集束化护理对自体头皮组织移植术患者的效果分析

doi:10.3760/cma.j.cn441417-20241008-06034

摘要/Abstract

摘要：

目的　探究集束化护理对自体头皮组织移植术患者的效果。方法　采用前瞻性研究，选取2021年1月至2023年12月在郑州市第一人民医院收治的68例以瘢痕皮肤为中厚供皮区的大面积烧伤后整形患者作为研究对象，按照随机数字表法分为对照组（34例）和观察组（34例）。对照组男16例、女18例，年龄（31.53±1.48）岁；观察组男20例、女14例，年龄（32.12±1.32）岁。所有患者进行自体头皮组织移植术，对照组进行常规护理，观察组进行集束化护理。对比两组患者伤口愈合时间，干预前后疼痛情况［视觉模拟疼痛量表（VAS）］、心理状态［抑郁自评量表（SDS）、焦虑自评量表（SAS）］、生活质量（活力、生理功能、社交功能）、修复效果及并发症发生情况。统计学方法采用t检验、χ²检验。结果　观察组伤口愈合时间短于对照组［（8.17±2.28）d比（12.56±2.34）d］，差异有统计学意义（t=7.835，P<0.05）。干预1、3、7 d后，观察组VAS评分均低于对照组［（4.54±1.14）分比（5.95±1.25）分、（3.15±0.61）分比（3.52±0.75）分、（2.03±0.34）分比（2.86±0.42）分］，差异均有统计学意义（t=4.860、2.232、8.956，均P<0.05）。干预7 d后，观察组SDS、SAS评分均低于对照组［（31.25±3.05）分比（39.56±2.21）分、（33.23±3.72）分比（41.56±2.35）分］，活力、生理功能、社交功能评分均高于对照组［（85.62±3.03）分比（76.25±3.56）分、（82.14±3.76）分比（75.65±4.15）分、（85.45±2.72）分比（80.65±2.44）分］，差异均有统计学意义（t=12.865、11.039、11.687、6.758、7.660，均P<0.05）。观察组并发症发生率为8.82%（3/34），与对照组［17.65%（6/34）］比较，差异无统计学意义（χ²=0.512，P>0.05）。观察组干预后6个月瘙痒、温哥华瘢痕评价量表评分及瘢痕增生率均低于对照组［（1.37±0.35）分比（1.84±0.47）分、（2.05±0.71）分比（4.31±1.53）分、（20.45±4.16）%比（42.23±3.52）%］，差异均有统计学意义（t=4.677、7.813、23.305，均P<0.05）。结论　集束化护理可促进自体头皮组织移植术患者供皮区创面愈合，缓解其疼痛，消除不良情绪，提升生活质量，并降低远期瘙痒、瘢痕增生。

关键词:

自体头皮组织移植术, 集束化护理, 效果

Abstract:

Objective　To explore the effect of cluster nursing for patients undergoing autologous scalp tissue transplantation. Methods　This was a prospective study. According to the random number table method, 68 patients with large area burn and with scar skin as the medium thick skin donor areas treated in Zhengzhou First People's Hospital from January 2021 to December 2023 were divided into a control group and an observation group, with 34 cases in each group. There were 16 males and 18 females in the control group; they were (31.53±1.48) years old. There were 20 males and 14 females in the observation group; they were (32.12±1.32) years old. All the patients underwent autologous scalp tissue transplantation. The control group received routine nursing, and the observation group cluster nursing. The wound healing times, scores of Visual Analogue Scale (VAS) , Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and life quality (vitality, physiological function, and social function) before and after the intervention, repair effects, and incidence rates of complications were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The wound healing time of the observation group was shorter than that of the control group [(8.17±2.28) d vs. (12.56±2.34) d], with a statistical difference (t=7.835; P<0.05). The scores of VAS 1, 3, and 7 d after the intervention in the observation group were lower than those in the control group (4.54±1.14 vs. 5.95±1.25, 3.15±0.61 vs. 3.52±0.75, and 2.03±0.34 vs. 2.86±0.42), with statistical differences (t=4.860, 2.232, and 8.956; all P<0.05). After the intervention, the scores of SDS and SAS in the observation group were lower than those in the control group (31.25±3.05 vs. 39.56±2.21 and 33.23±3.72 vs. 41.56±2.35); the scores of vitality, physiological function, and social function in the observation group were higher than those in the control group (85.62±3.03 vs. 76.25±3.56, 82.14±3.76 vs. 75.65±4.15, and 85.45±2.72 vs. 80.65±2.44); there were statistical differences (t=12.865, 11.039, 11.687, 6.758, and 7.660; all P<0.05). There was no statistical difference in the incidence rate of complications between the observation group and the control group [8.82% (3/34) vs. 17.65% (6/34); χ²=0.512, P>0.05]. Six months after the intervention, the scores of itch and Vancouver Scar Evaluation Scale and scar hyperplasia rate in the observation group were lower than those in the control group [1.37±0.35 vs. 1.84±0.47, 2.05±0.71 vs. 4.31±1.53, and (20.45±4.16)% vs. (42.23±3.52)%], with statistical differences (t=4.677, 7.813, and 23.305; all P<0.05). Conclusion　Cluster nursing can promote wound healing in the middle and thick donor area of scar skin repaired by autologous scalp tissue transplantation, relieve pain, eliminate adverse emotions, improve quality of life, and reduce long-term itching and scar hyperplasia.

Key words:

Autologous scalp tissue transplantation, Cluster nursing, Effect

屈要萍曹大勇郑毛沙孙银平余凯.

集束化护理对自体头皮组织移植术患者的效果分析 [J]. 国际医药卫生导报, 2025, 31(6): 1050-1056.

Qu Yaoping, Cao Dayong, Zheng Maosha, Sun Yinping, Yu Kai.

Effect of cluster nursing for patients undergoing autologous scalp tissue transplantation [J]. International Medicine and Health Guidance News, 2025, 31(6): 1050-1056.

参考文献

[1] 张美光,李天尹,阳纯兵. 自体头皮移植修复儿童重度瘢痕创面的效果观察[J].中外医学研究,2021,19(33):25-28.DOI:10.14033/j.cnki.cfmr.2021.33.007.
[2] 蒋文杰,林俊青,王博,等. 基于眶周形态及组织特点设计毛发移植治疗烧伤后眉缺损[J].中华整形外科杂志,2024,40(1):21-26.DOI:10.3760/cma.j.cn114453-20231122- 00235.
[3] Liu J, Wei J, Dai CC, et al. Scalp composite tissue transplantation for repairing upper lip defect: a feasible clinical study[J].J Craniofac Surg,2024,35(5):1537-1540.DOI:10.1097/SCS.0000000000010360.
[4] 周雅静,侯玉森,李冬海,等. 人工真皮联合自体刃厚头皮在修复儿童烧伤后肢体关节瘢痕挛缩中的临床应用效果[J/OL].中华损伤与修复杂志(电子版),2021,16(4):322-325[2024-09-12].https://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhssyxfzz202104007.DOI:10.3877/cma.j.issn.1673-9450.2021.04.007.
[5] 简桂女,戴小华,喻华妹,等. 集束化护理对危重烧伤患者俯卧位通气效果的影响[J].实用临床医学,2023,24(1):73-76,115.DOI:10.13764/j.cnki.lcsy.2023.01.021.
[6] 黎宁,陈华玲,李茂君,等. 柠檬酸体外抗凝集束化护理在严重烧伤患者连续性肾脏替代治疗中的应用效果[J].中华烧伤与创面修复杂志,2022,38(1):29-37.DOI:10.3760/cma.j.cn501120-20201201-00511.
[7] 王淑君,马春亭,鲁虹言,等. 成批烧伤患者肺部护理集束化管理方案的构建与应用[J].中华烧伤杂志,2020,36(8):665-670.DOI:10.3760/cma.j.cn501120-20200220-00073.
[8] Escalona-Marfil C, Coda A, Ruiz-Moreno J, et al. Validation of an electronic visual analog scale mHealth tool for acute pain assessment: prospective cross-sectional study[J].J Med Internet Res,2020,22(2):e13468.DOI:10.2196/13468.
[9] 袁刚,赵晋,郑冬,等. 抑郁自评量表和贝克抑郁量表区分抑郁症严重程度的准确度[J].神经疾病与精神卫生,2021,21(12):868-873.DOI:10.3969/j.issn.1009-6574. 2021.12.006.
[10] 赵众,周刚,黄耀明,等. 利用机器学习算法精简焦虑和抑郁自评量表[J].精神医学杂志,2023,36(5):466-471.DOI:10.3969/j.issn.2095-9346.2023.05.003.
[11] 戚伟伟,陈晨,徐飞,等. 负压封闭引流技术对颈部及躯干深度烧伤植皮修复患儿生活质量和血清炎症因子的影响[J].现代生物医学进展,2021,21(17):3336-3340.DOI:10.13241/j.cnki.pmb.2021.17.029.
[12] 于天培,姜春茹. 超声波加疤痕止痒软化膏治疗对烧伤瘢痕瘙痒患者康复的效果及预后的影响[J].临床与病理杂志,2020,40(10):2642-2647.DOI:10.3978/j.issn.2095-6959. 2020.10.023.
[13] Mahar PD, Spinks AB, Cleland H, et al. Improvement of burn scars treated with fractional ablative CO2 lasers-a systematic review and meta-analysis using the Vancouver scar scale[J].J Burn Care Res,2021,42(2):200-206.DOI:10.1093/jbcr/iraa130.
[14] 胡艳阁,丁伟,朱薇. 头皮刃厚皮回植治疗中厚皮供区创面的临床研究[J].皖南医学院学报,2023,42(1):40-42.DOI:10.3969/j.issn.1002-0217.2023.01.011.
[15] Xue DD, Zhou L, Yang Y, et al. Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: a case report[J].World J Clin Cases,2021,9(7):1646-1653.DOI:10.12998/wjcc.v9.i7.1646.
[16] 阎昱丞,范金财. 毛发移植在头皮及颜面部烧伤性脱发修复中的应用进展[J].中国美容整形外科杂志,2022,33(1):20-22.DOI:10.3969/j.issn.1673-7040.2022.01.007.
[17] Bovenberg MS, Williams PE, Goldberg LH. Assessment of donor site scar outcomes, healing time, and postoperative complications associated with split thickness skin grafts harvested from the hair bearing scalp[J].Dermatol Surg,2024,50(3):256-259.DOI:10.1097/DSS. 0000000000004041.
[18] 唐家国,喻忠斌,邹凯,等. 以头皮为供区在创面修复中的应用[J].临床骨科杂志,2023,26(1):57-59.DOI:10.3969/j.issn.1008-0287.2023.01.018.
[19] 赵磊,余秀菊,杨萃.基于加速康复外科理念的集束化护理模式对游离穿支皮瓣修复上肢创面患者疾病预后的影响[J]中国医疗美容,2024,14(3):81-86.DOI:10.19593/j.issn.2095-0721.2024.03.021.
[20] 张永兰,董丽娜,董岑.集束化护理干预在皮瓣移植修复巨大头皮合并颅骨缺损中的应用研究[J].中国医疗美容,2017,7(8):96-99.DOI:10.19593/j.issn.2095-0721.2017. 08.036.
[21] 黄静,冷佳梅,唐秋燕. 集束化护理联合银离子藻酸盐敷料在大面积烧伤患者中心静脉导管感染中的应用[J].中华灾害救援医学,2024,11(3):341-344,367.DOI:10.13919/j.issn.2095-6274.J202403097.
[22] 郭艳,赵恒斌,张三妮. 集束化疼痛护理对缓解烧伤患者康复期疼痛的影响[J].齐鲁护理杂志,2022,28(7):57-60.DOI:10.3969/j.issn.1006-7256.2022.07.017.
[23] 王晓慧,鲁玲,金募. 集束化护理在气道烧伤患者护理中的应用效果[J].生命科学仪器,2024,22(3):203-205.DOI:10.11967/2024220665.
[24] 李利,王伟娜,李亚琼. 集束化干预结合红外热疗对烧伤患者创面愈合与感染的影响[J].国际护理学杂志,2023,42(16):3032-3035.DOI:10.3760/cma.j.cn221370- 20210603-00742.
[25] 梁冬梅. 集束化护理对呼吸道烧伤气管切开患者救治效果的影响[J].中西医结合心血管病电子杂志,2020,8(14):143.DOI:10.16282/j.cnki.cn11-9336/r.2020.14.123.
[26] 常聪,张飞,李韵. 集束化护理对颅面骨缺损整形修复患者疼痛程度、心理状态及生存质量的影响[J].中国医疗美容,2020,10(7):130-132.DOI:10.19593/j.issn.2095-0721. 2020.07.032.
[27] 熊想莲. 集束化护理干预预防大面积烧伤患者下肢深静脉血栓形成的效果评价[J].国际医药卫生导报,2020,26(13):1963-1965.DOI:10.3760/cma.j.issn.1007-1245. 2020.13.043.
[28] 曹小霞,郭秀兰,陈莉娜,等. 集束化干预策略在烧伤康复期患者多重耐药菌感染管理中的应用[J]. 当代护士(下旬刊),2021,28(9):180-182.DOI:10.19793/j.cnki.1006-6411. 2021.27.066.
[29] 宋二凤. 五根管道集束化护理在特重度烧伤患者多管道急救护理中的应用效果[J].中外医学研究,2020,18(11):85-87.DOI:10.14033/j.cnki.cfmr.2020.11.035.
[30] 戴小华. 集束化护理在气道烧伤病人护理中的应用[J].全科护理,2015(26):2620-2621.DOI:10.3969/j.issn.1674- 4748.2015.26.028.