多专科综合干预在特重度烧伤患者整合治疗中的效果观察

Observation on the effects of multidisciplinary comprehensive intervention in integrated treatment of patients with extremely severe burns

目的探讨多专科综合干预在特重度烧伤患者整合治疗中的效果。方法2013年7月—2017年8月，笔者单位收治的110例特重度烧伤患者符合本研究入选标准，回顾性分析其病历资料。根据当时的医疗模式，2013年7月—2015年7月收治的56例患者接受由医师主导的常规综合治疗，设为常规干预组；2015年8月—2017年8月收治的54例患者，接受由包括医师与重症监护专科、烧伤专科、静疗专科、伤口造口专科护士以及康复治疗师组成的团队给予的多专科综合干预的整合治疗，设为整合干预组。统计入院时及治疗4周后急性生理与慢性健康评估Ⅱ（APACHEⅡ）评分，住院期间压力性损伤、创面脓毒症、肺部感染、导管相关性感染的发生情况，住重症监护病房（ICU）时间、总住院时间，出院时及出院后3个月简明烧伤专用健康量表（BSHS－A）评分。对数据进行t检验和χ2检验。结果2组患者入院时APACHEⅡ评分相近（t＝0.573，P〉0.05）；治疗4周后，2组患者APACHEⅡ评分均较组内入院时明显降低（t＝5.697、4.853，P〈0.01），且整合干预组明显低于常规干预组（t＝2.170，P〈0.05）。住院期间，2组患者均无压力性损伤发生，整合干预组患者创面脓毒症、肺部感染及导管相关性感染的发生率分别为18.5%（10/54）、3.7%（2/54）、9.3%（5/54），明显低于常规干预组的42.9%（24/56）、21.4%（12/56）、26.8%（15/56），χ2＝4.073、6.075、3.962，P〈0.05。整合干预组患者住ICU时间为（50±5）d，明显短于常规干预组的（62±4）d（t＝2.852，P〈0.01）；总住院时间为（115±8）d，明显短于常规干预组的（140±7）d（t＝16.885，P〈0.01）。出院时及出院后3个月，整合干预组50例患者BSHS－A总得分和躯体功能、心理功能及一般健康状况得分均显著高于常规干预组48例患者（t＝2.886、3.126、2.416、2.544，2.033、3.471、2.588、2.210，P〈0.05或P〈0.01），2组患者在社会功能得分上均相近（t＝1.570、1.350，P〉0.05）。结论对特重度烧伤患者实施多专科综合干预的整合治疗，可显著减轻病情危重程度，降低创面脓毒症、肺部感染及导管相关性感染的发生率，缩短住ICU时间及总住院时间，提高生活质量。

ObjectiveTo explore the effects of multidisciplinary comprehensive intervention in integrated treatment of patients with extremely severe burns.MethodsOne hundred and ten patients hospitalized in our center from July 2013 to August 2017 met the criteria for inclusion in this study, and their medical records were retrospectively analyzed. According to the medical model at that time, 56 patients hospitalized from July 2013 to July 2015 received routine comprehensive treatment led by doctors, and they were included in the conventional intervention group. From August 2015 to August 2017, 54 patients were treated with integrated multidisciplinary interventions performed by a team consisting of physicians, intensive care nurses, burn nurses, intravenous infusion nurses, wound stoma nurses, and rehabilitation therapists, and they were included in the integrated intervention group. Acute Physiological and Chronic Health Assessment Ⅱ （APACHE Ⅱ） scores on admission and 4 weeks after treatment, incidences of pressure injury, wound sepsis, lung infection, and catheter-related infection during hospitalization, length of stay in intensive care unit （ICU） and total length of hospital stay, and Abbreviated Burn Specific Health Scale （BSHS-A） scores at discharge and 3 months after discharge were analyzed. Data were processed with t-test and chi-square test. ResultsThe APACHE Ⅱ scores of patients in the two groups were close on admission （t=0.573, P〉0.05）. Four weeks after treatment, the APACHE Ⅱ scores of patients in the two groups were obviously lower than those on admission within the same group （t=5.697, 4.853, P〈0.01）, and the score of the integrated intervention group was obviously lower than that of the conventional intervention group （t=2.170, P〈0.05）. No pressure injury was observed in patients of any group during hospitalization. The incidences of wound sepsis, lung infection, and catheter-related infection of patients in the integrated intervention group were 18.5% （10/54）, 3.7% （2/54）, and 9.3% （5/54）, respectively, significantly lower than 42.9% （24/56）, 21.4% （12/56）, and 26.8% （15/56） of the conventional intervention group, χ2=4.073, 6.075, 3.962, P〈0.05. The length of stay in ICU of patients in the integrated intervention group was （50±5） d, obviously shorter than （62±4） d of the conventional intervention group （t=2.852, P〈0.01）. The total length of hospital stay of patients in the integrated intervention group was （115±8） d, obviously shorter than （140±7） d of the conventional intervention group （t=16.885, P〈0.01）. At discharge and 3 months after discharge, the scores of BSHS-A, physical function, psychological function, and general health status of 50 patients in the integrated intervention group were significantly higher than those of 48 patients in the conventional intervention group （t=2.886, 3.126, 2.416, 2.544, 2.033, 3.471, 2.588, 2.210, P〈0.05 or P〈0.01）, while the scores of social function of patients in the two groups were close （t=1.570, 1.350, P〉0.05）.ConclusionsIntegrative treatment of patients with extremely severe burns by multidisciplinary comprehensive intervention can significantly alleviate the severity of burns, reduce the incidences of wound sepsis, lung infection, and catheter-related infection, shorten the length of stay in ICU and total length of hospital stay, and improve the quality of life.