| Object(1)To explore the epidemiology and psychological stress of patients with keloid.(2)To explore whether cognitive behavioral therapy is effective in psychological stress of patients with keloid and whether it can reduce the recurrence of keloid.(3)To explore the risk factors of recurrence in patients with keloid.MethodsAccording to the score of Vancouver scar scale(diagnosed and scored by doctors),a total of 135 patients with keloid diagnosed and treated in Fuzhou skin disease prevention and treatment hospital from July 2017 to June 2019 were included.Basic data were collected,detailed information was asked and patients were asked to fill in the questionnaire.The contents include: basic information,conscious symptoms,onset time,treatment expectation,and ask patients to carefully fill in the self-rating scale of clinical symptoms(scl-90).The patients were randomly divided into two groups by the method of envelope random sampling.The control group adopted the routine nursing plan,and the experimental group adopted the cognitive behavioral therapy nursing plan.The intervention time was once a week after the beginning of treatment until the end of follow-up,first through face-to-face,later through the Internet(We Chat /QQ/ telephone)communication.Six months later,the patients returned to the hospital to follow up the efficacy of keloid(evaluated by doctors),and filled in the self-rating scale of clinical symptoms(scl-90).Evaluating the effect of the intervention.Descriptive analysis was used to describe the basic data of patients,independent sample T test was used to analyze the patients’ scl-90 scale,logistic binary regression was used to find the factors related to the recurrence of keloid,and R was used to construct the prediction model for the recurrence of keloid patients.Result135 patients were included.67 were in the conventional care group and 68 were in the cognitive behavioral therapy group.Three basic data of age,sex and education level between the two groups(P>0.05).In the evaluation of keloid,there were no significant differences in keloid site,voluntary symptoms,number of keloid and Vancouver score between the two groups(P>0.05).There was no significant difference between the two groups in the expectation of treatment and treatment regimen(P>0.05).Score of scl-90 scale indicated that 37 patients(27.4%)were positive with keloids.At the same time,we found in the subscale comparison that the scores of patients with keloid in the four aspects of obsessive-compulsive symptoms,interpersonal sensitivity,depression and anxiety were increased compared with the national norm group,with statistical significance(P = 0.034,P < 0.001,P < 0.001,P < 0.001).There was no significant difference in SCL-90 scores between the two treatment groups(P>0.05).Treatment over six months we then evaluated between the two groups of patients and found that cognitive behavioral therapy can significantly reduce scar a knot in the recurrence rate(7.5% VS 23.5%,P=0.016),while the SCL-90 scale score,depression score and interpersonal score of cognitive behavioral therapy group was significantly lower than that of conventional treatment group(cognitive behavioral therapy group: 1.48±0.28,1.27±0.26 and 1.44±0.30;Routine treatment group: 1.68±0.45,1.42±0.35,and 1.74±0.54;P<0.01,P<0.01,P<0.01).Cognitive behavioral therapy was a protective factor(OR=3.817,95%CI 1.309-11.111,P=0.014),the number of keloid greater than 1 was a risk factor(OR=7.608,95%CI 2.781-20.810,P<0.001),horror,anxiety,bigotry,and high interpersonal relationship score were all risk factors(P=0.035,P<0.001,P=0.044,P<0.001).In multivariate analysis,it was found that patients receiving cognitive behavioral therapy,and low scores of single keloid,and anxiety were protective factors for keloid recurrence.Based on the above factors,a nomogram and nomogram prediction model were constructed to predict keloid,and the calibration C index of the model was 0.972,with a confidence interval of 0.946-0.998.It shows that the model we built has very strong predictive ability.Conclusion(1)Patients with keloid have psychological stress.(2)Cognitive behavioral therapy can significantly reduce the recurrence rate of scar.(3)Cognitive behavioral therapy can reduce the psychological stress of patients with keloid.(4)Cognitive behavioral therapy,number of keloids,anxiety and interpersonal relationship are protective factors for keloid recurrence.(5)Our predict model for predicting the recurrence of keloid has good predictive efficacy. |
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