神经外科患者发生压疮的危险因素分析

目的 分析神经外科患者发生压疮的危险因素,为制定预防压疮有效措施提供依据.方法 收集神经外科有压疮发生危险的129例患者的一般资料及相关指标进行多元逐步Logistic同归分析,找出压疮发生的危险因素.结果 意识水平、活动能力、Braden得分是压疮发生的独立危险因素(P<0.05).结论 神经外科压疮预防应该更加关注意识、活动能力方面的评估,根据Braden量表评估结果进行有针对性的预防.     

压疮风险评估会诊单在手术室压疮高危患者管理中的应用

目的：探讨手术室压疮高危患者压疮管理的方法,以降低高危患者在体位安置时压疮的发生率。方法：采用手术室压疮高危患者压疮风险评估会诊单对手术患者进行评估,并对护理干预进行有效管理。结果：236例压疮高危患者中,220例无压疮发生,16例术后发生难免性压疮。结论：手术室压疮高危患者压疮风险评估会诊单的应用,能有效降低因为体位安置不当导致的压疮发生率。     

重症胰腺炎合并MODS患者压疮的预见性管理

[目的]探讨重症胰腺炎(SAP)合并多器官功能障碍综合征(MODS)患者压疮的预见性管理措施.[方法]回顾性分析52例SAP合并MODS患者的临床护理资料,采取评估筛查、个体化预防措施、动态持续质量评价等方法预见性的进行压疮管理.[结果]52 例患者仅一例发生难免压疮,压疮发生率1.9%.[结论]重视SAP合并MODS患者压疮的预见性护理,能有效预防压疮的发生.     

聚酯泡沫敷料在骨科医疗器械下方压疮预防中的应用

[目的]应用聚酯泡沫敷料预防骨科医疗器械下方压疮的效果分析。[方法]将240例使用骨科医疗器械病人随机分为对照组和观察组各120例,对照组使用传统方法预防压疮,观察组在传统方法的基础上加用聚酯泡沫敷料,比较两组压疮发生情况。[结果]观察组压疮发生率明显低于对照组(P0.05)。[结论]通过对骨科医疗器械下方压疮成因进行分析,采用聚酯泡沫敷料保护压疮易发生部位,可有效控制骨科医疗器械下方压疮发生。     

连续性肾脏替代治疗中骶尾部压疮的危险因素分析及防护措施

[目的]分析连续性肾脏替代治疗(CRRT)中骶尾部压疮的危险因素,探讨防护措施。[方法]回顾性分析CRRT中骶尾部压疮发生因素,制订综合干预措施,对入住重症监护室(ICU)行 CRRT 38例病人进行压疮高危因素评估、局部减压、体温管理、营养支持、心理支持等干预护理。[结果]38例中有5例发生骶尾部压疮,经过护理4例愈合良好。[结论]对 CRRT 病人进行压疮危险因素分析并进行有针对性的预防护理,可有效减少压疮的发生。     

神经内科昏迷患者压疮的预防性护理干预

目的：分析神经内科昏迷患者的压疮预防性护理效果。方法：针对压疮预防护理方式的不同将60例患者分为预防性护理干预组（干预组）和常规昏迷护理组（对照组）,观察两组患者住院期间的压疮发生情况。结果：干预组2例患者发生压疮,压疮均为I度,压疮的发生率为6.67%,对照组7例患者发生压疮,其中I度压疮4例,II度压疮3例,压疮发生率为23.33%,两组患者在压疮发生率之间的差异有统计学意义（P<0.05）。结论：针对神经内科昏迷患者压疮发生的危险因素进行预防性护理干预能够有效降低压疮的发生率。     

骨科患者发生压疮的早期预防及护理

目的:探讨骨科患者发生压疮的早期预防及护理措施。方法:对39例骨科患者给予早期压疮预防及积极护理干预。结果:本组24例院外带入压疮患者中1例放弃治疗,其余均痊愈出院;15例难免压疮患者中13例未发生压疮,另2例发生Ⅱ期压疮,经积极治疗后痊愈。结论:有效的早期预防和护理措施,能减少压疮的发生,提高压疮治愈率。     

肿瘤骨转移84例压疮高危因素分析及干预对策

目的分析骨转移癌患者发生压疮的高危因素并提出有针对性的措施。方法对2009-10-2010-08 84例住院患者进行压疮发生高危因素分析,在伤口专业护士指导下采取有针对性的干预措施,观察效果。结果84例患者中发生Ⅰ期压疮17例,占16%,未发生Ⅱ期以上的压疮。结论通过评估,有针对性的采取个性化的干预措施,能有效降低骨转移患者的压疮发生率。     

体外循环术后患者头枕部并发压疮的护理

目的:分析体外循环术后患者头枕部并发压疮的原因,探讨预防体外循环术后患者头枕部压疮发生的有效措施。方法:对我科26例体外循环术后发生头枕部压疮的患者进行原因分析,并采取针对性的护理措施。结果:26例体外循环术后患者头枕部压疮得到有效控制。结论:通过对体外循环术后患者全面详细的评估,加强对头枕部皮肤的观察,及时采取有效的措施防止头枕部压疮的发生。     

手术中发生压疮的相关因素及预防措施

目的 对手术中发生压疮相关因素进行分析,并探讨预防措施.方法 对578例手术患者术中发生压疮相关因素进行分析.结果 年龄、麻醉方式、手术持续时间、手术体位是手术中发生压疮的相关因素.结论 进行积极的预防和护理可有效降低患者术中发生压疮的概率,提高患者的舒适度和护理质量.     

压疮小组在临床压疮管理中的运行及效果

目的探讨压疮小组在临床压疮管理中的运行及效果。方法以压疮小组成立前2011年的压疮高危和院外带入压疮患者共145例为A组,采用传统防治压疮的方法;以压疮小组成立后2012年的压疮高危和院外带人压疮患者共199例为B组和2013年的压疮高危和院外带入压疮患者共380例为c组,由压疮小组制定压疮预防与治疗方案并监督实施;各护理单元推荐1名临床护士作为科室压疮督导员,共30人,成立压疮小组后进行统一培训与管理。比较压疮小组成立前后患者住院期间难免压疮发生率、院外带入压疮治愈率及压疮督导员的压疮相关知识水平。结果A、B、C组难免压疮发生率分别为76．20％、17．02％、14．61％,带人压疮治愈率分别为54．84％、86．84％、87．97％,B、C组与A组比较,差异均有统计学意义（P〈0．01）。护士压疮相关知识水平明显提高（P〈0．001）。结论成立压疮小组使临床压疮管理更具科学性和客观性,能有效降低压疮发生,提高护理质量,保障患者安全。     

Incidence of pressure ulcers due to surgery

Patients undergoing surgery are prone to develop pressure ulcers during the surgical procedure. The aim of the study was to gain insight into the problem by describing the incidence, clinical features and progression of pressure ulcers and closed pressure ulcers in patients undergoing surgery lasting more than 4 hours. A prospective follow-up study was conducted in a university hospital in the Netherlands. Two-hundred and eight patients from nine surgical specialities were included in the study. The skin of patients was observed the evening before surgery and, if the patient's condition allowed it, directly postoperatively and subsequently daily for 14 days or until discharge, whichever occurred first. When patients developed a pressure ulcer they were observed daily until discharge or until the pressure ulcer had healed. The size and colour of the lesion, stage and skin condition were described every day. In addition, data were collected concerning the operation, postoperative period, and general characteristics. Forty-four patients (21.2%) developed 70 pressure ulcers in the first 2 days following surgery. Twenty-one pressure ulcers deteriorated in the days following surgery. More than half (52.9%) of the lesions developed on the heels, and 15.7% developed in the sacral area. Twenty-five patients (12%) were impaired by the lesions they developed. None of the patients in the study developed closed pressure ulcers. Pressure ulcer development during a surgical procedure is a serious problem. Therefore, preventive measures should be taken during surgery and the first few days afterwards, until the patient is able to mobilize independently.     

Are patients with or at risk of pressure ulcers allocated appropriate prevention measures?

The aims of the study were to investigate the risk for and prevalence of pressure ulcers in different medical care groups, to discover if patients at risk for or with pressure ulcers are allocated appropriate pressure ulcer preventions and to investigate which variables are associated with appropriate pressure ulcer preventions. A cross-sectional survey design was used and followed the methodology developed by the European Pressure Ulcer Advisory Panel. A total of 612 patients participated in the study. The prevalence of pressure ulcers was greatest in geriatric care, followed by intensive care, acute care and neurological care. The majority of patients at risk for or with pressure ulcers did not receive appropriate preventative measures, either while they were in bed or in a chair. Significant variables associated with appropriate preventions in bed were intensive care, geriatric care, a low Braden score, a low score in the subscale activity and a long hospital stay.     

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.     

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact

OBJECTIVE: To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation. PARTICIPANTS: Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. RESULTS: Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. CONCLUSIONS: Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.     

规范化压疮管理体系的建立及应用

目的：构建规范化的压疮护理管理体系,并评价其应用效果。方法：自2013年起,成立皮肤治疗小组,分析压疮管理存在的问题,建立三级压疮监控管理组织和评估制度,完善上报、会诊和考评制度,形成了一套规范化的压疮管理体系。结果：2013-2015年3年院外带入压疮治愈/好转率分别为60.69%、71.73%和82.31%;2013-2015年压疮风险评估准确率、压疮预防措施正确率、压疮评估准确率、压疮护理措施正确率和患者满意率均呈现逐年升高趋势,差别均有统计学意义（P＜0.05）。结论：规范化压疮管理体系的建立,使压疮管理科学化、规范化,提高了压疮治愈效果,保障护理措施落实到位,提高了压疮护理质量和管理水平。     

Predicting pressure ulcers: cases missed using a new clinical prediction rule

AIM: The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'. BACKGROUND: Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified. METHODS: Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission. RESULTS: Patients who developed pressure ulcers experienced more problems with 'friction and shear' and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions. CONCLUSION: We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule from patients who were correctly classified as 'not at risk'. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.     

Incidence, prevention and treatment of pressure ulcers in intensive care patients: a longitudinal study

Background

Pressure ulcers are common in acute and long-term care. However, critically ill patients usually have multiple risk factors for pressure ulcers.

Objectives

The study was conducted to assess pressure ulcer incidence in intensive care patients, the factors related to pressure ulcer incidence and the course of pressure ulcers after the admission to an intensive care unit.

Design

A longitudinal design.

Setting

This study was carried out in cardiological and surgical intensive care of a general hospital and in a nephrological intensive care of a university hospital.

Participants

All patients admitted to intensive care wards during the period from April until October 2006 were invited to take a part in the study. One hundred and twenty-one patients were involved in the study. The inclusion criteria were adult intensive care patients, males and females, all diagnosis were included. The exclusion criterion was patients whose age less than 18 years.

Method

Each patient was assessed twice; first, upon admission and second upon discharge or death, or after 2 weeks if the patient was still in intensive care. The assessed data included pressure ulcer preventive measures, risk factors using Braden score, pressure ulcer characteristics and treatment. Additionally, incontinence supplies (urine/bowel) if used and the severity of illness using Acute Physiology and Chronic Health Evaluation (APACHE II score) were assessd.

Results

This study revealed a total incidence of 3.3% (4.5% in nephrological patients and 2.9% in surgical patients). Sixteen patients with a total of 21 pressure ulcers were admitted to the intensive care units. During the patients’ stay at the intensive care units six pressure ulcers developed newly and five pressure ulcers healed. The mean of the APACHE II score of patients with new pressure ulcers (16.6) were higher than in patients without new pressure ulcers (11.5).

Conclusion

Pressure ulcer incidence is low in this study compared to other studies. Pressure ulcers can be healed in intensive care patients. Using some preventive measures such as foam and alternating air pressure mattresses may help to decrease pressure ulcer development. Hydrocolloid dressing may help to increase the healing rate of pressure ulcers.