血管加压剂对重症监护病房老年住院患者压疮发生的影响研究

目的比较去甲肾上腺素、多巴胺、肾上腺素、苯肾上腺素等血管加压剂对重症监护病房(ICU)老年患者压疮发生的影响,为临床预防压疮提供参考依据。方法采用回顾性队列研究的方法,选取我院2017年1月-2019年12月848例在ICU住院治疗时间超过24 h的老年患者为研究对象。按血管加压剂使用情况分为暴露组和非暴露组,暴露组接受血管加压剂的治疗,非暴露组未使用血管加压剂的治疗。对两组患者的压疮发生等情况进行观察比较。结果暴露组患者压疮发生率11.9%,明显高于非暴露组3.4%,差异有统计学意义(P0.05)。单一种血管加压剂治疗与同时联用多种血管加压剂治疗患者的压疮发生率比较,差异无统计学意义(P0.05)。去甲肾上腺素治疗患者的压疮发生率为16.2%,均高于其它血管加压剂治疗患者的压疮发生率,差异有统计学意义(P0.05)。接受血管加压剂输注的压疮患者未愈合比例为72.6%,高于未接受血管加压剂治疗的压疮患者,差异有统计学意义(P0.05)。单用去甲肾上腺素和去甲肾上腺素联用肾上腺素总输注剂量与压疮发生存在关联,有统计学意义(P0.05)。单用去甲肾上腺素、去甲肾上腺素联用肾上腺素以及去甲肾上腺素联用多巴胺、肾上腺素的总输注小时数与压疮发生存在统计学关联(P0.05)。结论 ICU老年患者发生压疮风险较高,血管加压剂的使用与压疮发生存在关联,是压疮发生的影响因素。并且压疮发生也与血管加压剂的类型、总输注剂量、累计输注时间有关。建议临床护理人员加深对血管加压剂在压疮发生中所起作用的认识,加强监测,改善重症患者临床治疗效果,降低压疮发生率。     

重症脑梗死压疮风险现状调查与影响因素分析

目的对重症脑梗死的压疮风险现状及影响因素进行调查分析。方法选取2014年1月~2016年10月我院收治的280例重症脑梗死患者为研究对象,采用Braden量表对患者压疮的危险程度进行评分。按照患者是否出现压疮分为压疮组20例和对照组260例。对可能影响患者发生压疮的因素进行单因素及Logistic多因素回归分析。结果 280例重症脑梗死患者中发生压疮20例,发生率为7.14%。压疮组年龄、月收入、卧床时间、文化程度、照顾者、Braden评分、BMI、合并其他慢性疾病种类与对照组比较,差异有统计学意义(P0.05)。经Logistic多因素回归分析显示,年龄、照顾者、BMI、Braden评分及卧床时间是压疮发生的独立危险因素(P0.05)。结论重症脑梗死是压疮的风险人群,年龄、BMI及卧床时间等是压疮发生的影响因素,应采取必要的护理干预对策。     

急性脑卒中后压疮的危险因素分析及应对策略

目的 探讨急性脑卒中后压疮发生的危险因素,并提出应对策略.方法 以47例急性脑卒中后压疮患者为研究对象(压疮组),以及同期急性脑卒中后无压疮患者610例(无压疮组),收集其性别、年龄、体重、卒中类型、NIHSS评分、Waterlow压疮危险评分、感染、糖尿病、血清总蛋白量及白蛋白量,应用Logistic回归统计分析.结果 压疮组的年龄、NIHSS评分、Waterlow压疮危险评分、感染、糖尿病、血清总蛋白量和白蛋白量等与对照组比较有显著性差异(P<0.01,P<0.05),其中年龄、NIHSS评分、Waterlow压疮危险评分、糖尿病、低白蛋白是急性脑卒中后压疮的独立危险因素.结论 年龄、NIHSS评分、Waterlow压疮危险评分、糖尿病、低白蛋白是急性脑卒中后压疮的高危因素,针对高危因素制定干预措施,减低脑卒中后压疮发生的风险.     

外科重症病人压疮高危因素分析及护理对策

[目的]探讨外科重症病人压疮相关危险因素及护理对策。[方法]采用前瞻性队列研究设计,应用Braden量表筛选出105例Braden评分≤12分的病人为研究对象,分为压疮高度风险组(Braden评分10分～12分)和极度风险组(Braden评分6分～9分)。应用APACHEⅡ评分量表收集19项指标,比较两组独立样本间各项指标的差异,找到可能的危险因素;通过Logistic回归分析筛选出有意义的高危因素。[结果]单因素分析显示,极度风险组病人的平均动脉压、24h尿量低于高度风险组,而APACHEⅡ评分高于高度风险组,差异有统计学意义(P<0.01);多因素Logistic回归分析显示,平均动脉压低是导致压疮风险的高危因素(P<0.01)。[结论]护士应将休克病人视为外科ICU压疮防控的重点关注对象,将低血压作为重点关注的高危因素;树立休克抢救同时防控压疮的意识,积极配合医生尽快恢复有效循环血量,作好休克早期积极的液体复苏,并且在抢救的同时采取多种减压防控措施,有助于提高危重病人防控压疮的护理质量。     

循证护理在骨科患者预防压疮中的效果观察

目的：探讨对骨科患者预防Ⅰ期二级压疮发生的护理干预措施。方法：将132例患者经压疮危险因素评估分值〈12分的高危人群,随机分为2组,对照组按常规护理,试验组患者采用循证护理。结果：入院2周内试验组患者Ⅰ期二级压疮发生率显著低于对照组（P〈0.05）。结论：通过循证护理可有效降低压疮高危人群的压疮发生率,提高护理质量。     

肝移植手术中发生皮肤压疮的高危影响因素分析及护理对策

目的探讨肝移植手术中患者发生皮肤压疮的高危影响因素,并提出相应的护理对策。方法观察了24例(压疮组)肝移植手术过程中发生皮肤压疮患者,以及同期肝移植手术的无压疮的患者40例(对照组),观察两组手术时间、Waterlow6s压疮危险评分、血清总蛋白、血清白蛋白和失血量。结果单因素分析表明压疮组患者术前Waterlow6s评分、血清总蛋白、血清白蛋白和术中手术时间和失血量等均与对照组差异有显著性意义(P<0.05)。Logistic回归分析显示,两组中只有手术持续时间、Waterlow6s评分和失血量有统计学差异。结论压疮组患者肝移植手术时间、Waterlow6s评分和失血量是术中发生皮肤压疮的独立高危因素,针对这些高危因素制定相应的护理措施,降低术中发生皮肤压疮的风险。     

压疮危险评估告知书在颅脑外科压疮高危患者中的应用

目的探讨压疮危险评估告知书在脑外科压疮高危患者中的应用效果。方法选取2008年1-12月在本院住院的89例颅脑外科压疮高危患者作为对照组,选择与对照组匹配的2009年1-12月收治的106例颅脑外科压疮高危患者作为实验组。对照组采用Braden压疮危险评估单对新入院或手术后危重患者进行压疮危险因素评估,然后对患者或家属进行口头告知和采取针对性的预防压疮的措施;实验组在对照组基础上,发放压疮危险评估告知书,并由专人实施压疮预防管理。比较两组患者出院时压疮的发生率。结果两组患者出院时压疮的发生率比较,P0.05,差异具有统计学意义,实验组压疮发生率明显低于对照组。结论在颅脑外科压疮高危患者中应用压疮危险评估告知书,有利于提高护患双方的重视程度,降低了患者压疮发生率;并充分体现了护士履行告知的义务,减少护患纠纷的发生。     

脊柱骨折患者并发压疮危险因素分析及护理对策

目的:分析脊柱骨折患者并发压疮的危险因素,制定科学的护理对策。方法:将226例脊柱骨折患者分为非压疮组154例和压疮组72例,经单因素分析筛选并发压疮的相关因素,将有统计学意义的变量纳入多因素Logistic回归模型,分析脊柱骨折患者并发压疮的危险因素。结果:老年、肥胖、营养不良、糖尿病、高血压、保守治疗及疼痛与脊柱骨折患者并发压疮有关(P0.05)。多因素Logistic回归分析显示,老年、肥胖、营养不良及糖尿病是脊柱骨折患者并发压疮的独立危险因素。结论:老年、肥胖、营养不良及糖尿病与脊柱骨折患者并发压疮密切相关,可辅助制定更有针对性的护理对策,减少压疮的发生。     

ICU患者压疮发生的危险因素分析

目的 分析重症医学科(ICU)患者压疮发生的相关危险因素,探讨预防压疮的护理.方法 回顾分析ICU患者发生压疮组(42例)和无发生压疮组(183例),对比2组各项临床特点,并应用logistic回归分析筛选压疮发生的危险因素.结果 压疮组卧床＞14 d、肠外营养支持、低蛋白血症、吸烟史、发热、糖尿病发生率显著高于对照组;压疮危险因素的logistic回归分析中,卧床＞14 d、低蛋白血症、吸烟史、发热和糖尿病纳入方程.结论 ICU患者压疮的发生与卧床＞14 d、低蛋白血症、吸烟史、发热、糖尿病这些因素有较密切的关系.     

神经内科老年患者压疮危险因素分析及相关护理措施

目的探讨神经内科老年患者压疮的危险因素和护理措施。方法选取神经内科收治的老年患者675例为研究对象,应用自制压疮危险度评估量表动态评估压疮发生的危险性,并根据不同危险度实施护理干预,应用多因素Logistic回归分析筛选出独立危险因素。结果护理干预包括减少受压、皮肤护理、营养支持和健康宣教。观察期内,82例患者发生压疮,其中Ⅰ期压疮61例(74.3%),Ⅱ期压疮18例(22.0%),Ⅲ期压疮3例(3.7%)。多因素Logistic回归分析结果显示,意识障碍、活动能力和移动能力是压疮的独立危险因素(P0.01)。结论意识障碍、活动能力和移动能力降低是影响神经内科老年患者压疮发生的危险因素,应结合压疮危险度动态评估结果制定预防措施。     

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective:To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions.Methods:A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature.After being examined and validated by experts,the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital.Among the 47 patients enrolled into the study,the 14 who developed nosocomial pressure sores were allocated to the pressure sore group,and the remaining33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group.Univariate and multivariate logistic regression analyses were employed to examine the differences in22 indicators between the two groups in an attempt to identify the risk factors for pressure sores.Results:According to the univariate analyses,the maximum value of lactic acid in the arterial blood,the number of days of norepinephrine use,the number of days of mechanical ventilation,the number of days of blood purification,and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group(P0.05).The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores(P0.05).Conclusions:The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock.The adoption of measures specific to high-risk patient groups and risk factors,including the active control of primary diseases and the application of decompression measures during the treatment of the patients,are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.     

危重症患者应激性溃疡发生的危险因素分析

目的：分析危重症患者发生应激性溃疡的危险因素,为危重症患者应激性溃疡的合理预防提供理论依据。方法：回顾性分析2011-01-2013-12入住我院急诊重症监护病房患者的病例资料,以是否发生应激性溃疡将患者分为两组,以机械通气、凝血功能障碍、低血压、颅脑损伤、肝功能衰竭、肾功能衰竭、肠内营养、糖皮质激素的应用、创伤、饮酒史、消化道溃疡病史为变量,分析上述变量在两组患者中的差别,采用Logistic回归分析方法确定应激性溃疡发生的危险因素。结果：两组患者在机械通气、凝血功能障碍、低血压、颅脑损伤、肝功能衰竭和创伤方面存在差异（P〈0.05）,机械通气、凝血功能障碍、低血压和颅脑损伤是危重症患者应激性溃疡发生的危险因素。结论：当危重症患者并发存在机械通气、凝血功能障碍、低血压和颅脑损伤时应加强应激性溃疡的预防治疗。     

Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

OBJECTIVE: To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients. DESIGN: Prospective cohort study. SETTING: Adult intensive care department of a university medical center. PATIENTS: Critically ill patients (n = 399). INTERVENTIONS: A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six. CONCLUSIONS: The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.     

重症监护室患者非骨隆突部位压疮原因分析及对策

目的：分析重症患者非骨隆突部位压疮的原因并提出相应护理对策.方法：收集从2011年12月～2012年12月我医院重症监护室收治的40例非骨隆突部位压疮患者的临床资料并进行回顾性分析,同时研究防治非骨突部位压疮的主要对策.结果：重症监护室患者头面部、上肢、腰背臀部是非骨突部位发生压疮的主要部位.结论：分析重症监护患者非骨隆突部位压疮发生的原因,并进行危险因素评估,采取针对性的护理措施利于降低重症患者非骨突部位压疮的发生率.     

手术患者压疮发生率及发生时间和影响因素研究

目的：探讨手术患者压疮发生率、发生时间特点和相关因素,为临床制定应对措施提供依据。方法：按照统一标准在12所综合医院中入选1074例术后患者,预防措施相同,采用“外科压疮风险评估表”收集每例患者术后0～5d基线资料,使用Braden计分量表评估压疮危险。采用Logistic回归分析压疮发生的影响因素。结果：观察期内1074例手术患者中发生11例11处Ⅰ期压疮,发生率1.02%,其中外科监护病房发生率1.95%。多发生在术后1～3d内。压疮发生的影响因素为：手术时间、术后皮肤水肿和使用矫形装置及Braden计分（P〈0.05）。结论：对手术时间≥2h、术后皮肤水肿、使用矫形装置及Braden计分≤16分的患者应作为术后压疮预防的重点对象,但Braden量表对围手术期患者压疮风险的预测作用尚有待于进一步研究。     

Incidence of pressure ulcers in a neurologic intensive care unit

OBJECTIVES: To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. DESIGN: Cohort study of patients with no preexisting ulcers with a 3-month enrollment period. SETTING: The neurologic intensive care unit and the neurologic intermediate unit at a primary care/referral hospital with a level I trauma center. PATIENTS: A total of 186 patients entered the study. INTERVENTION: Within 12 hrs of admittance, initial assessment, photographs, and Braden score were completed. Patients were re-examined every 4 days or at discharge from the unit, whichever came first. MAIN OUTCOME MEASURES: Determining risk factors for pressure ulcers, performing detailed statistical analyses, and testing the usefulness of the Braden score as a predictor of pressure ulcer risk. RESULTS: Twenty-three of 186 patients developed at least one pressure ulcer (incidence = 12.4%) after an average stay of 6.4 days. The Braden scale, which measures six characteristics of skin condition and patient status, proved to be a primary predictor of ulcer development. No ulcers developed in the 69 patients whose Braden score was 16 or higher. The likelihood of developing a pressure sore was predicted mathematically from the Braden score. However, being underweight was a significant and distinct factor in pressure ulcer development. CONCLUSIONS: Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of < or = 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of < or = 13 and/or a low body mass index at admission.     

脊柱后路手术中压疮预防的对照研究

[目的]探讨脊柱后路手术中预防压疮的措施及效果,并调查脊柱后路手术中病人发生压疮的危险因素,为完善手术中压疮的评估方法提供依据。[方法]选取行脊柱后路手术的病人100例,随机分为两组,实验组使用康惠尔透明贴和泡沫敷料预防压疮;对照组使用手术室常规防护措施,术后0h、24h、72h对病人进行压疮评估。[结果]术前血红蛋白、年龄、术中出血量是术中压疮发生的危险因素（P〈0.05）,对照组病人术后发生压疮5例,实验组病人术后发生压疮2例,两组比较有统计学意义（P〈0.05）。[结论]康惠尔透明贴和泡沫敷料对于脊柱后路手术中压疮的预防有一定作用。     

危重病患者循环内皮细胞数量和氧代谢指标的动态变化

目的探讨危重病患者循环内皮细胞（CEC）数量、氧代谢指标的动态变化。方法35例危重病患者，20例健康体检者作为对照。用等密度梯度离心法分离血CEC，危重病患者右颈内静脉Swan Ganz导管血流动力学监测，于病后3、6、9和12d又各采集静脉血2mL，并记录其氧分压、血氧饱和度（SaO2）、血红蛋白（Hb）、CEC等指标，计算氧供（DO2）、氧耗（VO2）。结果危重病组与正常对照组比较，CEC数量明显增加，差异有显著性（P〈0.05）。危重病组患者3d内VO2随DO2增加的幅度增大，表明DO2和VO2呈病理性依赖关系；但3d后随着DO2增加，VO2的增加速度明显趋于平缓，VO2与DO2之间呈非依赖性关系。结论危重病患者血管内皮细胞功能受损，氧耗增加。     

Immobility--a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study

OBJECTIVE: To identify risk factors associated with pressure ulcer development among adult hospitalized medical and surgical patients. DESIGN: A prospective comparative study including 530 adult patients from medical and surgical wards. Registered Nurses made the data collection on admission and once a week for up to 12 weeks. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, including the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin. RESULTS: Sixty-two (11.7%) patients developed 85 pressure ulcers. The most common pressure ulcer was that of nonblanchable erythema. Patients who developed pressure ulcers were significantly older, hospitalized for a longer time, had lower scores on the total RAPS scale, had lower weight and lower diastolic blood pressure than nonpressure ulcer patients did. In the multiple logistic regression analyses using variables included in the RAPS scale immobility emerged as a strong risk factor. When adding remaining significant variables in the analyses, mobility, time of hospitalization, age, surgical treatment and weight were found to be risk factors for pressure ulcer development. CONCLUSION: It is confirmed that immobility is a risk factor of major importance for pressure ulcer development among adult hospitalized patients. The results also indicate that the RAPS scale may be useful for prediction of pressure ulcer development in clinical practice.