燒燙傷中心患者的早期物理治療

Acute Physical Therapy for Patients in Burn Center

李映琪(Ying-Chi Lee) ； 郭怡良(Yi-Liang Kuo)

《物理治療》 41卷4期 (2016/12) Pp. 254-263

https://doi.org/10.6215/FJPT.PTS1439193088

摘要

嚴重的燒燙傷患者會併發許多的後遺症，其中最顯著的疤痕攣縮問題會造成整體功能性的下降。為了讓患者在傷口復原後仍保有一定的生活品質，在燒燙傷中心裡的早期物理治療介入就成了燒燙傷復健的一個重要環節。物理治療師的評估可始於患者入院，包含傷口的評估及一般物理治療的理學檢查。早期物理治療的介入可區分成四個時期：急性期、植皮前期、植皮後期及出院準備期。在急性期，物理治療的介入以適當擺位及關節活動度運動為主。進入植皮前期時，在患者意識清楚、水腫消除及其餘相關狀況許可下可加強患者的功能性能力及行走訓練。在植皮手術過後，為了讓新植入的皮膚穩定生長，須固定不動5至7天，待植皮穩定後始可進行運動。在準備出院期，傷口面積已變小且呈現零星散布狀，物理治療的介入旨在協助患者重返生活，應著重在增加肌力及耐力，並執行疤痕伸展的運動以避免疤痕的攣縮。由於早期燒燙傷傷口及疤痕攣縮的變化相當快速，物理治療的介入計畫也應該依據需要調整內容，以期恢復燒燙傷患者最大的功能性能力。

關鍵字

燒燙傷 ； 物理治療 ； 行走訓練 ； 傷口評估 ； 疤痕攣縮

並列摘要

Patients suffered from severe burn injuries are prone to have complications. One of those complications is scar contracture, which can lead to reduced general functional abilities. In order to maintain patients' quality of life after burn injuries, physical therapy becomes an essential part of burn rehabilitation. Physical therapy can begin immediately after the burn patient is admitted to the hospital, and evaluation includes wound assessment and general physical examinations. Early physical therapy intervention for burn patients can be divided into four phases: acute phase, pregraft phase, post-graft phase and pre-discharge phase. During the acute phase, physical therapy focuses on proper positioning and range of motion exercises. During the pre-graft phase, physical therapy can start functional abilities and ambulation training if the patient's condition is stable. After skin grafting, the surgical site should be immobilized for 5 ~ 7 days. Once grafts are adherent, therapeutic exercises are resumed. During the pre-discharge phase, the burned areas gradually become smaller and scatter. The goal of physical therapy is to help patients return to their previous quality of life. Therefore, the physical therapy program should emphasize on muscle strengthening and endurance training and continue exercises for scar stretching to prevent scar contractures. Burn wounds and scar contractures change rapidly in the acute phase of burn care. Therefore, physical therapists should design and modify the intervention according to the needs of individual patients in order to restore their optimal functional abilities.

並列關鍵字

Burns ； Physical therapy ； Ambulation training ； Wound evaluation ； Scar contracture