早期整體康復(fù)治療在工傷燒傷職工臨床中的運用

摘要： 目的:探討工傷保險燒傷患者有效的康復(fù)措施。方法:對2005年4月至2009年1月,在我科收治的工傷燒傷患者150例,結(jié)合每位患者不同的病情,不同的工作環(huán)境,家庭生活背景進行個體化早期整體康復(fù)治療,并比較燒傷后不同時期入院患者治療及康復(fù)效果的差異。結(jié)果:150例患者中,輕、中度患者均完全康復(fù)出院,12例特重度燒傷患者中除3例在進行康復(fù)治療,死亡2例外,其余患者均已康復(fù)出院;145例康復(fù)出院患者中,98例患者已恢復(fù)原工作崗位,32例患者改換工作崗位,15例患者提前退休或仍在家療養(yǎng)。深Ⅱ度或Ⅲ度燒傷后功能部位瘢痕參照ADL分級標準及關(guān)節(jié)活動恢復(fù)程度、瘢痕有無增生作為評定,其中達到ADL4級者為90.56%,ADL3～4級者為5.64%,ADL0～2級者為3.9%。在深Ⅱ度創(chuàng)面平均愈合天數(shù),愈合后增生性瘢痕面積,畸形嚴重程度(后期手術(shù)次數(shù)),平均醫(yī)療費用情況等方面,燒傷后8小時內(nèi)入院且休克期度過平穩(wěn)的患者明顯優(yōu)于與燒傷后8小時后由外院轉(zhuǎn)入休克期勉強度過的患者。結(jié)論:在工傷燒傷患者的康復(fù)治療中以整體康復(fù)治療為基本原則,結(jié)合每位患者不同的病情,不同的工作環(huán)境,家庭生活背景進行個體化早期康復(fù),有助于工傷燒傷患者達到最佳康復(fù)效果,是適合我國國情的一種有效的康復(fù)手段。
Objective:To discuss the effective rehabilitation method in treating work - accident burn patients with insurance.Methods:150 hospitalized work - accident burn patients from Apr.2005 to Jan.2009 in our section were collected. Individual early overall rehabilitation treatment was conducted for each patient according to his illness,work condition and background of family.And the patients' treatment and rehabilitation results at the different stages of burns were observed and compared.Result:Of the 150 patients,138 cases of the patients with light and medium injury were discharged withcompleted recovery.In the rest 12 cases with extraordinarily severe burn patients,7 were discharged with rehabilitation. 3 cases were still receiving rehabilitation treatment and other 2 cases dead.Of 145 rehabilitation patients,98 returned to their original jobs;32 changed their jobs;15 had early retirement or stayed at home for further recuperation.Evaluation of the scar of functional parts for deepⅡI orⅢdegree burns was made according to ADL classify standard,the recovery of joints activity and hyperplasia of scars.The scar evaluation results showed that 90.56%of scars were evaluated as ADL - 4;while,5.64%as ADL - 3 and 3.90%as ADL0 - 2.Observed indexes for the deepⅡdegree patients hospitalized in 8h after burn injury and got through shocks stage smoothly were superior to those for the patients getting through shocks stage reluctantly and transferred from other hospitals after 8h of burn injury.The indexes included the average healing time, hypertrophic scar size after wounds closed,deformity degree(numbers of later surgery) and average medical costs.Conclusion: During treatment process of work - accident burn patients,individual early rehabilitation treatment is a basic principle to be followed.The rehabilitation should be based on each patient's illness,work condition and background of family. So it is an effective rehabilitation method which is suitable for the conditions of our country.