康复路径对深度烧伤手术后康复效果的影响

Effect of rehabilitation pathway on postoperative recovery of deep burn hands

摘要:

目的  通过制定、执行深度烧伤手康复路径，评估其对烧伤手切削痂植皮术后患者康复效果的影响。方法  选择2012年1月-2013年12月深度烧伤手采用早期切削痂+自体中厚皮移植的成年患者43例，随机分为对照组和实验组。对照组患者采用手烧伤常规护理、教育督促和接受患者咨询的方式实施康复；实验组患者从瘢痕预防、运动与功能康复、健康教育和心理支持4个主要范畴制定康复路径表，专人按康复路径实施各阶段的康复和指导，并定时电话随访。两组患者使用密歇根手功能量表（MHQ）、温哥华瘢痕量表（VSS）、焦虑自评量表（SAS），分别评估伤后1、3和6个月的患手整体功能、瘢痕情况和心理状态，并进行比较。结果  实验组患者1、3和6个月的MHQ、VSS、SAS总得分优于对照组。实验组伤后1、3和6个月的MHQ总得分比对照组高（P <0.01）；VSS总得分比对照组低（P <0.01）；SAS得分比对照组低（P <0.01）。结论  手深度烧伤康复路径的实施能有效地提高烧伤手的整体功能，降低瘢痕严重程度，改善患者的心理状态。

Abstract:

Objective To observe the effect of implementing a specialized rehabilitation pathway for the treatment of deep burn hands after early escharectomy with autologous split thickness skin grafting surgery. Methods From January 2012 to December 2013, 43 adult patients with deep burn of hands were treated in the Department of Burn and Reconstructive Surgery in Xiangya Hospital of Central South University. All the hands received early escharectomy with autologous split thickness skin grafting. The patitents were randomly divided into control group and experimental group. The patients in the control group were treated with routine nursing, rehabilitation education and burn consultation. A rehabilitation pathway was developed and used in the experimental group in four main areas including scar prevention, exercise and rehabilitation, health education and psychological support which were guided and implemented by special professionals; and regular telephone follow-up was made. Michigan Hand Outcomes Questionnaire (MHQ), Vancouver Scar Scale (VSS) and Self-rating Anxiety Scale (SAS) were used to evaluate the hand function, scaring and psychological status of the patients in 1, 3 and 6 months after injury. Results The MHQ score was higher, while VSS score and SAS score were lower in the experimental group than in the control group 1, 3 and 6 months after injury (P < 0.01). Conclusions Implementation of the deep burn hand rehabilitation pathway can improve hand function, reduce scaring and improve the mental state of the patients.