| Objective:Objective To explore the application effect of wound comfort nursing program based on the e CASH concept in alleviating pain and anxiety levels and accelerating wound healing of patients with acute and chronic wounds.Method:From December 2019 to January 2021,inpatients admitted to the department of Burn orthopaedics in a third-class hospital were selected as the subjects of this study,including 70patients with acute wounds and 53 patients with chronic wounds.The patients were divided into control group and experimental group by random number table method.The control group received wound care according to best clinical practice principles,and the experimental group received comfort treatment based on the standard wound care concept.Based on the clinical characteristics of chronic wound such as long course of disease and slow healing,the chronic wound group was supplemented with negative pressure treatment on the basis of comfort treatment,and was divided into continuous negative pressure group（IPTEG）and intermittent negative pressure group（CPTEG）according to different negative pressure modes.The visual analog scale（VAS）,Hamilton anxiety score（HAMA）,cytokine levels of IL-1β,IL-6,TNF-α,TGF-β1,VEGF and b FGF in the wound tissue were compared between the experimental group and the control group before,during and after treatment,as well as the wound healing rate after 14 days of treatment.SPSS20.0 software was used for analysis.Enumeration data were represented by example（percentage/percentage）andX2 test was performed.The measurement data conforming to normal distribution were expressed as（?）±s,and a t-test was performed.One-way ANOVA was used for comparison of general data or indicators at a single time point.Repeated measures ANOVA was used for comparison between groups at multiple time points,and LSD test was used for multiple comparison between groups at each time point.Kruskal-Wallis H test was performed for measurement data that did not conform to normal distribution.P<0.05 was considered statistically significant.Binary Logistic regression analysis was performed on the data of acute and chronic patients before and after treatment.The healing rate was more than 75%.The indexes of treatment（gender,age,total burn area,body mass index,smoking history,drinking history,hypertension history,diabetes history,coronary heart disease history,history of chronic organ dysfunction,history of other infectious diseases,IL-1β,IL-6,TNF-α,TGF-β1,VEGF,b FGF,VAS score,anxiety score）were independent variables.Screening for independent risk factors affecting non-significant wound healing before and after treatment.Results:（1）In terms of pain score,the total scores of T0,T1,and T2 of acute wounds in the control group were（6.60±1.38）,（8.34±1.21）and（7.00±1.24）points,respectively,and in the intervention group were（6.91±1.34）,（3.40±0.98）and（1.69±1.16）points respectively.There were statistically significant differences between the two groups at each time point after intervention(F group270.18,F time77.07,F interaction139.07,all P<0.01).The total scores of chronic wounds in the control group at T0,T1,and T2 were（6.82±1.47）,（6.12±1.11）,（4.29±1.05）points,CPTEG were（6.12±1.22）,（2.88±0.60）,（1.24±0.90）points,respectively.IPTEG were（6.26±1.41）,（3.95±1.13）,and（3.47±1.07）points,respectively,and there were statistically significant differences among the three groups at each time point(F group29.07,F time209.12,F interaction 14.89,all P<0.001).（2）In terms of anxiety scores,the total scores of T0,T1,and T2 of acute wounds in the control group were（7.40±2.24）,（8.34±1.83）and（10.46±1.58）points,respectively,and in the intervention group were（7.43±2.00）,（5.43±1.69）and（3.34±2.30）points respectively.There were statistically significant differences between the two groups at each time point after intervention（F group 74.81,F time 2.92,F interaction 96.37,all P<0.05）.The total scores of chronic wounds in the control group were（8.76±2.31）,（9.06±1.75）,（9.06±1.64）points at T0,T1,and T2,CPTEG were（9.29±1.65）,（5.24±1.68）,（3.53±2.24）points,respectively.IPTEG were（9.16±1.95）,（5.24±1.68）,and（3.53±2.24）points,respectively,and there were statistically significant differences among the three groups at each time point after intervention(F group23.09,F time85.42,F interaction24.84,all P<0.001).（3）In terms of wound healing,there was no statistical difference in the effective rate of acute wound treatment between the experimental group and the control group（X2=3.473,P=0.176）;The effective rate of chronic wound treatment in the experimental group was significantly higher than that in the control group（X2=4.031,P=0.045）.Before treatment,IL-6and TGF-β1 were independent risk factors for non-significant healing in patients with chronic wounds（P<0.05）.TNF-αwas a protective factor influencing wound healing（P<0.05）.After treatment,IL-1βwas a risk factor for significant healing in patients with acute wounds（P<0.05）.Conclusion:（1）The wound care program based on the concept of e CASH can help relieve patients’pain levels with acute and chronic wounds,reduce patients’pain,and improve rehabilitation nursing compliance.（2）The wound nursing program based on the e CASH concept can help relieve the anxiety level of patients with acute and chronic wounds,harmonize the nurse-patient relationship,and enhance patients’confidence in disease recovery.（3）At the micro-level,the wound care program based on the e CASH concept can help reduce inflammatory factors in acute and chronic wound repair and improve the level of growth factors in chronic wound repair.（4）The wound nursing program based on the e CASH concept can promote the healing of chronic wounds and improve the long-term prognosis of patients. |
