探讨影响老年难愈性创面患者创面愈合的相关原因及实施个体化护理措施的效果。

对2012年10月至2014年12月间武汉大学同仁医院暨武汉市第三医院烧伤科治疗的57例60岁以上老年难愈性创面患者的基础疾病、不良心理状况及药物治疗依从率进行干预，通过对患者实施个性化护理如基础疾病的护理、有效的药物治疗、加强营养支持、积极的创面处理、个性化健康宣教及心理护理以及加强基础护理等，评估基础疾病与不良心理状况的不同控制情况对创面愈合的影响，以及干预前后患者药物治疗依从率的变化。对数据行两独立样本Wilcoxon秩和检验和χ²检验。

糖尿病、高血压、营养不良等基础疾病的不同控制情况对创面愈合的影响差异有统计学意义(Z＝－2.989、－2.115、－3.669，P＝0.003、0.034, P<0.05)，焦虑、忧郁、孤独、暴躁等负性情绪的不同控制情况对创面愈合的影响差异有统计学意义(Z＝－2.676、－2.211、－2.063、－2.478，P＝0.007、0.027、0.039、0.013)，对糖尿病、高血压、营养不良等基础疾病进行干预前患者药物依从率分别为43.48%、34.78%、13.33%，干预后患者药物依从率分别为86.96%、78.26%、66.67%，干预前后患者药物治疗依从率明显上升，差异有统计学意义(χ²＝9.583、8.846、8.889，P＝0.002、0.003、0.003)。

老年难愈性创面的患者除积极的创面治疗外，应重视影响创面迁延不愈的合并症，如糖尿病、高血压、营养不良以及不良负性心理对创面愈合的影响，对患者实施个性化护理，以取得满意治疗效果。

To investigate the related factors which affecting the wound healing of elderly patients with refractory wounds and the effect of implementing individualized nursing measures.

The objects of this study were 57 patients with refractory wounds who aged over 60 in Tongren Hospital of Wuhan University, Wuhan Third Hospital from October 2012 to December 2014. All of these patients were received a treatment by intervention on basic disease, adverse psychological state and drug compliance rates. Through the use of individualized nursing such as basic disease nursing, effective drug therapy, nutritional support, active wound treatment, personalized health education, psychological care and the strengthening of basic nursing, the effects of different control conditions of basic diseases and unhealthy mental status on wound healing could be assessed, and the change of compliance rate of patients with drug treatment before and after intervention could be known. Date were analyzed by two independent samples Wilcoxon rank sum test and chi-square test.

The different control conditions of basic diseases like diabetes, hypertension and malnutrition had different effects on wound healing, the differences were statistically significant(Z=-2.989, -2.115, -3.669, P= 0.003, 0.034, P<0.05). The different control conditions of negative emotions such as anxiety, melancholy, loneliness and tepidity had different effects on wound healing, the differences were statistically significant (Z=-2.676, -2.211, -2.063, -2.478, P=0.007, 0.027, 0.039, 0.013). The drug compliance rates of patients before the intervention for basic disease such as diabetes, hypertension and malnutrition were 43.48%, 34.78% and 13.33%, and after the intervention, the drug compliance rates of the 3 kinds of basic disease were 86.96%, 78.26% and 66.67%. The drug compliance rates were increased obviously after the intervention, the differences were statistically significant (χ²=9.583, 8.846, 8.889, P=0.002, 0.003, 0.003).

In addition to positive wound treatment, elderly patients with refractory wounds should pay attention to the complications that affect the wounds healing, such as diabetes, hypertension, malnutrition and negative psychology, implement personalized care on them to receive satisfactory treatment effects.