改良敷料联合早期康复锻炼在毒蛇咬伤患者中的应用

Application of improved dressing combined with early rehabilitation exercise in patients with poisonous snakebite

目的 探讨改良换药法联合康复锻炼在提高毒蛇咬伤患者生活质量中的应用效果。方法 选择2015年1月-2016年7月我院收治的120例蛇咬伤患者为研究对象,按随机数字表法分为常规组和改良组各60例,两组均采取清创排毒、扩创排毒、局部封闭、刺络放血法、外敷双黄蛇伤散（我院自制粉末状蛇药）、全身用药等综合治疗及常规蛇伤护理措施。在此基础上,常规组予带孔透明聚乙烯胶纸敷料包扎伤口,关节处用胶布固定;改良组予弹性防水透气防渗敷料包扎伤口,辅以弹力带适当外固定,治疗后3-7天指导患者每天进行关节康复运动。两组观察时间均为7天。结果 治疗期间,两组患者均无明显不良反应。治疗后,改良组患者患肢疼痛消退时间、肿胀消退时间、肢体活动功能障碍、敷料评分、换药次数及住院时间均明显少于常规组,两组比较差异有统计学意义（t=3.599、3.583、2.703、2.178、3.394、6.384,均P〈0.05）;改良组生活质量评分显著优于常规组,差异有统计学意义（t=6.642,P〈0.05）。结论 采用改良敷料包扎蛇伤伤口并辅以弹力带外固定,具有稳固性强、美观、灵活的优点,便于患者关节活动,且可消肿止痛,减少换药次数,提高护理质量和效率;同时联合早期康复锻炼,有助于促进关节功能康复,改善患者生活质量,缩短住院时间,减轻患者经济负担,是一种安全、有效的康复锻炼方法,值得临床推广应用。

Objective To analyze the clinical effect of improved dressing method combined with rehabilitation training in improving snakebite patients ＇life quality. Methods From January 2015 July 2016,120 snakebite patients were enrolled in admission sequence, and randomly divided into two groups （with 60 cases separately）. Debridement and detoxification, partial closure, bloodletting, application of shuanghuang snake wound powder （selfmade powder Blyth）, systemic comprehensive treatment and routine nursing measures were taken both of two groups. On the basis of comprehensive treatment, control group were bound up with transparent polyethylene wound dressing with small holes,the joints were fixed with adhesive tape. Improved group were bound up with a kind of elastic breathable waterproof wound dressing, the joints were fixed with appropriate elastic band;after3 to 7 days＇ treatment,the patients were guided to take daily rehabilitation exercise. The observation time was 7d. Results During the treatment,all the patients had no obvious adverse reaction. The result showed that the two group at the time in easement of limbs pain and swelling,limb dysfunction,dressing score, dressing change times and hos; pitalization time had statistically significant differences （t= 3. 599,3. 583,2. 703,2. 178,3. 394,6. 384 ; P〈0.05） additionally, the patients of improved group had a significant superior activity for life quality. The life quality scores were significantly better than control group （t=6. 642,P〈0.05）. Conclusion To bund up snakebite with im- proved wound dressing and elastic band highlights the advantages of strong stability,attractive and flexible,and it＇s helpful for early joint exercise, relieving swelling and pain, reducing dressing times, improving the nursing quality and efficiency. Meanwhile,combining with early rehabilitation exercise, it helps to promote joint rehabilitation, improve life quality,shorten hospitalization time and reduce patients＇ economic burden,is a safe and effective rehabilitation exercise method, can be worthy of clinical application.