两种防褥疮床垫预防压疮的比较

[摘要]目的：探讨预防压疮的有效措施,降低压疮的发生率。方法：将100例符合入选标准的住院病人随机分组,其中女64例,男36例,年龄60～90岁,平均75岁,人工髋关节置换术后的35例,双膝置换术后的75例,将100例病人按入院的先后顺序编号,     

预防压疮床垫的制作与应用

采用市售棉市及荞麦皮等制作成预防压疮床垫,经临床应用10例均未发生压疮。提示该垫有良好的预防压疮作用。     

棕床垫的制作与预防压疮的应用

压疮是长期卧床病人的常见并发症 ,一般采用 2h定时翻身护理[1] ,但对骨盆骨折、脊椎骨折者 ,勤翻身给病人不但带来剧烈疼痛 ,且有引起骨折错位的危险。鉴此 ,我们自制了一种预防压疮的棕床垫 ,自 2 0 0 1年 3月至 2 0 0 3年 1月 ,经临床应用 85病人 ,效果满意。报告如下。1　材料与制作　　选用棕片、踏花棉及棉布。将数十层棕片压缩成板 ,长宽比病床缩小 1cm ,厚 18cm ,棕垫制成后在正中挖 1个上直径 2 0cm ,下直径 8cm ,深 15cm的圆锥形槽 ,内填踏花棉(厚度高于床垫 2～ 3cm) ;床垫上放一床棉垫 ,然后套上布制外套成席梦思床垫样。2　临…     

使用减压床垫患者翻身间隔时间的Meta分析

目的通过Meta分析来探讨使用减压床垫患者有效预防压疮的翻身间隔时间。方法计算机检索Cochrane Library、PubMed、维普、万方、中国知网、CBM等数据库。检索时限从建库至2015年10月15日。由2名评价员按纳入与排除标准独立筛选文献,提取资料并评价文献质量后,采用RevMan5.1软件进行分析。结果最终纳入13篇RCT文献,其中英文文献4篇,中文文献9篇,共3 510例患者纳入研究。Meta分析结果显示,翻身间隔时间2h、3h、4h预防压疮效果比较,差异无统计学意义(P0.05);4h与6h翻身1次压疮预防效果比较,差异有统计学意义(P0.05)。2h与4h翻身1次在预防肺炎效果方面差异无统计学意义(P0.05)。结论使用减压床垫患者翻身间隔时间可延长至4h,4h翻身1次不增加压疮和肺炎发生率,可减轻频繁翻身给患者带来的不适,减少护士工作量,节约医疗卫生资源等。     

ICU患者压疮研究进展

综述ICU压疮的风险因素、患病率和发病率、研究方法、评估量表、预防措施,以指导临床更好地预防压疮,减轻患者痛苦,降低医疗支出,同时为完善我国压疮相关研究提供参考。     

ICU患者压疮研究进展

综述ICU压疮的风险因素、患病率和发病率、研究方法、评估量表、预防措施,以指导临床更好地预防压疮,减轻患者痛苦,降低医疗支出,同时为完善我国压疮相关研究提供参考。     

QC活动预防开颅去骨瓣减压术后头皮压疮

目的利用QC小组活动降低开颅去骨瓣减压术后患者头皮压疮的发生率,提高护理质量,提升管理效果。方法按照QC小组活动的程序,从选题依据、现状调查、目标设定、分析原因、要因确定、制定对策、对策实施、效果检查8个步骤进行,对开颅去骨瓣减压术后患者进行头皮压疮预防。结果实施QC活动后,开颅去骨瓣减压术后患者头皮压疮发生率由2.99%降至0。结论 QC小组活动能有效降低开颅去骨瓣减压术后患者头皮压疮的发生。     

持续仰卧位减压法预防压疮效果观察

目的探讨持续仰卧位预防压疮的减压效果。方法将 6 0例持续仰卧位病人随机分A、B两组各 30例。A组平卧硬板床 ,间断使用气圈 ;B组平卧硬板床 ,采用减压动作 ,分别对两组入院时、1～ 5d每天进行压疮易患因素、护理工作量评分和住院日比较。结果压疮易患因素A组随时间延长而增加 ,B组随时间延长而减少 ,两组比较 ,差异有显著性意义 (P <0 .0 1) ;护理工作量A组随时间延长有上升趋势 ,B组 2 4h后明显下降 ,两组比较 ,差异有显著性意义 (P <0 .0 1) ;住院日两组比较 ,差异有显著性意义 (P <0 .0 1)。结论平卧硬板床加减压动作 ,是持续仰卧位预防压疮发生的有效方法之一 ,可减轻护理工作量、有利于骨折愈合 ,缩短住院日。     

两种减压床垫结合不同翻身频度预防压疮效果比较

目的比较两种减压床垫结合不同翻身频度在ICU患者压疮预防中的应用效果和可行性,为临床减压床垫的选择及确定相应的翻身频度提供参考。方法将156例ICU压疮危险患者随机分为气垫组和凝胶组各78例,气垫组使用气垫床结合2h翻身1次,凝胶组使用凝胶海绵床垫结合4h翻身1次预防压疮,观察7d,比较两组压疮发生率及护士对操作便利性的评价。结果两组压疮发生率比较,差异无统计学意义(P0.05);干预后第3~7天,凝胶组Braden评分显著高于气垫组(均P0.05);凝胶组护士对操作便利性评价显著高于气垫组(P0.01)。结论两种方案均能有效预防压疮,使用凝胶海绵床垫可以延长翻身时间至每4小时1次,减轻护士工作量。     

不同气垫床翻身间隔时间预防重型颅脑损伤患者压疮效果比较

目的比较不同类型气垫床及翻身间隔时间预防重型颅脑损伤患者压疮的效果。方法将180例压疮高危患者随机分为A、B、C、D、E、F六组,A、B、C组采用喷气式气垫床,翻身时间分别间隔2h、3h、4h;D、E、F组采用动态交替式气垫床,翻身间隔时间同前;连续观察72h,每次翻身观察记录患者皮肤压疮发生情况、压疮前期表现及Braden评分。结果六组患者均未发生压疮。干预后不同时间六组压疮前期发生率比较,差异有统计学意义(P0.05,P0.01);干预72hB组和E组、C组和F组差异有统计学意义(均P0.00313)。六组Braden评分在干预前、干预后各时间段组内比较差异无统计学意义(均P0.05)。组内比较,F组有统计学差异(P0.01)。结论重症颅脑损伤患者应用两种气垫床均能有效预防压疮,动态交替式气垫床效果更优。使用动态交替式气垫床可将翻身间隔时间延长至4h。     

Pressure ulcers in cardiac surgery: Few clinical studies,difficult risk assessment,and profound clinical implications

Pressure ulcers (PUs) are a common complication after cardiac surgery, with almost one third of patients suffering from PUs during hospitalisation. Because of the burden that PUs exert on both the patients and the health care system, prevention is of utmost importance. The first step in successful prevention, however, includes the identification of the main features that render patients prone to PU development. Cardiac surgery population is not adequately addressed in current clinical trials and studies. Few studies focused specifically on cardiac surgery patients, but the majority included cardiac surgery patients within a heterogeneous population of acute or critical care patients. Therefore, additional research is warranted to understand the unique risk profile of patients undergoing cardiac surgery. Intraoperative risk factors that affect tissue tolerance have not been thoroughly investigated but are likely to play an important role, which might explain the epidemiology of a PU. Further research is also needed to better comprehend the risk of PUs among cardiac surgery patients and to design effective and tailored preventative measures with the help of newer tools for risk assessment.     

防压疮气垫床压力选择的实证研究与分析

目的探讨临床防压疮气垫床的最佳压力。方法在改装设备测量气垫床压力和骶尾部压力的基础上,采用重复测量方法,选择76名健康志愿者仰卧于气垫床上,气垫床压力由充满逐渐降低,每降低5mmHg记录1次骶尾部压力;使用混合效应二次曲线模型分析气垫床压力与骶尾部压力的关系,通过固定效应确定最佳的气垫床压力,并根据个体随机效应分析气垫床压力的最佳范围。结果气垫床压力和骶尾部压力呈二次项分布,可以采用混合效应二次曲线模型进行分析;通过固定效应分析可得气垫床的最佳压力为24.55mmHg,根据个体随机效应分析可得气垫床的压力范围在20.23~29.40mmHg时,人体骶尾部所受的压力最低,与其他范围相比差异具有统计学意义(均P0.01)。结论气垫床最佳压力范围为20.23~29.40mmHg。     

心脏术后患者ICU早期康复锻炼的最佳证据总结

目的 提取并总结心脏术后患者ICU早期康复锻炼的最佳证据,为临床早期康复的开展提供参考.方法 计算机检索Med-line、Up To Date、PubMed、Cochrane Library、CINAHL、JBI循证卫生保健数据库及万方、知网、医脉通数据库,根据纳排标准选取临床指南、专家共识、最佳证据总结、系统评价等,由2名研究人员进行文献质量评价后提取证据.结果 共纳入12篇文献,从组建多学科团队、康复前评估、制订康复计划、心脏早期康复方案、康复过程动态评估、康复后评估、心理干预、健康教育8个方面对心脏术后患者早期康复进行总结,共34条证据.结论 本证据可为临床医护人员制订ICU心脏术后患者早期康复方案提供参考,建议证据转化时,应结合我国的医疗文化背景和证据应用场所,以及患者的需求和意愿.     

ICU患者压疮危险因素的Meta分析

目的系统分析重症监护室(ICU)患者压疮发生的危险因素。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普中文生物医学期刊、Pub Med,Web of Science,Springer,Cochrane Library数据库,并对文献进行筛选,运用Stata/SE 12.0软件对符合纳入标准的文献进行Meta分析。结果 12篇文献符合纳入标准,发生压疮患者1 217例,未发生压疮患者5 538例,共纳入压疮危险因素17个,其中高龄、吸烟、发热、平均动脉压低、水肿、糖尿病史、入住ICU时间延长、镇静、糖皮质激素、血管活性药物、血管加压素、机械通气、机械通气时间延长、白蛋白和血红蛋白水平低15个是ICU住院患者压疮发生的危险因素。对各危险因素发表偏倚进行分析,结果显示发表偏倚不明显。结论 ICU患者发生压疮的危险因素较多,需采取针对性措施预防ICU患者压疮的发生。     

Albumin administration prevents the onset of pressure ulcers in intensive care unit patients

Pressure ulcers (PUs) are a common problem in critically ill patients admitted to the intensive care units (ICUs) and they account for more than 70% of patients with low serum albumin at admission. The aim of this study was to test the efficacy of intravenous administration of albumin in patients with low serum albumin < 3·3 g/dl. In a 1‐year period, a total of 73 patients were admitted to the ICU (males 45, 61·64% and females 28, 38·36%); of these, 21 patients were admitted with hypoalbuminaemia (serum albumin < 3·3 g/dl) and randomised into two groups: 11 patients were treated with 25 g intravenous albumin for the first 3 days within the first week of ICU stay (group A) and 10 patients did not receive albumin (group B). Three patients (27·27%) showed the onset of PUs in group A, whereas seven patients (70%) showed the onset of PUs within the first 7 days of stay in group B. Moreover, ulcers of group B were more severe than those of group A. This study shows that intravenous administration of albumin reduces the onset of PUs in patients admitted to the ICU and in some cases it also reduces the risk of progression to advanced stages of PUs.     

COMHON量表和Braden量表在ICU纵隔术后患者压力性损伤风险评估中的比较

目的比较COMHON量表和Braden量表在ICU纵隔手术后患者压力性损伤风险评估中的预测效能。方法便利选取胸腔外科行纵隔手术治疗后入住ICU的232例患者为研究对象,采用COMHON量表和Braden量表对其进行压力性损伤风险评估。结果在72 h观察期内共29例(12.5%)患者发生压力性损伤,分期均为1期。使用两种量表评估时,压力性损伤组与非压力性损伤组量表总评分差异有统计学意义(均P0.01)。Braden量表ROC曲线下面积为0.747,当总分为13.5分时,约登指数为0.522,预测价值最大;COMHON量表ROC曲线下面积为0.976,当总分为9.5分时,约登指数为0.828,预测价值最大。结论 Braden量表和COMHON量表均可有效评估ICU纵隔手术后患者压力性损伤发生风险,而COMHON量表的预测效能高于Braden量表。     

成人心脏术后常用卧位下中心静脉压差异及压力零点位置研究

目的探讨成人心脏术后患者3种常用卧位(头高30°、头高30°左侧45°和右侧45°)测量中心静脉压(CVP)的差异及压力零点位置,为临床获取正确监测结果提供参考。方法选择成人心脏术后患者100例,在同一时段分别采用头高30°、头高30°左侧45°和右侧45°三种常用卧位测得CVP,并与平卧位测量值进行比较;当侧卧位时沿标准零点位置上下移动传感器,标记与平卧位CVP值相同时的压力零点胸壁位置,同时记录心率(HR)、平均动脉压(MAP)、呼吸(RR)、血氧饱和度(SpO2)变化。结果头高30°卧位与平卧位时CVP值比较,差异无统计学意义(P0.05);头高30°左侧45°卧位较平卧位时CVP值低,与平卧位CVP值相同的压力零点位于右侧腋后线与第四肋间交点(-0.15±0.49)cm;头高30°右侧45°卧位较平卧位时CVP值高,与平卧位CVP值相同的压力零点位于右侧腋前线与第四肋间交点(0.18±0.54)cm。3种常用卧位与平卧位时的HR、MAP、RR、SpO2比较差异无统计学意义(均P0.05)。结论心脏术后成人常用头高30°卧位下测得的CVP存在一定差异,且压力零点位置与平卧位不同。确定成人心脏术后患者临床3种常用卧位测量CVP的差异和压力零点位置的变化,有助于护理人员采取对应措施确保CVP测量值准确。     

Risk predictions of hospital-acquired pressure injury in the intensive care unit based on a machine learning algorithm

Pressure injury (PI), or local damage to soft tissues and skin caused by prolonged pressure, remains controversial in the medical world. Patients in intensive care units (ICUs) were frequently reported to suffer PIs, with a heavy burden on their life and expenditures. Machine learning (ML) is a Section of artificial intelligence (AI) that has emerged in nursing practice and is increasingly used for diagnosis, complications, prognosis, and recurrence prediction. This study aims to investigate hospital-acquired PI (HAPI) risk predictions in ICU based on a ML algorithm by R programming language analysis. The former evidence was gathered through PRISMA guidelines. The logical analysis was applied via an R programming language. ML algorithms based on usage rate included logistic regression (LR), Random Forest (RF), Distributed tree (DT), Artificial neural networks (ANN), SVM (Support Vector Machine), Batch normalisation (BN), GB (Gradient Boosting), expectation–maximisation (EM), Adaptive Boosting (AdaBoost), and Extreme Gradient Boosting (XGBoost). Six cases were related to risk predictions of HAPI in the ICU based on an ML algorithm from seven obtained studies, and one study was associated with the Detection of PI risk. Also, the most estimated risksSerum Albumin, Lack of Activity, mechanical ventilation (MV), partial pressure of oxygen (PaO2), Surgery, Cardiovascular adequacy, ICU stay, Vasopressor, Consciousness, Skin integrity, Recovery Unit, insulin and oral antidiabetic (INS&OAD), Complete blood count (CBC), acute physiology and chronic health evaluation (APACHE) II score, Spontaneous bacterial peritonitis (SBP), Steroid, Demineralized Bone Matrix (DBM), Braden score, Faecal incontinence, Serum Creatinine (SCr) and age. In sum, HAPI prediction and PI risk detection are two significant areas for using ML in PI analysis. Also, the current data showed that the ML algorithm, including LR and RF, could be regarded as the practical platform for developing AI tools for diagnosing, prognosis, and treating PI in hospital units, especially ICU.