中的柔软度评分及VSS总分，治疗6个月VSS中的血管分布评分及VSS总分，治疗1年VSS中的色泽、血管分布、柔软度、厚度评分及VSS总分均明显低于常规护理组（Z值分别为-2.51、-3.37，-2.05、-3.28，-3.12、-5.86、-4.63、-5.56、-6.76，P<0.05或P<0.01）。序贯护理组患者治疗3个月FIIQ中瘙痒对睡眠的影响评分及治疗3个月、6个月、1年FIIQ总分均明显低于常规护理组（Z值分别为-4.17、-6.56、-5.53、-5.84，P<0.01）。治疗1年，序贯护理组患者治疗有效率为96.3%（52/54），明显高于常规护理组的81.8%（45/55），χ2=5.83，P<0.05；序贯护理组患者对治疗效果的满意度评分明显高于常规护理组（Z=-4.49，P<0.01）。治疗期间，序贯护理组患者未出现不良反应；而常规护理组中有3例患者创面出现瘙痒、周边红疹，经换药治疗后改善。 结论 序贯式护理能有效提升面颈部深度烧伤后患者新生皮肤瘢痕预防及管理效果，改善患者瘙痒，提高治疗有效率及患者对治疗效果的满意度。 Abstract:Objective To explore the clinical application effect of sequential nursing on the management of new skin on face and neck after deep burns. Methods The retrospective case-control research approach was used. From January to December 2019, 109 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) within 1 week after deep burn wound healing on the face and neck. Fifty-five patients who were admitted to the hospital from January to June and received comprehensive treatment and conventional nursing were included in conventional nursing group (27 males and 28 females, aged 21-65 (40±17) years), and fifty-four patients who were admitted to the hospital from July to December and received comprehensive treatment and sequential nursing were included in sequential nursing group (29 males and 25 females, aged 18-57 (37±11) years). The scores of pigmentation, vascularity, pliability, and thickness in Vancouver scar scale (VSS), the total score of VSS, the score of itch's impact on sleep in the four-item itch questionnaire (FIIQ), and the total score of FIIQ of patients were counted in the two groups before the first treatment (hereinafter referred to as treatment) and 3 months, 6 months, and 1 year after treatment. The treatment effective rate and the score of patients' satisfaction with the treatment effect in one year after treatment and the occurrence of adverse reaction during the treatment were counted. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. Results The scores of pigmentation, vascularity, pliability, and thickness in VSS and the total VSS score of patients between the two groups before treatment were close (P>0.05). The pliability score in VSS and total VSS score after 3 months of treatment, the score of vascularity in VSS and total VSS score after 6 months of treatment, and the scores of pigmentation, vascularity, pliability, and thickness in VSS and total VSS score of patients after 1 year of treatment in sequential nursing group were significantly lower than those in conventional nursing group (with Z values of -2.51, -3.37, -2.05, -3.28, -3.12, -5.86, -4.63, -5.56, -6.76, respectively, P<0.05 or P<0.01). The score of itch's impact on sleep in FIIQ after 3 months of treatment of patients in sequential nursing group was significantly lower than that in conventional nursing group (Z=-4.17, P<0.01), and the total scores of FIIQ after 3 months, 6 months, and 1 year of treatment of patients in sequential nursing group were significantly lower than those in conventional nursing group (with Z values of -6.56, -5.53, -5.84, respectively, P<0.01). After 1 year of treatment, the treatment effective rate of patients in sequential nursing group was 96.3% (52/54), which was significantly higher than 81.8% (45/55) in conventional nursing group (χ2=5.83, P<0.05), and the score of patients' satisfaction with the treatment effect in sequential nursing group was significantly higher than that in conventional nursing group (Z=-4.49, P<0.01). During the treatment period, there was no adverse reaction in patients in sequential nursing group, but there were 3 patients with pruritus and peripheral erythema on the wound in conventional nursing group, which were improved after dressing changes. Conclusions Sequential nursing can effectively improve the prevention and management of new skin scars in patients after deep burns on the face and neck, improve the itching, the efficiency of treatment, and the satisfaction of patients with the treatment effect. -
Key words:
- Burns /
- Cicatrix /
- Face and Neck /
- New skin management /
- Sequential nursing
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参考文献
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1 序贯护理组面部深度火焰烧伤患者新生皮肤综合治疗和序贯护理的效果。1A.伤后1个月，创面基本愈合，皮肤呈粉红色，表面平整；1B.伤后4个月（治疗3个月），皮肤呈紫红色，瘢痕增生，充血明显；1C.伤后7个月（治疗6个月），皮肤颜色较图1B淡化，瘢痕增生仍明显，充血较明显；1D.伤后13个月（治疗1年），皮肤接近正常肤色，瘢痕充血消退、增生明显减轻
表1 2组面颈部深度烧伤患者一般资料比较
组别 例数 性别［例（%）］ 年龄（岁， 面颈部烧伤面积（%TBSA， 男 女 烧伤总面积 深Ⅱ度+Ⅲ度烧伤面积 序贯护理组 54 29（53.7） 25（46.3） 37±11 5.3±1.5 4.8±1.9 常规护理组 55 27（49.1） 28（50.9） 40±17 3.7±1.7 3.4±2.1 统计量值 χ2=0.23 t=-0.86 t=1.15 t=0.65 P值 0.630 0.393 0.255 0.513 注：TBSA为体表总面积 
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表2 2组面颈部深度烧伤患者新生皮肤首次治疗前及治疗各时间点VSS中各维度评分及总分比较[分，M（Q1，Q3）]
组别与时间点 例数 色泽 血管分布 柔软度 厚度 总分 序贯护理组 54 治疗前 2（2，2） 2（2，2） 2（1，2） 2（1，2） 6（6，6） 治疗3个月 2（2，2） 2（2，2） 2（2，2） 2（2，3） 8（8，9） 治疗6个月 2（2，2） 2（2，2） 2（2，3） 2（2，3） 8（8，9） 治疗1年 1（1，2） 1（1，1） 1（1，2） 1（1，1） 5（4，6） 常规护理组 55 治疗前 2（2，1） 2（2，2） 2（2，2） 2（1，2） 7（6，8） 治疗3个月 3（2，3） 2（2，2） 2（2，3） 3（2，4） 9（8，11） 治疗6个月 2（2，2） 2（2，2） 3（2，3） 3（2，4） 9（8，11） 治疗1年 2（1，2） 1（1，1） 1（1，2） 2（1，2） 6（5，7） Z1值 -0.38 -1.30 -1.30 -0.61 -1.18 P1值 0.700 0.192 0.171 0.536 0.237 Z2值 -2.07 -2.42 -2.51 -2.00 -3.37 P2值 0.144 0.128 0.048 0.176 <0.001 Z3值 -2.18 -2.05 -2.01 -2.18 -3.28 P3值 0.112 0.032 0.176 0.112 <0.001 Z4值 -3.12 -5.86 -4.63 -5.56 -6.76 P4值 <0.001 <0.001 <0.001 <0.001 <0.001 注：VSS为温哥华瘢痕量表；Z1值、P1值，Z2值、P2值，Z3值、P3值，Z4值、P4值分别为2组间治疗前及治疗3个月、6个月、1年各指标比较所得
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表3 2组面颈部深度烧伤患者新生皮肤首次治疗前及治疗各时间点FIIQ中瘙痒对睡眠的影响评分和总分比较[分，M（Q1，Q3）]
组别与评价指标 例数 治疗前 治疗3个月 治疗6个月 治疗1年 序贯护理组 54 瘙痒对睡眠的影响评分 1.0（1.0，1.0） 2.0（2.0，3.0） 2.0（2.0，3.0） 2.0（1.0，2.0） 总分 4.0（4.0，4.0） 8.0（7.0，9.0） 7.0（7.0，8.0） 6.0（6.0，7.0） 常规护理组 55 瘙痒对睡眠的影响评分 1.0（1.0，1.0） 3.0（3.0，3.0） 3.0（2.0，3.0） 2.0（2.0，2.8） 总分 4.0（4.0，5.0） 12.0（11.0，13.0） 10.0（9.0，13.7） 9.0（8.0，10.0） Z1值 -0.44 -4.17 -2.24 -2.23 P1值 0.657 <0.001 0.100 0.104 Z2值 -0.37 -6.56 -5.53 -5.84 P2值 0.709 <0.001 <0.001 <0.001 注：FIIQ为四项目瘙痒量表；Z1值、P1值，Z2值、P2值分别为2组间FIIQ中瘙痒对睡眠的影响评分及总分各时间点比较所得
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