自制糜子垫在预防压疮中的应用

目的探讨自制糜子垫在预防压疮中的效果。方法将60例具有压疮风险病人按入院次序分为对照组和实验组,每组各30例。对照组采用气垫床防压疮护理,实验组采用自制糜子垫防压疮护理。比较两组病人的不舒适感和压疮发生情况。结果实验组与对照组均无发生压疮;实验组患者不舒适感低于对照组,两组比较,P<0.05,差异具有统计学意义。结论采用自制糜子垫可有效保护受压皮肤,达到预防压疮的效果,同时提高病人的舒适度。     

Intervention studies to reduce the prevalence and incidence of pressure sores: a literature review

Much has been written about the prevention of pressure sores. However, electronic and manual searches located only 10 studies within the literature in the UK that described interventions able to reduce either their incidence or prevalence. All the studies located contained serious methodological flaws. Apparent success in reducing the number or severity of pressure sores could have resulted because staff involved in data collection were aware that the study was being undertaken and thus took more interest in pressure area care. From the review findings it is apparent that there is a dearth of research evidence upon which to base practice in the sphere of pressure sore prevention and further research is urgently required.     

住院患者压疮防范质量评价指标体系的构建

目的构建住院患者压疮防范质量评价指标体系。方法在文献回顾和专家访谈的基础上,结合临床工作的实践经验,确立备选指标,设计专家函询问卷,采用德尔菲法对26名专家进行3轮函询。结果 3轮函询专家的积极性系数均为100%,权威程度系数分别为0.9308、0.9088和0.9276;确立住院患者压疮防范质量评价体系包括3个一级指标、8个二级指标和37个三级指标。结论住院患者压疮防范质量评价指标体系权威程度高、可信度高,为住院患者压疮防范质量评价提供了科学客观的依据。     

社区护士压疮认知的现状调查

目的:了解社区护士对压疮的认知现状,为制定和实施相关培训提供依据。方法:选取上海市浦东新区全部(11家)社区卫生服务中心的276名社区护士进行问卷调查,调查内容包括对压疮预防的态度、压疮防治相关知识和压疮预防的障碍等3方面。结果:276名社区护士的压疮防治相关知识得分为(51.20±11.28)分,对压疮预防总体持积极态度,缺乏人员、时间和患者家属的配合等是压疮预防的障碍。结论:社区护士对压疮知识掌握不够全面,压疮预防态度积极,压疮预防存在障碍,尤其压疮护理新进展知识欠缺,部分压疮知识实际应用存在盲目性,须加强社区护士压疮相关知识培训,进一步提高对压疮预防的正确认知,促进积极态度,进行合理社区护理人力资源配备,切实提高社区压疮防治质量。     

加强压疮预防管理的对策

目的:提高压疮的防治率,最大限度降低压疮的发生率。方法:制定压疮管理措施,应用《褥疮危险因素评估量表》,实施压疮登记预报制度。结果:提高了预防压疮的护理能力和意识,降低了压疮的发生率。结论:预见性地进行有效的健康教育,加强过程管理,保证护理措施的落实,是防治压疮的关键和有效手段。     

ICU患者持续外周血压监测袖带压疮的预防方法探讨

目的观察普通卫生纸在预防袖带压疮中的效果。方法将100例持续外周血压监测的患者随机分为对照组和观察组各50例。对照组每2h松开袖带缓解压力,定时清洁局部皮肤;观察组采用普通卫生纸将患者测量部位缠绕2周,再将测量袖带缠绕在卫生纸外围进行持续测量。结果观察组皮肤完好无损,无1例发生袖带压疮。结论普通卫生纸能有效预防持续外周血压监测患者的袖带压疮。     

压疮监控小组在压疮防治中的作用

目的探讨压疮监控小组在压疮防治中的作用。方法回顾2012年1月~2013年12月在我院住院并上报护理部的压疮高危患者378例,其中发生院内外压疮患者135例为研究组,通过压疮监控小组同一规范的管理,规范压疮监控制度和流程,定期对压疮患者进行追踪、指导、督促。并与2010年1月~2011年12月在我院住院并上报护理部的压疮高危患者153例,其中发生院内外压疮患者88例为对照组,并对两组疗效及发生院内难免压疮情况进行比较。结果两组疗效及发生院内难免压疮情况比较有显著性差异（P〈0.01,P〈0.05）。结论压疮监控小组对压疮患者进行同一规范的管理,提高了护理人员对预防和治疗压疮患者的管理技能,提高了护理质量。     

褥疮预防的管理

目的　提高褥疮防治率 ,最大限度降低褥疮的发生率。方法　建立科学的管理制度 ,制定褥疮预防管理办法 ,实施难免褥疮申报制度 ,强化过程管理 ,加强考核力度。结果　提高了预防褥疮的护理能力和意识 ,降低了褥疮的发生率 ,提高了院前褥疮的治愈率。结论　加强过程管理和考核力度 ,保证制度落实 ,是褥疮防治的关键和有效手段 ,对提高护理质量十分重要     

Physical activity levels and torso orientations of hospitalized patients at risk of developing a pressure injury: An observational study

Pressure injury guidelines recommend regular repositioning yet patients' mobility and repositioning patterns are unknown. An observational study using activity monitors was undertaken to describe the 24 h activity patterns of 84 hospitalized patients at risk of developing a pressure injury. The vast majority of participants' time was spent in the sedentary activity range (94% ± 3%) followed by the light range (5% ± 4 %). Patients changed their posture a median of 94 (interquartile range 48) time in the 24‐h period (range 11–154), or ≈ 3.8 times per hour. Although a main focus for pressure injury prevention has been on repositioning, this study shows that patients with restricted mobility are actually moving quite often. Therefore, it might be appropriate to focus more attention on other pressure injury prevention strategies such as adequate nutrition, appropriate support surfaces and good skin care.     

玉疮风险评估工具与预防进展

本文对国内外主要的压疮风险评估量表和压疮预防研究现状进行分析,结果发现：压疮风险评估量表中Braden量表具有较好的预测价值,但须进一步研究和明确不同量表的适用人群;应根据风险程度采取有效的预防措施,减轻局部压力、剪切力和摩擦力,增强皮肤耐受性,加强健康教育,从而减少压疮的发生。     

波浪床预防压力性溃疡的临床研究

目的观察波浪床对高危患者压力性溃疡(PU)发生的预防作用,探索波浪床的最佳临床使用方法。方法328例符合入选标准的住院患者随机分成对照组和实验第1,2,3组。在常规治疗基础上,对照组采用卧医院标准床及标准海绵床垫(厚9cm)上,加以每2小时的翻身;实验第1,2,3组采用卧波浪床并分别加用每2,4,6小时翻身的方案。每2小时对患者的PU发生情况进行评估并作好记录。结果入院第1周后第1,2组Ⅰ度以上PU的发生率减少,与对照组比较,差异有统计意义(P<0.05)。第2周后第1,2组Ⅰ、Ⅱ度以上PU的发生率亦减少,与对照组比较,差异有统计学意义(P<0.05)。结论波浪床+4h翻身的方案可以有效预防PU的发生,并且可节约护理翻身时间、减少对患者休息和睡眠的干扰;用Ⅱ度以上PU的发生率来评价PU预防效果可能比用Ⅰ度以上PU的发生率更准确。     

压疮上报数据库数据分析与对策

目的对压疮上报数据库的数据进行分析,为指导临床压疮预防工作提供依据。方法回顾分析2011年至2012年压疮上报数据。结果2011年至2012年共收治住院患者140839例,共发生压疮193例,院内压疮发生率为0．05％,院外带入压疮占0．09％。院内压疮发生患者Braden评分在6—12分。发生压疮最高的年龄段是70-79岁,压疮发生部位前3位分别为骶尾部、髋部和足跟部,压疮发生原因前3位分别为强迫体位、低蛋白、大小便失禁。结论通过对压疮上报数据库的数据分析,能够为指导临床压疮预防工作提供依据。     

压疮管理流程的建立与应用

目的降低住院患者压疮的发生率。方法于2002年建立并实施高危压疮筛查-高危压疮预报-压疮预防-压疮护理会诊-护理质量考评的压疮管理流程。结果住院患者压疮发生率明显降低(P<0.01),护理人员预防压疮的意识提高。结论压疮管理流程的实施能有效降低住院患者压疮的发生。     

Interface pressure measurements: Visual interpretation of pressure maps with MS clients

Purpose. Pressure mapping systems provide useful information for pressure care assessment. Healthcare professionals tend to rely upon their colour-coded pressure maps to assist clinical decision-making, based on ranking these from best to worst pressure distribution. The current study investigated whether such ranking is an appropriate method of assessment when compared to use of the numerical output of average and maximum pressure values (mmHg), yielded by the system.

Method. This community-based correlational study involved 27 multiple sclerosis clients (15 wheelchair users; 12 non-wheelchair users). Pressure maps were recorded on each participant's current seating surface and on six pressure reducing cushions, using the Force Sensing Array pressure mapping system. Outcome measures included (1) rank order of pressure maps based on visual interpretation by two occupational therapists, (2) average pressure (mmHg) and (3) maximum pressure (mmHg). Visual ranking of the colour-coded pressure maps was correlated with average and maximum pressure values for each map.

Results. Correlations between visual ranking of maps and maximum pressures were high for six out of seven surfaces (p < 0.05) for non-wheelchair users; however, they were much less between average pressures and visual interpretation for the same cohort. Similarly, correlations between visual ranking of maps and average pressures for wheelchair users was minimal and was only noted as being high (p < 0.05) on two surfaces when considering maximum pressures and visual interpretation.

Conclusions. This study contests the usefulness of the visual ranking of pressure maps in interpreting interface pressures with MS clients, especially with wheelchair users. Visual interpretation of pressure maps by clinicians may be useful in eliminating inappropriate support surfaces from a selection, or those that display easily identifiable ‘extremes’ of pressure values. Clinicians need to incorporate and interpret the numerical data as well as pressure maps when conducting their assessment and making provision.     

波浪床结合创面封闭负压引流及延期减张缝合治疗Ⅳ期压力性溃疡的临床研究

目的 观察波浪床、创面封闭负压引流及延期减压缝合治疗Ⅳ期压力性溃疡（PU）的效果。方法 将46例符合人选标准的Ⅳ期PU患者随机分成治疗组和对照组，每组23例。2组患者在实施原发病常规治疗的基础上，治疗组采用波浪床、创面封闭负压引流及延期减张缝合进行治疗，对照组采用传统疗法进行治疗。每日测量PU的大小，并按压力性溃疡愈合评估表3（Push Tool 3．0）评分；每周一取创面肉芽进行光镜及电镜检查。结果 治疗第50天时，治疗组Push Tool 3．0评分与对照组相比，差异有统计学意义（P〈0．01）。治疗50d后，治疗组PU的光镜及电镜下改变较对照组明显改善。结论 波浪床结合创面封闭负压引流及延期减张缝合可加速PU愈合，改善其光镜及电镜下改变。     

Development and evaluation of an air mattress structure and function for reducing discomfort when elevating the head-of-bed

Purpose: To develop a new structure and function of alternating pressure air mattress (APAM) which reduces discomfort during head-of-bed (HOB) elevation and evaluate the effectiveness.

Method: An observational study (Study 1) and randomized crossover experiment (Study 2) were conducted in healthy adult volunteers. External force (interface pressure and shear force), body shift, discomfort (pushing feeling and pulling feeling) and HOB elevation angle were measured in Study 1. We developed a new APAM according to these findings. Study 2 compared the external force and discomfort of the new APAM with a control APAM. The magnitude of the discomfort was measured by visual analogue scale. Results: Study 1 clarified that the external force and discomfort during HOB elevation are positively correlated, and that discomfort can be reduced by decreasing the external force. Thus, we designed an APAM with a low friction layer and a novel mattress air-cell pressure control function to reduce the external force. Study 2 confirmed that the external force and discomfort were significantly decreased in the developed APAM. Conclusions: In this study, we developed a new APAM to reduce discomfort during HOB elevation and confirmed its effectiveness.

• Implications for Rehabilitation

• A positive correlation exists between the external force and the discomfort that arises during head-of-bed (HOB) elevation, and a mattress could be developed to reduce the discomfort by decreasing the external force.

• A new alternating pressure air mattress (APAM) with a low friction layer structure and novel control of mattress air-cell pressure that responds to HOB elevation angle can reduce discomfort during HOB elevation.

• This new APAM should allow more comfortable rehabilitation in bed-bound patients with mobility impairments.