中药浸浴联合功能训练用于儿童手部烧伤康复治疗的临床研究

余方珍; 张建芬; 吴晓霞; 卞卫霞

doi:10.16766/j.cnki.issn.1674-4152.002915

中药浸浴联合功能训练用于儿童手部烧伤康复治疗的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002915

浙江衢化医院护理部，浙江衢州 324004

基金项目:

浙江省医药卫生科技计划项目 2022KY1350

衢州市科技攻关项目 2022081

详细信息

通讯作者:
张建芬，E-mail: 1063545182@qq.com

中图分类号: R644 R244.9 R473.3
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- 文章访问数: 177
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- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2022-10-19
- 网络出版日期: 2023-04-19

Study on traditional Chinese medicine immersion combined with functional training in the rehabilitation of hand burns in children

Department of Nursing, Quhua Hospital, Quzhou, Zhejiang 324004, China

摘要

摘要: 目的针对手部烧伤患儿采取科学、系统、有效的术后康复理疗措施，对于其整体预后水平的提高至关重要。本研究观察中药浸浴联合功能训练对儿童手部烧伤植皮术后的康复治疗效果。方法选择2019年1月—2022年3月于浙江衢化医院就诊并接受植皮手术治疗的104例手部烧伤患儿为研究对象，使用随机数表法将患儿分为研究组(52例)和对照组(52例)，对照组患儿术后实施压力康复治疗，研究组患儿在此基础上增加中药浸浴联合功能训练。干预前后采用数字评定量表(NRS)、面部表情分级评分(FRS)和温哥华瘢痕量表(VSS)评价患肢瘙痒、疼痛及瘢痕症状程度，比较腕关节背伸活动度、手指关节总主动活动度(TAM)和Jebsen手功能测试时间等患肢运动功能指标变化，评估患肢功能恢复情况。结果干预后，研究组患肢NRS、FRS和VSS评分[(1.49±0.54)分, (1.59±0.62)分，(4.23±0.56)分]低于对照组[(2.16±0.61)分, (2.23±0.73)分，(4.97±0.63)分，均P＜0.05]。干预后，研究组患肢腕关节背伸活动度和TAM[(68.59±4.93)°，(157.84±6.29)°]均显著高于对照组[(57.66±4.85)°，(139.71±6.17)°]，Jebsen手功能测试时间[(6.14±0.75)min]显著短于对照组[(7.23±0.82)min]，均P＜0.05。研究组患肢功能恢复优良率显著高于对照组(P < 0.05)。结论中药浸浴联合功能训练有助于缓解手部烧伤患儿瘙痒、疼痛症状，提高烧伤创面愈合美观程度和患肢运动功能恢复水平。
- 手部烧伤 /
- 儿童 /
- 中药浸浴 /
- 功能训练 /
- 康复治疗
Abstract: Objective It is very important to take scientific, systematic and effective postoperative rehabilitation physiotherapy measures for children with hand burn to improve their overall prognosis. This study aims to observe the rehabilitation treatment of traditional Chinese medicine immersion combined with functional training after skin grafting for children with hand burn. Methods A total of 104 children with hand burns who were treated with skin grafting in Zhejiang Quhua Hospital from January 2019 to March 2022 were taken as the study subjects. The children were divided into research group (52 cases) and control group (52 cases) according to the random number table method. The pressure rehabilitation treatment was carried out for the children in the control group, and on the basis of this, the children in the research group were treated with the addition of traditional Chinese medicine immersion and combined with functional training. The numerical rating scale (NRS), face rating scale (FRS) and Vancouver scar scale (VSS) were used to assess the degree of itch, pain and scar symptoms of the injured limb before and after the intervention. The changes of the exercise function of the injured limb such as wrist dorsiflexion mobility, the time of total action motion (TAM) and Jebsen' s hand function test were compared. The recovery level of the injured limb and the overall health condition of the child were also evaluated. Results After the intervention, the scores of NRS, FRS and VSS in the research group [(1.49±0.54) points, (1.59±0.62) points, (4.23±0.56) points] were significantly lower than those in the control group [(2.16±0.61) points, (2.23±0.73) points, (4.97±0.63) points, all P < 0.05]. After the intervention, the degree of back stretching and TAM of the injured limbs in the research group [(68.59±4.93)°, (157.84±6.29)°] were significantly higher than those in the control group [(57.66±4.85)°, (139.71±6.17)°], while the time of Jebsen' s hand function test [(6.14±0.75) min] was significantly shorter than that of the control group [(7.23±0.82) min], all P < 0.05. The excellent recovery rate of the injured limb in the research group was significantly higher than that in the control group (P < 0.05). Conclusion The combination of traditional Chinese medicine immersion and functional training could relieve the itch and pain of the burned hand, improve the aesthetic level of the burned wound healing, and the recovery of the motor function of the injured limb.
- Hand burn /
- Children /
- Traditional Chinese medicine bath /
- Functional training /
- Rehabilitation therapy

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表 1 2组手部烧伤患儿干预前后患肢NRS、FRS和VSS评分比较(x±s，分)

Table 1. Comparison of NRS, FRS, and VSS scores of affected limbs before and after intervention in children with hand burns in the two groups(x±s, points)

组别	例数	NRS评分		FRS评分		VSS评分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
研究组	52	3.47±0.72	1.49±0.54^a	5.82±1.13	1.59±0.62^a	7.18±0.84	4.23±0.56^a
对照组	52	3.42±0.69	2.16±0.61^a	5.77±1.16	2.23±0.73^a	7.09±0.81	4.97±0.63^a
t值		0.362	5.931	0.223	4.819	0.556	6.331
P值		0.718	＜0.001	0.824	＜0.001	0.579	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 2 2组手部烧伤患儿干预前后患肢运动功能指标比较(x±s)

Table 2. Comparison of motor function indexes of the affected limbs of children with hand burns in the two groups before and after intervention(x±s)

组别	例数	腕关节背伸活动度(°)		TAM(°)		Jebsen测试完成时间(min)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
研究组	52	24.36±2.85	68.59±4.93^a	86.92±4.18	157.84±6.29^a	9.26±1.09	6.14±0.75^a
对照组	52	24.73±2.96	57.66±4.85^a	87.45±4.29	139.71±6.17^a	9.18±1.14	7.23±0.82^a
t值		0.649	11.527	0.638	14.838	0.351	7.628
P值		0.518	＜0.001	0.525	＜0.001	0.690	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 3 2组手部烧伤患儿干预后患肢功能恢复优良率比较[例(%)]

Table 3. Comparison of excellent and good rates of functional recovery of the affected limb of children with hand burns in the two groups after intervention [cases (%)]

组别	例数	优	良	可	差	总体优良
研究组	52	21(40.38)	25(48.08)	5(9.62)	1(1.92)	46(88.46)
对照组	52	15(28.85)	22(42.31)	11(21.15)	4(7.69)	37(71.15)
注：2组优良率比较，χ²=4.833，P=0.028。

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参考文献(20)

[1]	付琼, 张雅萍, 赵振华. 放射性皮肤损伤经不同护理措施干预的效果对比[J]. 中华全科医学, 2020, 18(5): 878-881. doi: 10.16766/j.cnki.issn.1674-4152.001381 FU Q, ZHANG Y P, ZHAO Z H, et al. Intervention effect of different nursing measures on radiation skin injury[J]. Chinese Journal of General Practice, 2020, 18(5): 878-881. doi: 10.16766/j.cnki.issn.1674-4152.001381
[2]	章雄. 儿童烧伤治疗[J]. 中华损伤与修复杂志(电子版), 2020, 15(3): 240. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHSX202003021.htm ZHANG X. Burn treatment for children[J]. Chinese Journal of Injury Repair and Wound Healing (Electronic Edition), 2020, 15(3): 240. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHSX202003021.htm
[3]	杨鸣. 艾司氯胺酮用于胸部肿瘤手术中的临床效果研究[J]. 中国实用医药, 2021, 16(15): 135-137. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202115050.htm YANG M. Clinical effect of esketamine in thoracic tumor surgery[J]. China Practical Medical, 2021, 16(15): 135-137. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202115050.htm
[4]	潘孙峰, 王晶, 王振君, 等. 软坚化瘀中药浸浴联合功能训练治疗手部深度烧伤瘢痕效果观察[J]. 中国乡村医药, 2022, 29(9): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYY202209008.htm PAN S F, WANG J, WANG Z J, et al. Observation on the effect of traditional chinese medicine soaking bath combined with functional training on deep burn scar of hand[J]. Chinese Journal of Rural Medicine and Pharmacy, 2022, 29(9): 19-21. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYY202209008.htm
[5]	郭振荣. 我国烧伤康复的现状与展望[J]. 中华损伤与修复杂志(电子版), 2018, 13(3): 161-164. doi: 10.3877/cma.j.issn.1673-9450.2018.03.001 GUO Z R. Current situation and prospect of burn rehabilitation in China[J]. Chinese Journal of Injury Repair and Wound Healing (Electronic Edition), 2018, 13(3): 161-164. doi: 10.3877/cma.j.issn.1673-9450.2018.03.001
[6]	刘晶晶, 肖婷, 蒋丽丹, 等. 布洛芬注射液在小儿骨科麻醉恢复室镇痛中的应用[J]. 临床小儿外科杂志, 2021, 20(3): 268-272, 296. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXR202103015.htm LIU J J, XIAO T, JIANG L D, et al. Application of analgesia of intravenous ibuprofen for orthopedic children in PACU[J]. Journal of Clinical Pediatric Surgery, 2021, 20(3): 268-272, 296. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXR202103015.htm
[7]	王向华. 阶段性康复护理对手部烧伤后瘢痕形成患者功能恢复的影响[J]. 中国农村卫生, 2020, 12(14): 62. https://www.cnki.com.cn/Article/CJFDTOTAL-NCWS202014062.htm WANG X H. Effect of staged rehabilitation nursing on functional recovery of patients with hand burn scar formation[J]. China Rural Health, 2020, 12(14): 62. https://www.cnki.com.cn/Article/CJFDTOTAL-NCWS202014062.htm
[8]	吕红芝, 王博, 郭家良, 等. 胫骨pilon骨折患者的流行病学特征分布研究[J]. 中华创伤骨科杂志, 2021, 23(7): 602-607. LYU H Z, WANG B, GUO J L, et al. Epidemiological characteristics of patients with tibial pilon fracture[J]. Chinese Journal of Orthopaedic Trauma, 2021, 23(7): 602-607.
[9]	陈媛, 刘建, 李孝建. DPL在防治儿童烧伤后早期增生性瘢痕中应用的研究进展[J]. 组织工程与重建外科, 2021, 17(6): 497-502. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZCW202106011.htm CHEN Y, LIU J, LI X J. Research progress of DPL in early prevention and treatment of hypertrophic scar after burn in children[J]. Journal of Tissue Engineering and Reconstructive Surgery, 2021, 17(6): 497-502. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZCW202106011.htm
[10]	钟莉, 陈晓娟, 古芝燕. 烧伤植皮联合综合性康复护理干预治疗手部烧伤临床效果分析[J]. 中国美容医学, 2022, 31(1): 152-155. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202201043.htm ZHONG L, CHEN X J, GU Z L. Clinical effect analysis of burn skin grafting combined with comprehensive rehabilitation nursing intervention on hand burns[J]. Chinese Journal of Aesthetic Medicine, 2022, 31(1): 152-155. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202201043.htm
[11]	陈琛, 陈婧婧, 刘晴, 等. 抗阻力训练应用于烧伤患者肢体康复锻炼效果的Meta分析[J]. 现代临床护理, 2020, 19(4): 39-44. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202004008.htm CHEN S, CHEN Q Q, LIU Q, et al. Effect of resistance training on rehabilitation in burn patients: a meta-analysis[J]. Modern Clinical Nursing, 2020, 19(4): 39-44. https://www.cnki.com.cn/Article/CJFDTOTAL-XDLH202004008.htm
[12]	赵海洋, 韩军涛, 刘佳琦, 等. 手持续被动运动系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩的效果[J]. 中华烧伤杂志, 2021, 37(4): 319-326. ZHAO H Y, HAN J T, LIU J Q, et al. Effects of hand continuous passive motion system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand[J]. Chinese Journal of Burns and Wounds, 2021, 37(4): 319-326.
[13]	李婷, 潘建华, 黄峻, 等. 序贯压力康复疗法联合负压创面治疗技术对手烧伤后瘢痕挛缩修复患者关节功能障碍及瘢痕情况的影响[J]. 中国美容医学, 2021, 30(10): 51-54. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202110017.htm LI T, PAN J H, HUANG J, et al. Effect of sequential pressure rehabilitation therapy combined with negative pressure wound therapy on joint dysfunction and scar in patients with scar contracture after hand burn[J]. Chinese Journal of Aesthetic Medicine, 2021, 30(10): 51-54. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202110017.htm
[14]	马平, 尚文静, 张娜. 手术结合综合康复治疗在手部烧伤后瘢痕挛缩中的效果[J]. 中国现代药物应用, 2020, 14(18): 240-242. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202018118.htm MA P, SHANG W J, ZHANG N. Effect of surgery combined with comprehensive rehabilitation on cicatricial contracture after hand burns[J]. Chinese Journal of Modern Drug Application, 2020, 14(18): 240-242. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202018118.htm
[15]	陈思雄, 董永盛. 探讨手术结合康复治疗对手部烧伤后瘢痕挛缩的临床效果[J]. 中国实用医药, 2020, 15(27): 197-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202027087.htm CHEN S X, DONG Y S. Explore on the clinical effect of surgery combined with rehabilitation on cicatricial contracture after hand burns[J]. China Practical Medical, 2020, 15(27): 197-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202027087.htm
[16]	蔡夺, 贺婷婷, 张丹丹, 等. 多学科团队制作手功能康复视频在烧伤患儿中的应用[J]. 护理学杂志, 2021, 36(6): 101-104. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202106032.htm CAI D, HE T T, ZHANG D D, et al. Application of multidisciplinary hand rehabilitation video in children with burns[J]. Journal of Nursing Science, 2021, 36(6): 101-104. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202106032.htm
[17]	柳林霞, 张小明, 李娜, 等. 中药浸浴熏洗治疗四肢Ⅱ度烧伤创面临床疗效观察[J]. 四川中医, 2021, 39(12): 179-183. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202112055.htm LIU L X, ZHANG X M, LI N, et al. Clinical curative observation of applying traditional chinese medicine immersion bath fumigation in the treat-ment of second-degree limb burn wounds[J]. Journal of Sichuan Traditional Chinese Medicine, 2021, 39(12): 179-183. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202112055.htm
[18]	徐丽华, 俞婷婷. 冬菊洗液浸泡联合早期康复训练对手烧伤患者手部功能恢复的影响[J]. 新中医, 2019, 51(10): 159-161. https://www.cnki.com.cn/Article/CJFDTOTAL-REND201910046.htm XU L H, YU T T. A study on effect of immersion in Dongju lotion combined with early rehabilitation training on recovery of hand function in patients with hand burns[J]. Journal of New Chinese Medicine, 2019, 51(10): 159-161. https://www.cnki.com.cn/Article/CJFDTOTAL-REND201910046.htm
[19]	黄爱萍, 陈悠琴, 李小燕. 中药浸浴联合外敷治疗烧伤后残余创面临床观察[J]. 光明中医, 2019, 34(23): 3620-3622. https://www.cnki.com.cn/Article/CJFDTOTAL-GMZY201923038.htm HUANG A P, CHEN Y Q, LI X Y. Clinical observation on treatment of residual burn wound with chinese medicine immersion bath and external application[J]. Guangming Journal of Chinese Medicine, 2019, 34(23): 3620-3622. https://www.cnki.com.cn/Article/CJFDTOTAL-GMZY201923038.htm
[20]	兰宏伟, 周忠志, 邹梅林, 等. 大叶桉煎剂浸浴联合短波紫外线照射对深度烧伤残余创面愈合及血清IL-1β、TNF-α、IL-6表达的影响[J]. 中国美容医学, 2020, 29(8): 88-92. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202008031.htm LAN H W, ZHOU Z Z, ZOU M L, et al. Effects of bathing with eucalyptus grandis decoction combined with short-wave ultraviolet irradiation on wound healing and expression of serum IL-1β, TNF-α, IL-6 in residual wounds of deep burns[J]. Chinese Journal of Aesthetic Medicine, 2020, 29(8): 88-92. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202008031.htm