压疮防治与护理体会

目的:通过对压疮易感人群实施有效的预防护理措施及综合治疗,以达到减缓压疮形成及最终治愈压疮的目的.方法:减少压力,保护皮肤,增加营养,对压疮的不同时期实施物理或药物治疗.结果:通过早期合理的预防护理措施,有效防止了压疮的形成.结论:通过对不同时期压疮的治疗与护理,使已经形成的压疮都得到不同程度的改善.     

褥疮护理的研究进展

压疮的发生存在多种危险因素,且彼此相互影响.本文结合近年来压疮发展各方面观念的转变,从压疮主要危险因素、发病原理和治疗护理方法等多方面进行综述,认为压疮应重在预防,并体现因素完整性和人群针对性.     

自制压疮灵治疗第三期压疮患者的疗效观察

目的 观察自制压疮灵治疗压疮的疗效.方法 对42例第三期压疮患者的疮面进行不同方法的治疗.结果 42例压疮患者26例痊愈、15例显效、1例无效.结论 自制压疮灵治疗压疮疗效显著,无不良反应,且降低了医疗护理费用.     

晚期肿瘤患者压疮的预防与护理

目的：为晚期肿瘤患者寻找更加科学,有效地预防、护理和治疗压疮的方法。方法：对30例晚期肿瘤卧床患者进行翻身、擦浴、加用气垫床、加强营养以及消毒、消炎药定期涂擦创面等方法,进行压疮的防治和护理工作。结果：除院外压疮2例治疗痊愈外,其余均未发生压疮。结论：晚期肿瘤患者是压疮高发人群,采取有效的防治和护理,不但能减少压疮的发生,消除患者的痛苦,提高患者的生存质量,同时也提高了患者的满意度。     

晚期肿瘤患者压疮的预防与护理

目的:为晚期肿瘤患者寻找更加科学,有效地预防、护理和治疗压疮的方法。方法:对30例晚期肿瘤卧床患者进行翻身、擦浴、加用气垫床、加强营养以及消毒、消炎药定期涂擦创面等方法,进行压疮的防治和护理工作。结果:除院外压疮2例治疗痊愈外,其余均未发生压疮。结论:晚期肿瘤患者是压疮高发人群,采取有效的防治和护理,不但能减少压疮的发生,消除患者的痛苦,提高患者的生存质量,同时也提高了患者的满意度。     

深度压疮创面护理的研究进展

目前压疮多以局部治疗,包括清创、负压封闭引流、西药制剂治疗、中药制剂治疗及新型保湿敷料。本文对深度压疮创面治疗进行了综述。提出应根据病人实际情况选择合适的药物及治疗方法,以促进压疮早期愈合。     

呼吸内科压疮风险因素分析及护理对策探讨

目的：分析呼吸内科压疮风险因素,探讨其护理对策。方法：采用Braden压疮风险评估表,筛选出55例Braden评分≤16分患者,对其存在的风险因素进行风险评估和分析。结果：呼吸内科存在的压疮高危因素依次是摩擦力和剪切力、移动能力大小、活动是否受限、潮湿与否、营养状态以及感觉有无障碍。结论：呼吸内科存在诸多压疮高危因素,应针对不同情况给予相应预防措施并根据压疮分期区别对待,才能取得满意的效果。     

髋部骨折患者发生压疮的医护干预

目的 对压疮的预防护理,在于避免髋部骨科住院患者的压疮发生几率,要求医护人员通过探索及讨论压疮预防与护理的方法,综合分析临床疗效,从而总结临床护理经验,使患者及其家属得到较为满意的答复.方法 采用随机抽样的方法,在对患者进行功能锻炼的同时,采用压疮风险评估量表(危险因素评估),对病人实施有效的预防护理干预,加强对病人的轮换护理.结果 实验中所选取患者中大多数通过实施一系列的护理干预措施后,其髋部压疮发生率明显有效降低,同时护理人员的自身素质得到提高,加强了其对压疮病情的及时护理剂预防意识.结论 在临床治疗中我们应及时采取措施防预防压疮的发生,从而有效降低压疮发生率,给患者的髋部病情的及时恢复提供了有利条件.同时,我们总结出压疮的治疗需要多学科的合作,一般由皮肤科、外科、创伤科护士和康复医师共同进行治疗干预,在特殊情况下时,还要心理科、感染科及营养科的支持.     

老年卧床患者压疮的防治及护理

目的：探讨老年卧床患者压疮的防治及护理.方法：本人阅读大量的相关文献,就压疮形成的原因及老年卧床患者压疮的防治及护理治疗进行总结. 结果：把压疮消灭在萌芽状态,所有进行防治和护理的患者发生压疮的机率下降.结论：通过采用各种综合性护理措施干预和治疗,具有良好效果,认真分析发生压疮的原因,采取积极的预防措施,能减轻老年患者的痛苦,提高生活质量具有重要的意义.     

压疮患者的治疗、护理和预防

目的:对压疮发生的原因进行分析,并提出有效的护理措施和治疗,以便于提升提高护理效果,采取相应的预防措施,预防压疮的发生,促使患者的疾病康复和生活质量得到提升.方法:对压疮发生进行调查和分析,并采取针对性的治疗于护理,从而使患者得到康复.结果:8例压疮患者均治愈.结论:长期卧床患者的发生压疮的概率很高,采取科学的治疗方法护理措施以及预防措施气起到很大的作用,能明显减少压疮的发生.     

Micronutrients decrease incidence of common infections in type 2 diabetic outpatients

A randomized, double-blind, placebo-controlled trial was carried out to investigate the effects of micronutrients supplementation on immunity and the incidence of common infections in type 2 diabetic outpatients. A total of 196 type 2 diabetic outpatients were randomized to receive tablets of micronutrients (n=97) or placebo (n=99) for 6 months. Individualized dietary energy intake and daily physical activity were recommended. Anthropometric measurements, blood biochemical variables and the incidence of common infections were measured at baseline and at 6 months. Data on diet, exercise and infection (upper respiratory tract infection, skin infection, urinary and genital tract infections, other infections) were recorded 1 month before the study and every month during the study. Blood concentrations of total protein, iron (Fe), folic acid and hemoglobin increased and unsaturated iron-binding capacity(UIBC) levels were decreased in the micronutrients supplementation group compared to the placebo group at 6 months. Moreover, at 6 months, compared to the placebo group, the blood concentrations of IgE, CD4+, CD4+/CD8+, WBC, lymphocyte counts, basophilic leukocyte increased and CD8+ count decreased in the supplementation group, and the levels of IgA, IgM, IgG and complements C3 and C4 did not differ. The incidence of upper respiratory infection, whitlow, dermapostasis, vaginitis, urinary tract infection, gingivitis and dental ulcer were lower and body temperature and duration of fever greatly improved in the supplementation than the placebo group. These data indicated that supplementation of micronutrients might increase immune function and reduce the incidence of common infections in type 2 diabetic outpatients.     

纽曼系统模式在压疮管理中的应用探析

目的:探讨纽曼系统模式在压疮管理中的应用效果.方法:应用纽曼系统模式对23例压疮或压疮高危患者进行护理干预,与对照组比较院内压疮发生率及护理干预有效率.结果:两组患者在院内压疮发生率及护理干预有效率方面有明显的统计学差异.结论:纽曼系统模式应用于压疮管理,能降低院内压疮发生率,提高护理干预有效率.     

浅谈推拿技术在褥疮的防治中的应用

褥疮是皮肤出现的最严重的问题之一,对于长期卧床的患者,稍微不及时的护理措施,患者都可能在原发病的基础上并发褥疮。褥疮的防治最重要的就是及时让患者更换体位,出现褥疮时应当根据褥疮分期,辨证用推;重点部位、重点施治;病症同治,全面护理的推拿办法治疗。但是,并不是所有的褥疮都能预防的,只有更好的提高护理人员及患者预防褥疮发生的意识,才能将褥疮的病发率降到最低。     

Hypotension Is a Risk Factor for New Pressure Ulcer Occurrence in Older Patients After Admission to an Acute Hospital

BackgroundPressure ulcer occurrence in older patients admitted to hospital has not been studied thoroughly; yet, pressure ulcers frequently develop among the frail older patients who are hospitalized. Identifying risk factors for pressure ulcer occurrence is of utmost importance in preventing its development in this group of patients. Hypoperfusion, as manifested by hypotension, is theoretically important in the development of pressure ulcer. However, studies on this aspect are scarce.ObjectiveTo examine whether a hypotensive episode (systolic blood pressure less than or equal to 90 mm Hg) is associated with pressure ulcer occurrence.MethodThis was a retrospective cohort study in a regional hospital. It recruited 259 patients aged 65 or older who were admitted to a convalescence ward and had a hospital stay for more than 5 days. Baseline clinical characteristics and the possible risk factors of pressure ulcer occurrence on admission and any episode of hypotension were recorded. The primary outcome measured was the incidence of pressure ulcer occurrence in the index admission.ResultsHypotension was strongly associated with incident pressure ulcer occurrence (odds ratio 6.71, P = .001).ConclusionsHypotension was an important risk factor for incident pressure ulcer occurrence during hospital stay. Every effort has to be taken to try to prevent hypotension. Precautions to prevent pressure ulcer development should be taken on patients who are hypotensive.     

SHEL事故分析法在ICU获得性压疮预防中的应用研究

目的采用SHEL模式分析ICU医院内获得性压疮发生的原因,以降低其发生率。方法采用SHEL模式分析ICU20例医院内获得性压疮病例并制订对策,比较采取控制措施前、后ICU压疮预防的效果。结果采取控制措施前ICU医院内获得性压疮发生率为6.25%,SHEL模式分析结果为与人员素质和能力有关(S)占30.0%,与硬件有关(H)占20.0%,与临床环境有关(E)占35.0%,与当事人及他人有关(L)占15.0%;采取控制措施后ICU医院内获得性压疮发生率为2.83%,显著低于采取措施前(P<0.05),SHEL模式分析结果为15.4%与S有关、15.4%与H有关、30.8%与E有关、38.4%与L有关。结论应用SHEL模式分析ICU医院内获得性压疮发生的原因,制定有效的措施,对降低ICU医院内获得性压疮的发生率有着积极的意义。     

伤口专科护理小组在压疮护理管理中的作用

目的观察开展伤口专科小组对压疮护理记录的影响效果。方法选择2009年1月至2009年12月成立伤口专科小组前的50例护理记录为实施前组,选择2012年1月至2012年12月成立伤口专科小组运作1年后的56例护理记录为实施后组．通过回顾调查实施前后两组病历中与压疮预防、治疗、处理等有关的护理记录内容进行对比分析效果。结果压疮大小、减压措施采用率及压疮风险评估、告知制度落实均明显提高,与实施前比较差异具有统计学意义（P〈0．05）。结论建立伤1：2小组使压疮伤口护理记录更规范．培养护士防治压疮的新理念．减少护理不良事件的发生．     

Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale

To derive a brief bedside pressure ulcer prediction tool for patients admitted to acute care hospitals, we conducted a prospective study of first pressure ulcer incidence among 1,190 consecutive patients hospitalized in selected wards of a Swiss teaching hospital. Baseline predictors included patient age and items from the Norton and Braden ulcer prediction scales. During follow-up, 170 patients developed new pressure ulcers. The predictive ability of baseline assessments decayed over time. Occurrence of first pressure ulcer in the 5 days after admission (129 events) was best predicted by patient age (5 levels), mobility (3 levels), mental status (3 levels), and friction/shear (3 levels). The Fragmment score (sum of friction, age, mobility, mental status) was linearly related to pressure ulcer risk, and its area under the receiver operating characteristic curve (0.80) was higher than for the Norton (0.74; P = 0.006) and Braden (0.74; P = 0.004) scores. This brief pressure ulcer prediction scale performed well in an acute care setting. Use of this scale may facilitate the implementation of pressure ulcer prevention interventions.     

老年髋部骨折围手术期疼痛控制对骶尾部压疮的影响

目的探究疼痛控制治疗对老年髋部骨折患者围手术期骶尾部压疮发生率和压疮病变严重程度的影响。 方法连续纳入2011年10月至2014年10月解放军第一八○医院骨科收治的214例老年髋部骨折患者(男性84例,女性130例;年龄61～90岁)进行前瞻性随机对照研究。将患者按随机表分为治疗组(121例)和对照组(93例)。对照组采用标准治疗方法,未进行特别疼痛治疗;治疗组除标准治疗方法外,还接受不同方法的疼痛控制治疗。治疗组患者根据镇痛方式不同,进一步按确诊顺序根据随机表分为4个亚组：静脉泵镇痛组(30例,地左辛注射液、高乌甲素注射液、哌替啶注射液,个体化用药,持续静脉泵入)、规律肌肉注射镇痛药组(24例,双氯芬酸钠利多卡因2 mL,肌注,2次/d)、口服中枢镇痛药组(33例,镇痛药物为氨酚羟考酮片5 mg,口服,3次/d)和口服非甾体类镇痛药组(34例,双氯芬酸钠释片,75 mg,口服,1次/d)。观察各组患者骶尾部压疮的发生率;入院时、术前和术后1周Braden压疮评分,术后1周压疮严重程度分级,药物镇痛的不良反应情况。 结果治疗组和对照组患者入院时和术前的Braden压疮评分差异均无统计学意义(P均>0.05);疼痛控制治疗组患者在术后1周的Braden压疮评分为(12.6±3.3)分,低于对照组的(14.8±3.4)分,差异有统计学意义(P<0.01)。各疼痛控制治疗亚组在入院时、术前和术后1周时Braden压疮评分间的差异均无统计学意义(P均>0.05)。对照组患者压疮发生率为23.66%(22/93),高于疼痛控制治疗组的10.74%(13/121),差异有统计学意义(P<0.05),但各疼痛控制亚组压疮发生率间的差异无统计学意义(P>0.05)。治疗组和对照组压疮的等级差异均有统计学意义(P<0.01),而四个疼痛亚组间的压疮等级比较差异无统计学意义(P>0.05)。静脉泵镇痛组和口服中枢镇痛药组出现呕吐和神经系统不良反应较明显;肌肉注射镇痛药组和口服非甾体类镇痛药主要产生胃肠道不良反应,通过制酸和保护胃粘膜等治疗后症状缓解或消除。 结论合适的疼痛控制可减少老年髋部骨折围手术期压疮的发生。在镇痛方法的选择上,肌注和口服非甾体类镇痛药使用方便、耐受性好、效果确切,但应注意预防胃肠道反应。     

Summary of 'Decubitus' guideline of the Dutch College of Family Practitioners

The guideline 'Decubitus' published by the Dutch College of General Practitioners contains guidelines with instructions for prevention, diagnosis and treatment of pressure ulcers in primary care. The classification used for severity is: redness of the skin, superficial damage, superficial ulcer, deep ulcer. This classification follows the one used internationally and the one in the consensus of the Dutch Institute for Health Care Improvement CBO. For each patient who becomes (totally or partly) immobile measures to prevent pressure ulcers are necessary, with emphasis on minimizing pressure and shearing forces acting upon the skin. After a pressure ulcer has developed these measures remain important. Guidelines for treatment are given for each level of severity of the pressure ulcer; the main aim is to keep the ulcer moist, to remove necrosis and exudate and to treat infection.