氧合作用和血流灌注指标对ICU患者压疮发生的预警作用

目的 了解ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性,为临床预防压疮提供依据.方法 采用自行设计问卷,通过皮肤检查和查阅病历,收集ICU患者的压疮发病情况及氧合作用和血流灌注指标等资料,将226例分为压疮组52例(为医院获得性压疮),非压疮组174例,并用SPSS15.0对各因素进行统计分析.结果 两组在年龄、动脉血酸碱度、动脉二氧化碳分压、收缩压、舒张压、平均动脉压及Braden评分等方面的差异有统计学意义(P<0.05);经多因素非条件Logistic回归分析,平均动脉压和Braden评分增加为ICU压疮的保护因素,呼吸系统疾病、外伤和其他类型疾病是ICU压疮的危险因素.结论 ICU患者是压疮的危险人群,平均动脉压和Braden评分高者发生压疮的危险较小,呼吸系统疾病、外伤和其他类型疾病的患者发生压疮的危险较大,年龄可能是压疮的间接危险因素.建议临床医护人员加强对ICU患者的血流动力学和动脉血气分析指标的监测,从中获取压疮预警信息,采取适当的预防措施,以降低压疮的发生率.     

压疮危险因素评估量表在ICU患者中预防压疮应用现状研究进展

使用压疮危险因素评估量表评估压疮风险度是重症监护室(intensive care unit,ICU)患者预防压疮发生的重要及首要措施。本文通过对压疮危险评估量表相关文献的总体回顾,探讨其在ICU患者预防压疮应用现状中存在的问题,以期为ICU患者选择合适的压疮危险因素评估量表提供依据,帮助解决现有问题从而有效预防压疮,降低压疮的发生率。     

ICU住院患者发生院内获得性压疮的危险因素分析

目的 :分析ICU住院患者发生院内获得性压疮的危险因素。方法 :采用自制的ICU压疮发生情况资料收集表与ICU压疮预警相关因素资料收集表对2011年10月至2013年10月在广州市某三级甲等医院ICU(MICU、CCU)住院的468例患者资料进行回顾,采用Logistic回归分析ICU压疮的危险因素。结果 :多因素Logistic回归分析显示,高龄、ICU住院日延长、舒张压偏低、清蛋白偏低、有机械通气、有大便失禁为ICU压疮的独立危险因素,Braden总分为保护因素(P0.05)。结论 :应针对ICU压疮高危人群和危险因素采取针对性预防措施,警惕高龄、ICU住院日延长、舒张压偏低、清蛋白偏低、机械通气及伴有大便失禁的患者,重视Braden评分的准确性与规范化。     

压疮高危患者临床特征及危险因素分析

目的分析压疮高危患者的临床特征、管理现状及高危患者压疮发生的影响因素,探讨切实的压疮预防对策。方法采用压疮危险因素评估表筛选压疮高惫患者,并对其临床特征、压疮发生的危险因素和管理现状进行分析。结果2007年3-12月共有315例压疮高危患者,以ICU分布最多,占32．4％,其次为神经外科,占18．74％;初评分（16．91&#177;2．29）分;压疮高危期持续时间（13．00&#177;18．00）d;315例压疮高危患者中共发生压疮19例。高危期持续时间是高危患者发生压疮的危险因素,意识清醒、扶助行走、体温正常和压疮终评分是发生压疮的保护因素。压疮高危患者管理中仍存在忽视高危患者家属教育及预防措施落实、记录不全等问题。结论重视ICU等压疮高危高发科室和压疮高危持续期长患者的管理,根据压疮发生的危险因素科学定义难免压疮,建立护理会诊制度和压疮护理指南等规范压疮高危患者的过程管理,可有效预防和减少压疮的发生。     

ICU患者发生压疮的危险因素分析

目的分析ICU患者发生压疮的相关危险因素,探讨减少压疮的干预措施。方法比较2012年1月~2012年6月入住ICU的112例患者的临床特点,发生压疮的为压疮组共16例,未发生压疮的为对照组96例,采用多因素回归分析筛选发生压疮的危险因素。结果压疮组男性、来自急诊比例、APACHEⅡ评分和水肿比例均显著高于对照组。压疮组移动能力、潮湿、营养和摩擦/剪切力评分均显著低于对照组,差异均具有统计学意义(P0.05)。多因素回归分析,APACHEⅡ评分和水肿是发生压疮的独立危险因素(P0.05)。结论 ICU,APACHEⅡ评分和水肿是预测发生压疮的独立危险因素,来自急诊的患者压疮发生率高,护理人员需根据危险因素采取针对性的干预措施。     

外科重症患者压疮发生高危因素分析

目的：探讨外科重症患者压疮发生相关危险因素,为制定预防压疮的有效措施提供依据。方法：采用自设外科重症患者压疮危险因素调查表收集某三级甲等医院47例外科重症患者资料,将其中发生院内压疮的14例患者设为压疮组,未发生压疮的33例患者设为对照组,两组间对20项指标进行单因素分析及多因素Logistic回归分析,找出压疮发生的危险因素。结果：单因素分析显示,压疮组在ICU住院期间去甲肾上腺素使用总计小时数、动脉血乳酸最高值、机械通气总天数、血液净化治疗天数、排便失禁天数5项指标值高于对照组,差异有统计学意义（P〈0.05）;多因素Logistic回归分析显示,去甲肾上腺素使用总计小时数、动脉血乳酸最高值是压疮发生的高危因素（P〈0.05）。结论：应针对压疮高危人群和危险因素采取有针对性的措施,积极控制原发病,在抢救的同时采取积极的减压措施,以提高危重患者压疮防控的护理质量。     

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.     

前瞻性护理对急诊危重患者 ICU期间压疮形成的影响

目的：探讨前瞻性护理对急诊危重患者ICU期间压疮形成的影响。方法选取我院2012年2～10月ICU收治的危重患者80例为研究对象,随机分为对照组和观察组各40例,对照组常规护理,观察组在常规护理的基础上采用前瞻性护理干预,观察两组患者存在压疮高危因素的人数及压疮的发生率。结果观察组存在压疮高危因素4例,压疮发生率为0,对照组存在压疮高危因素9例,压疮发生率为7.5％,两组比较,差异有统计学意义（ P＜0.05）。结论采取前瞻性护理措施可有效降低压疮发生的高危因素,减少及预防急诊危重患者ICU期间压疮的发生,减轻患者的痛苦,提高生活质量。     

ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性研究

【目的】分析 ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性。【方法】113例ICU患者分为压疮组（26例）与非压疮组（87例）。比较两组患者入院时的一般情况、氧合作用与血流灌注指标,并对有意义的指标进行进一步的 Logistic回归分析。【结果】压疮的多发部位为骶尾部、臀部及肩胛部,大多数压疮患者的分期为Ⅰ期或Ⅱ期;压疮组平均年龄及入院诊断为呼吸系统疾病与外伤患者的比例明显高于非压疮组（P＜0．05）;压疮组与非压疮组动脉血酸碱度（pH）、动脉二氧化碳分压（PaCO2）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及Braden评分比较有统计学意义（P ＜0．05）;多因素分析结果显示高龄（β＝1．637,OR＝5．140）、呼吸系统疾病（β＝1．592,OR＝4．914）、外伤（β＝1．748,OR＝5．743）是 ICU患者发生压疮的危险因素,而高 MAP（β＝-1．528,OR＝0．217）、高Braden评分（β＝-1．705,OR＝0．182）是保护因素。【结论】高龄、呼吸系统疾病、外伤是 ICU患者发生压疮的危险因素,而高 MAP、高 Braden评分是保护因素。     

开胸术围手术期发生压疮的调查分析

目的 通过对胸外科围手术期压疮危险因素的评估,准确及时采取护理措施,预防压疮发生,提高护理质量及患者的生存质量.方法 应用压疮危险因素评估量表对100例开胸术后患者发生压疮的情况及危险因素进行调查,比较相关因素对压疮发生率的影响.结果 单因素分析显示,术前吸烟、白蛋白含量、术后翻身时间延长对压疮发生有显著影响.结论 开胸手术患者是院内压疮发生的高危人群,手术当天至手术后第3天为术后压疮预防的关键时期.     

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.     

集束干预策略在ICU患者压疮预防中的应用

目的探讨集束干预策略在重症监护室(intensive care unit,ICU)患者压疮预防中的应用效果。方法选择入住ICU治疗的289例患者为实验组,在压疮预防中实施集束干预策略;选择268例患者为对照组,在压疮预防中实施常规护理。比较两组患者压疮发生情况。结果实验组患者压疮发生率为2.1%低于对照组的5.2%,两组比较,P<0.05,差异具有统计学意义。结论采用集束干预策略可有效预防ICU患者压疮的发生。     

Pressure relief bedding to prevent pressure ulcer development in critical care

One major risk for the critically ill patient is the development of pressure ulcers during the intensive care unit (ICU) stay. These patients have many of the risk factors for the development of pressure ulcers including reduced mobility/activity, medications, neurologic deficits, increasing age, incontinence, decreased mental status, poor nutrition, pressure, shear forces, and friction. Pressure ulcers are known to be costly for the health care system and delay recovery in many patients. Different strategies have been advocated for the prevention of pressure ulcers, and the Agency for Healthcare Research and Quality (AHRQ) has identified the use of pressure relief bedding as a means to prevent the development of pressure ulcers during hospitalization. The use of pressure relief bedding has received the most research attention to date. The focus of this article is to describe the state of the current research in this area and how this applies to critical care. Development of protocols and guidelines for the use of pressure ulcer preventing strategies are important to improve the quality of care in the ICU.There is still a need to examine the impact of the evidence of pressure ulcer prevention in the ICU and this review should help to build a framework for future research and protocol development.     

Validity of the Waterlow scale for pressure ulcer risk assessment in the intensive care unit: a prospective analysis of 698 patients

Critically ill patients are at a particular risk for developing pressure ulcers. Yet until now, no sufficiently specific, validated pressure ulcer risk assessment instruments exist for critically ill patients. In a prospective study of 698 patients of medical intensive care unit (ICU), we therefore analyzed if the Waterlow scale is suitable for pressure ulcer risk assessment in the ICU. Only patients with no pressure ulcer on admission to the ICU were included. The Waterlow scale was used to assess pressure ulcer risk on admission to the ICU, and the number of points on the scale were analyzed with regard to pressure ulcers development in the course of the ICU stay (121 patients). Our results show that adequate pressure ulcer risk assessment on admission to the ICU is not possible with the Waterlow scale. Sensitivity and specificity reached their maximal values of 64.6% and 48.8%, respectively, at a comparably high cut-off of 30 points on the Waterlow scale (positive and negative likelihood ratio being 1.26 and 0.73, respectively). The area under the curve (AUC) was 0.59 in the receiver-operator-characteristic curve. Adding intensive care related parameters to the scale yielded some degree of improvement (AUC 0.69), but the development of ICU specific pressure ulcer risk scales still seems to be necessary to allow reliable pressure ulcer risk assessment in the ICU.     

Prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units

OBJECTIVE: Evaluating the prevalence, risk factors and prevention of pressure ulcers in Dutch intensive care units (ICUs). DESIGN: Cross-sectional design. SETTING: ICUs of acute care hospitals that participated in the 1998 and 1999 national prevalence surveys. Data were collected on 1 day in each year. PATIENTS: Eight hundred fifty patients admitted to Dutch ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six categories of data were collected: (1) characteristics of the institution, (2) characteristics of the ward, (3) characteristics of the patients (age, sex, date of admission, reason for admission), (4) risk assessment using the Braden scale and two additional risk factors (malnutrition and incontinence), (5) severity of the pressure ulcers and (6) supportive surface used. The prevalence of pressure ulcers was 28.7%. In a forward logistic regression analysis, four risk factors were significantly associated with the presence of pressure ulcers: infection, age, length of stay and total Braden score. Of the patients at high risk of developing pressure ulcers but without actual pressure ulcers, 60.5% were positioned on a support system. Only 36.8% of the patients who were determined to need repositioning were actually being turned. CONCLUSIONS: The prevalence of pressure ulcers in Dutch ICUs is high and their prevention is flawed, especially as regards the use of support systems. Patients for whom turning is indicated are not being turned. Predicting pressure ulcers in ICU patients is difficult and needs further investigation.     

综合性医院压疮现患率多中心联合调研

目的:获得综合性医院住院成人患者的压疮现患率和医院获得性压疮发生率,为下一步预防策略的制定提供依据。方法:采用统一的调研时间、工具、方法、流程及判断标准,组织统一培训合格的护士457名对12所综合性医院≥18岁的住院患者实施横断面调研,统计压疮现患率和医院获得性压疮发生率,采用SPSS16.0统计软件进行描述性统计分析。结果:压疮现患率为1.579%,医院获得性压疮发生率为0.628%。压疮现患率排序前三位科室分别为ICU、老年科、神经内科,医院获得性压疮发生率排序前三位科室分别为ICU、老年科、内科;前三位年龄分别为>89岁、80～89岁、70～79岁;前三位压疮部位分别为骶尾部、足跟部、髂嵴;前三位发生时段为不清楚发生时间、8∶00-12∶00和2∶00-8∶00。结论:本研究所获得的压疮现患率和发生率可代表我国部分地区住院患者的基线值。≥70岁者是压疮预防的重点对象;骶尾部、足跟部和髂嵴部是压疮重点防护部位;ICU、老年科和内科是重点预防科室;8∶00-12∶00和2∶00-8∶00是重点预防时段,值得注意的是有76.545%的压疮发生时段不清楚,因此需要加强护士的压疮预防意识并严格执行交接班制度,按要求检查皮肤。     

Pressure ulcer risk assessment immediately after cardiac surgery – does it make a difference? A comparison of three pressure ulcer risk assessment instruments within a cardiac surgery population

The intensive care unit (ICU) population has a high risk of developing pressure ulcers. According to several national expert guidelines for pressure ulcer prevention, a risk assessment for every situation in which the patient's condition is changing should be performed using a standardized risk assessment instrument. The aims of this study were to (a) assess the number of patients who are 'at risk' for the development of pressure ulcer according to three commonly used risk assessment instruments in the intermediate period after cardiac surgery procedures, (b) assess which instrument best fits the situation of the ICU patients and c) decide if 'static' risk assessment with an instrument should be recommended. The modified Norton scale, the Braden scale and the 4-factor model were used in a convenience sample of 53 patients to assess the risk for development of pressure ulcer in the first 5 days (in ICU) after cardiac surgery procedures. The number of patients at risk were >60% by the 4-factor model, >70% by the modified Norton scale and >80% by the Braden scale. Sensitivity and specificity in all scales were not satisfactory. Forty-nine per cent (n= 26) of the patients developed a pressure ulcer in the operating room, 13% (n= 7) up to day 5 in the cardiac surgery ICU. Only 1.9% (n= 1) of the pressure ulcers were stage 2. The study concluded that the patients in the cardiac surgery ICU can be identified as at risk during the first 5 days after surgical procedure without continuously using a standardized risk assessment instrument in every changing condition. Individual risk assessment by a standardized risk assessment instrument is only recommended to enable initiation of preventive measures based on patient-specific risk factors.     

老年压疮相关因素的Logistic回归分析

目的 发现老年患者发生院内压疮的相关因素.方法 选取某三级甲等医院压疮高发科室中的老年住院患者271例,连续观察各种指标变化和压疮结局,运用Logistic回归分析观察指标与压疮的关联.结果 医疗护理措施、手术、活动度受损、组织耐受性改变等与压疮发生相关显著.2种压疮结局(I度以上压疮和II度以上压疮)的因素分析结果 基本一致.结论 医疗护理措施、手术、活动度受损、组织耐受性改变等可增加老年住院患者的压疮风险,临床护理中需实施针对性的预防和干预.     

Pressure ulcers in intensive care patients: a review of risks and prevention

OBJECTIVE: Review of the literature concerning pressure ulcers in the intensive care setting. DATA SOURCE AND STUDY SELECTIONS: Computerized databases (Medline from 1980 until 1999 and CINAHL from 1982 until 1999). The indexing terms for article retrieval were: "pressure ulcers", "pressure sores", "decubitus", and "intensive care". Nineteen articles met the selection criteria, and seven more were found from the references of these articles. One thesis was also analyzed. RESULTS: Data on prevention, incidence, and costs of pressure ulcers in ICU patients are scarce. Overall there are no conclusive studies on the identification of pressure ulcer risk factors. None of the existing risk-assessment scales was developed especially for use in ICU patients. It is highly questionable to what extent these scales can be used in this setting as they are not even reliable in "standard care". The following risk factors might play a role in pressure ulcer development: duration of surgery and number of operations, fecal incontinence and/or diarrhea, low preoperative protein and albumin concentrations, disturbed sensory perception, moisture of the skin, impaired circulation, use of inotropic drugs, diabetes mellitus, too unstable to turn, decreased mobility, and high APACHE II score. The number of patients per study ranged from 5 from 638. The definition of "pressure ulcer" varied widely between authors or was not mentioned. CONCLUSIONS: Meaningful comparison cannot be made between the various studies because of the use of different grading systems for pressure ulcers, different methods of data collection, different (or lack of) population characteristics, unreported preventive measures, and the use of different inclusion and exclusion criteria. There is a need for well-conducted studies covering all these aspects.