Jonsson C E, Schüldt K, Linder J, Björnhagen V, Ekholm J
Department of Surgical Sciences, Karolinska Institute/Hospital, Stockholm, Sweden.
Acta Chir Plast. 1997;39(1):3-8.
Patients consecutively treated for burn injuries for four or more days during 1994 were examined one year after admission by a plastic surgeon, a specialist in rehabilitation medicine and a psychiatrist. Of thirty-nine such patients treated, two were dead, 11 did not present and six thought they had no remaining problems. Aesthetic and functional problems were present in 16 patients, in 11 reconstructive surgery given in one or more sessions was judged to have improved the condition. Of eighteen patients referred to a rehabilitation medicine specialist, 14 were assessed. Nine of these had functional impairments in the burn-injured body regions. A majority had functional impairments, persistent decrease in range of upper extremity motion, reduced muscle force, altered sensibility and itch. One patient suffered from pain. Three patients had occupational handicaps. Work disability occurred in two patients and further two were in need of vocational counselling due to the burn injury. In a subgroup of 11 patients four fulfilled criteria for one or more personality disorders, and two of these also suffered from major depression. Quality of life assessed with the SF-36 was lower than in a normal population. Some of the patients had psychiatric disease and personality disorders. Although rehabilitation started early in the acute phase of treatment, rehabilitation medicine function-increasing measures were needed in several cases. Individual rehabilitation programmes based on the patient's particular features and needs are recommended. The findings support the idea of a multidisciplinary approach for patients with burn injury and indicate that a subgroup of burn injury patients have functional impairments and/or disabilities which can probably be improved with reconstructive surgery and rehabilitation.
1994年连续接受烧伤治疗四天或更长时间的患者，在入院一年后由一名整形外科医生、一名康复医学专家和一名精神科医生进行了检查。在接受治疗的39名此类患者中，2人死亡，11人未到场，6人认为自己没有遗留问题。16名患者存在美学和功能问题，其中11名患者接受了一次或多次重建手术，病情被判定有所改善。在转介给康复医学专家的18名患者中，14人接受了评估。其中9人在烧伤部位存在功能障碍。大多数患者存在功能障碍、上肢活动范围持续减小、肌肉力量减弱、感觉改变和瘙痒。1名患者疼痛。3名患者存在职业障碍。2名患者出现工作残疾，另外2名患者因烧伤需要职业咨询。在11名患者的亚组中，4人符合一种或多种人格障碍的标准，其中2人还患有重度抑郁症。用SF - 36评估的生活质量低于正常人群。一些患者患有精神疾病和人格障碍。尽管在治疗急性期早期就开始了康复，但在一些病例中仍需要康复医学的功能增强措施。建议根据患者的具体特征和需求制定个性化的康复计划。这些发现支持了对烧伤患者采取多学科方法的观点，并表明一部分烧伤患者存在功能障碍和/或残疾，通过重建手术和康复可能会得到改善。
