中重度烧伤早期急性应激下的心理干预  

Psychological intervention under early acute stress of moderate and severe burns

作　　者：杨佳佳 童纪文[2] 胡德林[2] 杨树慧[1] 孙业祥 毕清泉[1] YANG Jiajia;TONG Jiwen;HU Delin(Nursing College of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学护理学院,230032 [2]安徽医科大学第一附属医院烧伤与创面修复外科

出　　处：《中国健康心理学杂志》2022年第12期1782-1786,共5页China Journal of Health Psychology

基　　金：安徽省2018年度重点研究与开发计划项目(编号:1804h080202)。

摘　　要：目的:观察中重度烧伤患者早期急性应激下的心理干预与临床预后的相关分析。方法:选择就诊于安徽医科大学第一附属医院烧伤与创面修复科的119名中重度烧伤患者,分为干预组,完成早期心理干预,即从入院时给予心理评估干预,对照组完成常规康复治疗。两组患者在每个时期段末利用烧伤专用健康简表(BSHS-C)评估烧伤病人临床预后。根据预后结果把患者分为良好组以及一般组,分析影响临床预后的相关因素。结果:①心理干预组与对照组在年龄、性别、总烧伤面积(TBSA%)、烧伤程度和手面部烧伤数量上不存在统计学显著差异。②多因素方差分析表明:两组在基线水平的T1期BSHS-C评分的各个方面差异无统计学意义。在T2期:早期心理干预组在综合健康水平评分以及心理功能评分上比对照组有所改善,差异有统计学意义(F=6.048,4.760;P<0.05)。在T3期:早期心理干预组在综合健康水平评分及身体机能评分、心理功能评分、社会功能评分、一般健康状况评分上与对照组相比都有明显改善,有显著性差异(F=48.881,15.432,30.103,11.065,31.410;P<0.05)。进行多因素logistic回归分析时发现男性、早期心理干预组、未累及手面部的烧伤和出院时BSHS-C评分高与患者6个月良好预后明显相关,4项敏感指标以及联合预测因子的ROC曲线的AUC值分别为0.9910、0.9341、0.9055、0.9074以及0.9910。约等指数为0.956,其对应的联合预测因子的临界值为:7.3128即当联合预测因子>7.3128时6个月后有着良好的预后。结论:与传统烧伤康复护理相比,中重度烧伤患者在急性应激状态下早期心理干预,可提高患者的综合健康水平、心理生理和社会功能水平,同时男性、未累及手面部的烧伤患者以及出院时BSHS-C评分高的烧伤患者有着更好的临床预后。Objective:To observe the correlation analysis between psychological intervention and clinical prognosis in patients with moderate and severe burns under early acute stress.Methods:A total of 119 patients with moderate and severe burns who were admitted to the Department of Burn and Wound Repair of the First Affiliated Hospital of Anhui Medical University were selected by random sampling method.They were divided into two groups: Intervention group for early psychological intervention, i.e.psychological evaluation intervention from admission, and control group for routine rehabilitation treatment.The clinical outcomes of burn patients were assessed at the end of each period using the Burn Specific Health Profile(BSHS-C).According to the prognostic results, the patients were divided into good group and general group, and the related factors affecting the clinical prognosis were analyzed.Results:①There were no significant differences in age, gender, total burn area(TBSA%),burn degree and number of burns on hands and face between the psychological intervention group and the control group.②Multivariate ANOVA showed that: There were no significant difference in all aspects of BSHS-C score at T1 at baseline between two groups.At T2 stage, the comprehensive health level score and mental function score of the early psychological intervention group were improved compared with the control group, and the difference was statistically significant(F=6.048,4.760;P<0.05).Compared with the control group, the comprehensive health level score, physical function score, psychological function score, social function score and general health status score of the early psychological intervention group were significantly improved in T3 stage(F=48.881,15.432,30.103,11.065,31.410;P<0.05).Multiple logistic regression analysis found that male, early psychological intervention group, burns not involving hands and face, and high BSHS-C score at discharge were significantly associated with good outcomes at 6 months.The AUC values of the ROC cu

关 键 词：急性应激反应 早期心理干预 临床预后 生理-心理-社会模式 

分 类 号：R395.9[哲学宗教—心理学]