泡沫敷料在术后预防压疮的应用观察

[目的]探讨泡沫敷料在术后预防压疮的应用。[方法]选择2011年3月—2012年3月我院收治的160例术后需俯卧或侧卧位的病人,随机将160例病人平均分为研究组和观察组,观察组采用海绵垫进行常规方式预防压疮,研究组采用泡沫敷料贴敷预防,观察比较两组病人的皮肤受压情况及压疮发生率。[结果]研究组的压疮发生率为6.25%,观察组为33.75%,研究组的压疮发生率明显少于观察组,差异有统计学意义(P<0.05)。[结论]选用泡沫敷料预防术后病人压疮的出现,明显加强了受压部位的抗压性,减少病人压疮的发生率及相关病发症状,安全可靠。     

Bed surfaces and pressure sore prevention: an abridged report

PURPOSE: This article summarizes the results of a systematic review of randomized controlled trials testing the effectiveness of special beds, mattresses, and cushions in preventing and treating pressure sores. The review's citation is Cullum, N., Deeks, J., Sheldon, T.A., Song, F., & Fletcher, A.W. (2000). Beds, mattresses and cushions for pressure sore prevention and treatment (Cochrane Review). The Cochrane Library, 4. DESIGN: An integrative research review. SAMPLE: 37 studies were included in the analysis. METHODS: A broad search of databases and unpublished studies was conducted. Data were extracted from those that met the inclusion criteria. Studies were grouped in various ways but mainly by type of product evaluated. FINDINGS: Many special products designed to prevent or treat pressure sores are more effective than standard hospital foam mattresses in preventing and treating pressure sores. CONCLUSIONS: Special pressure-relieving surfaces should be used for patients at risk for skin breakdown. IMPLICATIONS FOR NURSING PRACTICE: Individual practitioners and agencies should have a systematic protocol for assessing patients' risk of skin breakdown and for taking action when patients are determined to be at risk. The findings of this review provide some guidance for choosing particular products, albeit not definitive evidence for matching risk levels to products.     

Preventing pressure ulcers: an evaluation of four operating-table mattresses.

Pressure is a major factor in the development of pressure ulcers. This research focused on assessing the pressure-reducing effects of operating-table mattresses. Five mattresses were tested: a standard operating-table mattress, a foam mattress, a gel mattress, a visco-elastic polyether mattress, and a visco-elastic polyurethane mattress. Four intraoperative postures were evaluated: supine, lateral, fossa, and the Miles-Pauchet position. Interface pressure measurements were performed on 36 healthy volunteers. The foam mattress and the gel mattress seem to have little or no pressure-reducing effect; the polyurethane mattress and the polyether mattress reduce interface pressure significantly better (p < .001); but none of the mattresses reduce pressure sufficiently to prevent the occurrence of pressure ulcers.     

两种经鼻气管插管固定法预防颌面部手术患者鼻部压疮的效果观察

目的探讨两种经鼻气管插管固定法预防颌面部手术患者鼻部压疮的效果观察。方法将300例经鼻气管插管全麻手术时间≥4 h患者,随机分为对照组和实验组,每组各150例。对照组采用透明胶布在鼻背固定气管导管,并在导管末端与螺纹管衔接处用厚层纱布包裹;实验组在固定导管前先用美皮康敷贴包裹气管导管弯曲处1圈,然后按对照组方法固定导管。比较手术结束至术后第1天两组患者鼻部压疮发生情况。结果对照组患者鼻部术后Ⅰ期压疮发生率为4.7%,实验组患者未发生压疮,两组患者压疮发生率比较,P0.05,差异具有统计学意义,实验组患者压疮发生率明显低于对照组。结论应用美皮康敷贴改进气管导管固定法,能有效预防经鼻气管插管全麻手术≥4 h颌面部手术患者鼻部压疮的发生。     

The user--friendliness of protective support surfaces in prevention of pressure sores

Special mattress overlays and seat cushions for the prevention of pressure sores constitute a large portion of the rehabilitation products market. Consumers frequently face economic concerns in choosing among these products. This article summarizes the favorable and unfavorable features of major support surface types: foam, air-filled, flotation, and alternating air. A careful consideration of characteristics, such as fire safety, patient comfort, and ease of transfer and handling, may facilitate selection and result in more satisfied users and caregivers.     

Effects of absorbent incontinence pads on pressure management mattresses

AIM: The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses. BACKGROUND: Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads. METHODS: An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition. RESULTS: There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads. CONCLUSIONS: Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care.     

Reducing pressure ulcer incidence in a long-term setting

Selection of appropriate pressure prevention equipment relies on risk assessment and clinical assessment of the resident/patient. Decisions are then made in combination with manufacturer's recommendations, such as interface pressure testing. However, risk assessments can over-predict and laboratory investigations do not necessarily provide an accurate picture of how individual patients will react to pressures from support services. There are few studies on visco-elastic mattresses and their benefits in reducing pressure ulcer incidence. Therefore, a small study was undertaken to review the efficacy of a pressure-reducing visco-elastic foam mattress. For the benefit of the study, a 20-bedded nursing home was provided with 20 visco-elastic mattresses (Pressurease) and 20 pressure-reducing cushions (Mediform Visco). The study aimed to demonstrate a reduction in pressure ulcer prevalence. The study involved 21 residents over a 6-month period. There was a 58.3% prevalence (of Stirling grade 1-2 pressure damage) at trial initiation. The results showed an 85.7% decrease of pressure ulcers within 4 weeks, and an overall decrease of 82.5% over the 6-month period. Comfort levels, scored by residents on a visual analogue scale, demonstrated the Pressurease mattress to be superior to the nursing home standard mattress.     

Hammocking: The effect of cushion covers on interface pressure measurements

Purpose.?To investigate the effects of the cushion covers on interface pressure measurements using pressure mapping technology.

Methods.?Sixty-one healthy participants were recruited for a laboratory-based study using a single group design. Participants were pressure mapped on a visco-elastic foam cushion and a foam and fluid pack cushion with their covers on and with their covers removed. An air-filled cushion was tested with two different types of covers, an incontinence cover and a ‘Comfair’ cover. Average and maximum pressures recorded at 6 mins by the Force Sensing Array pressure mapping system were used for statistical analysis.

Results.?There were no significant differences in maximum pressures for the three cushions tested with their covers on or with their covers removed. The cushion with the foam base and fluid pack did not demonstrate any significant differences in average pressure with the cover on or with the cover removed. However, the visco-elastic foam cushion showed significantly lower average pressures with the cover on (p = 0.019). The air-filled cushion showed lower average pressures with the incontinence cover on, when compared to the Comfair cover (p = 0.029).

Conclusion.?Contrary to the belief that the process of hammocking may create surface tension within the cushion covers, which in turn may adversely affect the cushions ability to reduce interface pressure, the cushions tested in the current study did not show significantly lower interface pressure measurements with the covers removed. Therefore the covers did not adversely affect the cushion's ability to reduce interface pressure. The findings of this study require verification with disabled clients.     

Pressure ulcer prevention and treatment: the Transair range.

The Transair range has been updated as a result of clinical and technical advances. The Transair 500 cushion system utilizes foam and air technology to minimize disturbance to the user. Clinical trials suggest that this cushion is of benefit in both the prevention and treatment of pressure ulcers. The Transair 1001 alternating pressure air overlay and the Transair 2002 mattress replacement have both been revised to provide improved performance and both have been subjected to clinical trials. The results of these trials suggest that both have a role in the prevention and treatment of pressure sores in the individual in the high/very high risk group. This article examines these innovations in the Transair mattress and seating systems.     

Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries

Pressure sores are a medical problem for wheelchair users worldwide. In developing countries this problem is more critical because of lack of access to specialized technologies and medical assessment. Seat cushions to relieve pressure represent one of best ways to prevent pressure sores for people with spinal cord injury, amputation, cerebral palsy, and other disabilities that require use of wheelchairs for long periods of time. The purpose of this study was to evaluate the performance of a low cost cushion, called the Tuball, designed for low-income communities in developing countries. The Tuball is made from bicycle inner tubes and plastic balls. Its durability and pressure-relieving characteristics were compared with the ROHOTM cushion and the foam cushions now used in Brazil. A sample of 30 participants tested the three cushions: 15 persons with paraplegia and 15 matched able-bodied persons evaluated the capacity of the cushions to distribute pressure. This study also addressed the use of samples of persons without disabilities to test wheelchair cushions.The Tuball cushion provided significantly better pressure distribution than the foam cushion. A t-test was used to compare disabled persons and non-disabled persons as samples in testing cushions. No difference between pressure distribution between non-disabled and disabled participants was found in testing the ROHO cushion or the foam cushion. However, both capacities of pressure distribution and HICPR varied between non-disabled and disabled participants for the Tuball cushion.To determine the useful life of the Tuball cushion, a fatigue test was conducted to simulate sitting and transfer. Both the Tuball and ROHO cushions withstood the equivalent of at least 1 year of use, whereas the foam cushion broke down.     

Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools.

Patients in intensive care units (ICU) are at high risk of developing pressure sores and the use of pressure sore risk tools has been advocated as a means of identifying patients at risk. A prospective multi-site observational study was conducted to define the incidence of pressure sores, assess two pressure sore risk scales and to define risk factors relevant to intensive care. Patients (n = 534) were assessed for the presence of pressure sores. The Waterlow and Jackson/Cubbin risk scales were completed each day for 314 and 188 of these patients respectively. A total of 75 pressure sores were recorded. Of these, 34 were present on admission. Of the remaining 41, 16 were classified as Grade 1 and 24 as Grade 2 sores. The pressure sore (PS) incidence was 5.2 per cent. Expressed as PS/1000 patient days there were 18.48 pressure sores per 1000 patient days. The ability of the risk scores to predict pressure sores was tested using a Receiver Operating Characteristic (ROC) analysis. The association of risk score with pressure sores was analysed using a survival function (Kaplan Meier) and variables compared using a logrank test (Mantel-Cox). Factors associated with pressure sore occurrence were developed and tested using a survival regression model. Both risk scales were poor predictors of pressure sores (ROC curve area approximately 70 per cent for both). The factors, coma/unresponsiveness/paralysed & sedated and cardiovascular instability were significantly associated with pressure sores with relative risks of 4.2 and 2.5 respectively. Risk increased as a function of time such that the cumulative risk was 50 per cent at 20 days.     

Efficacy and cost-effectiveness of the Thermo contour mattress

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that 'patients with Waterlow scores of 23 can be nursed safely on this product' were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.     

Reducing inpatient hospital usage for management of pressure sores after spinal cord lesions

Recurrent pressure sores are a devastating complication for people with spinal cord lesions as well as posing a drain on health resources. A programme of community outreach involving the long-term follow-up of people post-hospitalisation for severe pressure sores has been developed in Queensland, Australia. This service is known as SPOT (Spinal Outreach Team). The primary objective of this follow-up is to prevent recurrence of pressure sores where possible or alternatively to detect problems early so that rehospitalisation is avoided. In order to assess the effectiveness of this programme the readmission patterns of 14 patients with recurrent pressure sores were examined. The mean number of hospitalised days per patient per month were examined between 1991 and 2001. Three phases within this time frame were examined 1991-1995, no SPOT service; 1996-1998, generic SPOT service (without individual interventions) and 1999-January 2002, individualised SPOT programmes for high users. Hospital days per patient per month were significantly lower for the individualised phase than for the other two phases combined. Proactive, individually tailored approaches are recommended for individuals at high risk of readmission for pressure sores.     

脊柱后路手术中压疮预防的对照研究

[目的]探讨脊柱后路手术中预防压疮的措施及效果,并调查脊柱后路手术中病人发生压疮的危险因素,为完善手术中压疮的评估方法提供依据。[方法]选取行脊柱后路手术的病人100例,随机分为两组,实验组使用康惠尔透明贴和泡沫敷料预防压疮;对照组使用手术室常规防护措施,术后0h、24h、72h对病人进行压疮评估。[结果]术前血红蛋白、年龄、术中出血量是术中压疮发生的危险因素（P〈0.05）,对照组病人术后发生压疮5例,实验组病人术后发生压疮2例,两组比较有统计学意义（P〈0.05）。[结论]康惠尔透明贴和泡沫敷料对于脊柱后路手术中压疮的预防有一定作用。     

Monitoring the pressure sore problem in a teaching hospital

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in-patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme     

Split skin graft application over an integrating, biodegradable temporizing polymer matrix: immediate and delayed

The objective of this study is to further investigate the NovoSorb? biodegradable polyurethane in generating dermal scaffolds; to perform a pilot study comparing the previously used spun mat against a recently developed NovoSorb? foam, ascertaining the optimum structure of the matrix; and to evaluate the successful matrix as an immediate adjunct to split skin grafting and as a temporizing matrix in a prospective six-pig study. A pilot study comparing a previously investigated form of the polymer (spun mat) against a new structural form, a foam, was performed. This was followed by a six-pig study of the foam matrix with three treatment arms-autologous split skin graft alone, polymer foam with immediate engraftment, and polymer foam with delayed engraftment. The foams allowed less wound contraction than the spun mats. The foam structure is less dense (cheaper to produce and having less degradation products). The material remained in situ despite clinical wound infection. Proof of concept was achieved in both treatment modalities in the main study. Split skin graft applied immediately over the polymer foam was able to engraft successfully. The result was "thicker" to pinch and "flush" with the skin surrounding the wound. There was no significant difference in the degree of wound contraction between the graft alone and the polymer plus immediate graft groups. Split skin graft also "took" when applied to the surface of a polymer that had been applied to a wound 11 days earlier, again with a thicker result, flush with the surrounding skin. Split skin grafts alone left a persisting depression. However, a significant degree of wound contraction (compared with the other two groups) was observed in the polymer plus delayed graft group. This has prompted further investigation into "sealing" the polymer foam with a membrane, to prevent evaporative water loss, when the foam is to be used as a biodegradable temporizing matrix. The studies indicate that the NovoSorb? platform will allow the creation of two inexpensive dermal matrix products; an immediate scaffold to allow a thicker grafting result and a biodegradable temporizing matrix (BTM) for wound integration after burn debridement while donor sites become reharvestable. However, further modification on the BTM structure is necessary to further reduce wound contraction pregrafting.     

Equipment and products used in management and treatment of pressure ulcers

The new generation of products to put on pressure sores and equipment to put beneath the patient have caused health care professionals to reevaluate how they manage the high-risk patient with pressure sores. Those who use the new products and equipment must appreciate the principles on which they are based. These supportive interventions complement and augment, but do not replace, competent nursing care. Nurses must continue to assess the patient, products and equipment used; monitor the effectiveness of the management protocol; and evaluate the patient's progress.     

Reduction of abnormal foot pressures in diabetic neuropathy using a new polymer insole material

The precise pressures and loads under 69 neuropathic feet have been measured during walking using a modified microprocessor-controlled optical system. Abnormally high pressures were demonstrated in 94% of feet with a history of foot ulceration, with pressures as high as 20-30 kg X cm-2 under the forefoot. All subjects were also studied using a new visco-elastic polymer material recently used for insole manufacture. A reduction in pressure was demonstrated that was proportional to peak pressure (linear regression line correlation coefficient of 0.91; P less than 0.001). We conclude that this material causes a significant reduction in the abnormally high pressures recorded under neuropathic feet, and should provide a useful insole for the management of patients at risk of neuropathic foot ulceration.