Fu Q Q, Li M J, Huang L, Tan J L, Zhou Y Q, Li N
State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 Oct 20;38(10):952-958. doi: 10.3760/cma.j.cn501120-20210323-00101.
To explore the clinical application effect of sequential nursing on the management of new skin on face and neck after deep burns. 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 test, Mann-Whitney test, and chi-square test. 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 (>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 values of -2.51, -3.37, -2.05, -3.28, -3.12, -5.86, -4.63, -5.56, -6.76, respectively, <0.05 or <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 (=-4.17, <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 values of -6.56, -5.53, -5.84, respectively, <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 (=5.83, 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 (=-4.49, <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. 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.
探讨序贯护理在面颈部深度烧伤后新生皮肤管理中的临床应用效果。采用回顾性病例对照研究方法。2019年1月至12月，选取陆军军医大学第一附属医院（第三军医大学）收治的109例符合纳入标准的患者，均为面颈部深度烧伤创面愈合后1周内入院。1月至6月入院并接受综合治疗及常规护理的55例患者纳入常规护理组（男27例，女28例，年龄21 - 65岁（40±17）岁），7月至12月入院并接受综合治疗及序贯护理的54例患者纳入序贯护理组（男29例，女25例，年龄18 - 57岁（37±11）岁）。统计两组患者首次治疗前（以下简称治疗前）、治疗后3个月、6个月及1年时温哥华瘢痕量表（VSS）中色素沉着、血管分布、柔韧性及厚度评分、VSS总分、四项瘙痒问卷（FIIQ）中瘙痒对睡眠影响评分及FIIQ总分。统计治疗有效率、治疗后1年患者对治疗效果的满意度评分及治疗期间不良反应发生情况。采用独立样本t检验、Mann - Whitney U检验及卡方检验进行统计学分析。两组患者治疗前VSS中色素沉着、血管分布、柔韧性及厚度评分及VSS总分相近（>0.05）。序贯护理组治疗3个月后VSS中柔韧性评分及VSS总分、治疗6个月后VSS中血管分布评分及VSS总分、治疗1年后VSS中色素沉着、血管分布、柔韧性及厚度评分及VSS总分均显著低于常规护理组（t值分别为 - 2.51、 - 3.37、 - 2.05、 - 3.28、 - 3.12、 - 5.86、 - 4.63、 - 5.56、 - 6.76，均<0.05或<0.01）。序贯护理组患者治疗3个月后FIIQ中瘙痒对睡眠影响评分显著低于常规护理组（t = - 4.17，<0.01），序贯护理组患者治疗3个月、6个月及1年后FIIQ总分均显著低于常规护理组（t值分别为 - 6.56、 - 5.53、 - 5.84，均<0.01）。治疗1年后，序贯护理组患者治疗有效率为96.3%（52/54），显著高于常规护理组的81.8%（45/55）（χ² = 5.83，<0.05），序贯护理组患者对治疗效果的满意度评分显著高于常规护理组（t = - 4.49，<0.01）。治疗期间，序贯护理组患者未出现不良反应，常规护理组有3例患者伤口出现瘙痒及周围红斑，经换药后好转。序贯护理可有效改善面颈部深度烧伤患者新生皮肤瘢痕的防治效果，减轻瘙痒，提高治疗有效率及患者对治疗效果的满意度。
