疼痛管理联合支持性心理干预对烧伤整形植皮患者术后疼痛感及负性情绪的影响

Effect of pain management combined with supportive psychological intervention on pain and negative emotions of patients after burn and plastic skin grafting

目的:分析疼痛管理联合支持性心理干预对烧伤整形植皮患者术后疼痛感及负性情绪的影响。方法:选取2017年2月-2018年2月我院收治的重度烧伤需整形植皮患者120例为研究对象,采用随机数字表法平分为观察组、对照组各60例,围术期对照组予以常规疼痛管理及干预,观察组在此基础上联合支持性心理干预,比较两组手术效果、干预前后疼痛视觉模拟评分(VAS)、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)、心理困扰管理量表(DM)]、社会支持度[社会支持评定量表(SSRS)]、生活质量[生活质量量表(SF-36)]及并发症。结果:观察组皮下血肿个数、瘢痕指数、创面愈合时间小/短于对照组(t=-27.138,-17.898,-2.547;P<0.05),而植皮成活创面覆盖率高于对照组(t=8.584,P<0.05);观察组干预后3d、7d、1个月VAS评分低于对照组(t=-3.786,-20.422,-19.685;P<0.05);观察组干预后SAS、SDS、DM评分低于对照组(t=-4.152,-13.310,-7.345;P<0.05);干预后观察组SSRS、SF-36评分明显高于对照组(t=6.731,4.221;P<0.05);观察组并发症发生率5.00%低于对照组16.67%(χ^2=4.227,P<0.05)。结论:疼痛管理联合支持性心理干预有助于提高烧伤患者整形植皮术效果,减轻术后疼痛感及负性情绪,提高社会支持度与生活质量,减少术后并发症,值得在临床推广实践。

Objective:To analyze the effect of pain management combined with supportive psychological intervention on pain and negative emotions of patients after burn and plastic skin grafting.Methods:A total of 120 patients with severe burns requiring plastic skin grafting who were admitted to the hospital from February 2017 to February 2018 were enrolled in the study.They were divided into the observation group and the control group by the random number table method,60 patients in each group.The control group was given routine pain management and nursing intervention in perioperative period.On this basis,the observation group was additionally given supportive psychological intervention.The surgical outcomes,pain visual analogue scale(VAS)scores,negative emotions[Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Distress Management(DM)],social support[Social Support Rating Scale(SSRS)]and quality of life[Quality of Life Scale(SF-36)]before and after intervention and complications were compared between the two groups.Results:The number of subcutaneous hematoma,scar index and wound healing time in the observation group were smaller/shorter than those in the control group(t=-27.138,-17.898,-2.547;P<0.05),while the coverage rate of wounds with survival skin grafts was higher than that in the control group(t=8.584,P<0.05).The VAS scores of the observation group were lower than those of the control group at 3 d,7 d and 1 month after intervention(t=-3.786,-20.422-19.685;P<0.05),while the SAS,SDS and DM scores were lower than those of the control group(t=-4.152-13.310,-7.345;P<0.05).SSRS and SF-36 scores of the observation group were significantly higher than those of the control group(t=6.731,4.221;P<0.05).The incidence of complications in the observation group was lower than that in the control group(χ^2=4.227,P<0.05).Conclusion:Pain management combined with supportive psychological intervention can improve the effects of plastic skin grafting in patients with burns,relieve postoperative pain and negative emotions,improve social support and quality of life,and reduce postoperative complications.