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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2021, Vol. 16 ›› Issue (03) : 216 -223. doi: 10.3877/cma.j.issn.1673-9450.2021.03.010

所属专题： 文献；

论著

小面积烧伤患者出院后生存质量及其影响因素的研究
胡伦阳1, 王宝丽1, 侯文佳1, 周万芳1, 施靖1, 蒋勇1, 伍国胜1, 孙瑜1, 夏照帆1,†()   
  1. 1. 200433　上海，海军军医大学第一附属医院烧伤外科，全军烧伤研究所，中国医学科学院烧伤暨烧创复合伤救治关键技术创新单元
  • 收稿日期:2021-04-02 出版日期:2021-06-01
  • 通信作者: 夏照帆
  • 基金资助:
    国家自然科学基金(81930057，81772076); 中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-076); 海军军医大学高等级成果培植计划(2018-CGPZ-B03)

Quality of life and its influencing factors in patients with small area burns after discharge

Lunyang Hu1, Baoli Wang1, Wenjia Hou1, Wanfang Zhou1, Jing Shi1, Yong Jiang1, Guosheng Wu1, Yu Sun1, Zhaofan Xia1,†()   

  1. 1. Department of Burn Surgery, People′s Republic of China; Burn Institute of Chinese People′s Liberation Army, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
  • Received:2021-04-02 Published:2021-06-01
  • Corresponding author: Zhaofan Xia
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引用本文：

胡伦阳, 王宝丽, 侯文佳, 周万芳, 施靖, 蒋勇, 伍国胜, 孙瑜, 夏照帆. 小面积烧伤患者出院后生存质量及其影响因素的研究[J]. 中华损伤与修复杂志(电子版), 2021, 16(03): 216-223.

Lunyang Hu, Baoli Wang, Wenjia Hou, Wanfang Zhou, Jing Shi, Yong Jiang, Guosheng Wu, Yu Sun, Zhaofan Xia. Quality of life and its influencing factors in patients with small area burns after discharge[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2021, 16(03): 216-223.

目的

对小面积烧伤患者群体出院后生存情况进行调查，并探讨影响其生存质量的相关危险因素。

方法

选择海军军医大学第一附属医院烧伤外科2017年1月至2018年12月收治的符合要求的123例小面积烧伤患者，并收集其人口学特征资料和烧伤疾病相关资料，包括年龄、性别、学历、婚姻状况、付费方式、烧伤面积、烧伤种类、吸入性损伤、气管切开、住院时间、住ICU时间和并发畸形。采用电话随访并采用健康调查(SF-36)简表、抑郁自评量表(SDS)、事件影响(IES-R)量表和烧伤后应对方式(CBQ)量表对患者进行调查，参照SF-36量表中国量化标准及评价参考值对本研究SF-36量表得分情况的8个方面进行评价，使用斯皮尔曼相关性分析探讨烧伤患者临床指标与SDS得分和CBQ量表得分之间的相关性，并将烧伤患者临床指标纳入单因素、多因素分析，探讨影响烧伤患者出院后抑郁及应对能力的独立危险因素。

结果

纳入本研究的小面积烧伤患者平均年龄为(47.3±16.4)岁，男(69.1%)为主。中位烧伤面积为[6.0(1.0, 17.0)%总体表面积(TBSA)]。烧伤部位以面部烧伤[(50例(40.7%)]和手部烧伤[(88例(39.0%)]为主。本组患者共有(19例(15.4%)合并吸入性损伤，7例(5.7%)接受了气管切开术。所有患者中位住院时间为10(5, 19)d，中位住ICU时间为0(0, 5)d。康复期合并畸形的有22例(17.9%)。SF-36量表得分显示，相比SF-36量表中国量化标准及评价参考值，本研究患者在躯体功能[(75.43±25.60)分]、生命活力[(48.78±12.25)分]、情感角色[(52.71±11.55)分]方面得分显示低于参照人群；IES-R量表得分显示90例(73.2%)患者表现为不同程度的应激状况，重症2例(1.7%)，中症28例(22.8%)，轻症60例(48.8%)，亚临床33例(26.8%)；SDS得分显示26例(21.1%)患者表现为不同程度的抑郁症状，重度抑郁2例(1.6%)，中度抑郁8例(6.5%)，轻度抑郁16例(13.0%)；CBQ量表得分显示，大多数患者[(109例(88.6%)]烧伤后应对问题表现良好，表现适中11例(8.9%)，表现优秀3例(2.4%)。相关性分析发现，面部烧伤与SDS得分呈正相关(r＝ 0.345, P＝0.020)，与CBQ得分呈负相关(r＝-0.444，P＝0.002)。患者的付费方式(OR：-0.508, 95%CI：-15.256, -3.070)和面部烧伤(OR：0.533，95%CI：5.131, 18.938)是导致患者出院后抑郁的独立危险因素；面部烧伤(OR：-0.568, 95%CI：-25.576，-6.313)是影响患者出院后应对能力的独立危险因素。

结论

小面积烧伤患者，尤其是面部烧伤患者的出院后生存质量仍是需要引起关注的医疗问题和社会问题。

关键词: 烧伤, 生活质量, 危险因素
Objective

To investigate the survival of patients with small area burns after discharge, and explore the related risk factors that affect their quality of life.

Methods

All 123 burn patients with small area admitted to Department of Burn Surgery, First Affiliated Hospital of Naval Medical University from January 2017 to December 2018 were selected, and their demographic characteristics and burn disease related data were collected, including age, gender, education background, marital status, payment method, burn area, burn type, inhalation injury, tracheotomy, length of hospital stay and length of stay in ICU and deformity. Follow-up by telephone and short-form 36 item health survey questionnaire (SF-36) scale, selfrating depression scale (SDS), impact of event scale-revised (IES-R) scale and coping with burns questionnaire (CBQ) scale were used to investigate the patients. According to the Chinese quantitative standard and evaluation reference value of SF-36, 8 aspects of SF-36 score in the study were evaluated. Spearman correlation analysis was used to explore the correlation between clinical indicators and two scoring systems (SDS score and CBQ scale score) in burns patients. The clinical indexes of burn patients were included in univariate and multivariate regression analysis to explore the independent risk factors of depression and coping ability in burn patients after discharge.

Results

The average age of patients with small area burns included in this study was (47.3 ± 16.4) years old, mainly male (69.1%). The median of total burn area was [6.0 (1.0, 17.0) % total body surface area (TBSA)]. The main burn sites were facial burns (50 cases, 40.7%) and hand burns (88 cases, 39.0%). There were 19 cases (15.4%) with inhalation injury, and 7 cases (5.7%) underwent tracheotomy. The median hospital stay was 10 (5, 19) days and the median ICU stay was 0 (0, 5) days. There were 22 cases (17.9%) with deformity in the stage of rehabilitation. SF-36 scale score showed that, compared with the Chinese quantitative standard and evaluation reference value of SF-36 scale, the scores of physical functions [(75.43±25.60) scores)], vitality [(48.78±12.25) scores] and emotional role [(52.71 ± 11.55) scores] of the patients in this study were lower than those of the reference group. According to the IES-R scale, 73.2% (90 cases) of the patients showed different degrees of stress, including severe stress [(2 cases (1.7%)], moderate stress [(28 cases (22.8%)], mild stress [(60 cases (48.8%)] and subclinical stress [(33 cases (26.8%)]. SDS scale showed that 21.1% (26 cases) of the patients showed different degrees of depression, including severe depression [(2 cases (1.6%)], moderate depression [(8 cases (6.5%)] and mild depression [(16 cases (13.0%)]. CBQ showed that most of the patients [(109 cases, 88.6%)] performed well in coping with problems after burn, a small number of patients performed moderately [(11 cases, 8.9%)], and several patients performed excellently [(3 cases, 2.4%)]. Correlation analysis showed that facial burn was positively correlated with SDS score (r= 0.345, P=0.020), and negatively correlated with CBQ score (r=-0.444, P=0.002). Payment method (OR: -0.508, 95%CI: -15.256, -3.070) and facial burn (OR: 0.533, 95%CI: 5.131, 18.938) were independent risk factors for post discharge depression. Facial burn (OR: -0.568, 95%CI: -25.576, -6.313) was an independent risk factor for coping ability after discharge.

Conclusions

The quality of life in patients with small area burns after discharge, especially the face burn patients, still need to be concerned about medical and social problems.

Key words: Burns, Quality of life, Risk factors
表1 123例小面积烧伤患者的一般资料
临床指标 结果
年龄(岁，±s) 47.3±16.4
  男[例(%)] 85(69.1)
学历[例(%)]  
  高中以下 41(33.3)
  高中至本科以下 50(40.7)
  本科及以上 32(26.0)
婚姻状况[例(%)]  
  已婚 96(78.1)
  未婚 24(19.5)
  离婚 3(2.4)
付费方式[例(%)]  
  自费 66(53.7)
  保险 48(39.0)
  免费 9(7.3)
烧伤面积[%TBSA, M(P25, P75)] 6.0 (1.0, 17.0)
烧伤种类[例(%)]  
  面部烧伤 50(40.7)
  手部烧伤 48(39.0)
  其他 25(20.3)
吸入性损伤[例(%)] 19(15.4)
气管切开[例(%)] 7(5.7)
住院时间[d, M(P25, P75)] 10 (5, 19)
住ICU时间[d, M(P25, P75)] 0 (0, 5)
畸形[例(%)] 22(17.9)
表2 123例小面积烧伤患者与参照人群SF-36量表的得分情况(分，±s)
项目 本研究烧伤患者 参照人群[11]
躯体功能 75.43±25.60 86.02±18.75
躯体角色 71.67±42.84 72.48±40.92
身体疼痛 88.11±20.77 81.54±20.89
生命活力 48.78±12.25 68.38±17.41
社会功能 83.06±13.63 86.29±18.08
情感角色 52.71±11.55 75.97±40.13
心理健康 80.85±37.50 73.23±16.54
总体健康状况 60.00±29.34 64.10±23.98
表3 123例小面积烧伤患者相关指标与SDS得分、CBQ量表得分之间的相关性分析
因素 SDS得分 CBQ得分
r值 P值 r值 P值
年龄 0.098 0.523 0.050 0.744
性别 0.097 0.519 0.270 0.069
学历 -0.155 0.310 0.026 0.865
婚姻状况 -0.072 0.640 0.036 0.815
付费方式 -0.170 0.260 0.047 0.757
总烧伤面积 0.057 0.530 -0.102 0.261
Ⅲ度烧伤面积 0.083 0.363 -0.145 0.113
面部烧伤 0.345 0.020 -0.444 0.002
手部烧伤 0.278 0.064 -0.248 0.100
吸入性损伤 0.002 0.988 0.094 0.539
气管切开 0.108 0.480 -0.012 0.935
住院时间 0.050 0.744 0.110 0.474
ICU住院时间 0.179 0.048 -0.077 0.396
畸形 0.254 0.093 -0.181 0.233
表4 影响123例小面积烧伤患者出院后抑郁的单因素及多因素分析
变量 单因素分析 多因素分析
OR值(95%CI) P值 OR值(95%CI) P值
年龄 0.083(-0.178，0.310) 0.588 0.185(-0.069, 0.363) 0.177
性别 0.102(-4.523，9.156) 0.498    
学历 -0.106(-2.515，1.216) 0.487 -0.241(-3.279, 0.338) 0.108
婚姻状况 -0.060(-10.715，7.209) 0.695    
付费方式 -0.238(-9.044, 0.967) 0.111 -0.508(-15.256, -3.070) 0.004
总烧伤面积 0.057 (-0.071, 0.138) 0.530    
Ⅲ度烧伤面积 0.083 (-0.096, 0.262) 0.363    
面部烧伤 0.362(1.694, 14.652) 0.015 0.533(5.131, 18.938) 0.001
手部烧伤 0.224(-1.737, 11.922) 0.140    
吸入性损伤 0.027(-8.172, 9.777) 0.858    
气管切开 0.176(-6.877, 25.918) 0.248    
住院时间 0.353(0.006, 0.062) 0.017 0.103(-0.018, 0.038) 0.482
ICU住院时间 0.179 (0.002, 0.455) 0.048    
畸形 0.268(-0.758, 15.151) 0.075    
表5 影响123例小面积烧伤患者出院后应对能力的单因素及多因素分析
变量 单因素分析 多因素分析
OR值(95%CI) P值 OR值(95%CI) P值
年龄 0.038(-0.266, 0.342) 0.802 -0.097(-0.398, 0.206) 0.524
性别 0.289(-0.055, 16.285) 0.051    
学历 0.012(-2.238, 2.422) 0.937 0.021(-2.365, 2.681) 0.900
婚姻状况 0.038(-9.765, 12.515) 0.805    
付费方式 0.002(-6.346, 6.448) 0.987 0.245(-3.014, 13.987) 0.199
总烧伤面积 -0.102 (-0.189, 0.052) 0.261    
Ⅲ度烧伤面积 -0.145 (-0.373, 0.040) 0.113    
面部烧伤 -0.433(-19.926, -4.369) 0.003 -0.568(-25.576, -6.313) 0.002
手部烧伤 -0.195(-14.051, 3.014) 0.199    
吸入性损伤 0.126(-6.505, 15.613) 0.411    
气管切开 0.004(-20.425, 20.937) 0.980    
住院时间 -0.110(-0.050, 0.023) 0.471 0.096(-0.028, 0.051) 0.560
ICU住院时间 -0.077 (-0.378, 0.151) 0.396    
畸形 -0.141(-14.849, 5.449) 0.356    
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