Evaluation of a new pressure ulcer preventive dressing containing ceramide 2 with low frictional outer layer

AIM: This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. BACKGROUND: Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. METHOD: An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. FINDINGS: The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63) ]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). CONCLUSION: This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.     

麝香生肌膏在压疮护理中的应用及效果

目的探讨麝香生肌膏对Ⅱ度以上压疮的治疗效果。方法对40例Ⅱ期以上压疮患者,分别用麝香生肌膏和凡士林纱布换药各20例,观察创面愈合效果、愈合时间和疼痛情况。结果麝香生肌膏组治愈率、创面愈合时间、患者疼痛情况均优于凡士林纱布组（JP〈0．Ol或P〈O．05）。结论麝香生肌膏能够提高创面修复质量,缩短创面愈合时间,减轻患者痛苦。     

碱性成纤维细胞生长因子及bFGFR-3在皮肤溃疡组织中的表达及对溃疡形成的影响

目的研究碱性成纤维细胞生长因子(bFGF)及bFGFR-3在急性放射性皮肤溃疡组织中的表达及对溃疡形成的影响。方法采用Wistar大鼠,以γ射线局部照射法建立皮肤溃疡动物模型,以手术法建立皮肤伤口模型,采用免疫组化、原位杂交等方法检测伤口及皮肤溃疡组织中bFGF及bFGFR-3的转录和表达水平。结果皮肤受照区多种细胞中bFGF及bFGFR-3的表达水平均较正常皮肤组织有所增强,但与单纯伤口组比较,溃疡组织中两者的转录和表达水平明显降低。结论辐射诱导的皮肤溃疡组织中bFGF及bFGFR-3的表达水平降低可能与溃疡发生及难愈合的分子机制相关。     

中性粒细胞陷阱网对糖尿病足临床愈合结局的预测价值

目的 探讨中性粒细胞陷阱网（neutrophil extracellular traps, NETs）标志物对糖尿病足溃疡（diabetic foot ulcer, DFU）临床愈合结局的预测价值及相关性。方法 回顾性纳入2019年6月至2021年6月于上海交通大学医学院附属仁济医院血管外科诊治的DFU患者120例，纳入60例非溃疡糖尿患者及60名健康人群作为对照。收集和分析患者基本信息、合并基础疾病情况、实验室检查数据、溃疡创面测量数据及1年内创面愈合随访信息。检测DFU患者及对照组血液中NETs标志物，收集溃疡组织检测弹性蛋白酶水平。进行体外NETs释放实验验证DFU患者血液微环境能否促进NETs释放。评价NETs标志物与DFU患者1年内溃疡愈合和截肢的相关性及预测价值。结果 与非DFU患者相比，DFU患者血液所提取血浆和血小板更容易在体外刺激中性粒细胞释放NETs(P<0.05)。与健康对照组相比，DFU患者血液中NETs标志物水平显著增高（P<0.05）。非愈合亚组溃疡组织中弹性蛋白酶水平显著高于愈合亚组，合并感染的DFU患者溃疡组织中弹性蛋白酶水平显著高于非感染患...     

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。     

压疮危险因素评估表预测不同患者群体压疮发生的研究

目的比较压疮危险因素评估表（Norton ulcer risk assessment scale,以下简称Norton量表）对不同年龄组及不同病区患者压疮的预测效果。方法运用Norton量表对内外科住院患者进行连续评估,计算量表对不同患者群体预测的灵敏度、特异性、预测值。结果 Norton量表对老年患者灵敏度96.96%、特异性87.68%、阳性预测值22.96%,阴性预测值99.87%;对中青年患者灵敏度97.37%、特异性96.73%、阳性预测值12.05%、阴性预测值99.98%,Norton量表对老年患者及中青年患者压疮预测均具有较高的灵敏度和特异性。Norton量表对内科、外科及不同病区患者均具有较高的预测灵敏度;对神经外科、ICU患者预测特异性较低。结论 Norton量表对不同年龄组和不同病区患者皆具有较好的预测效果,内外科各病区可以统一使用Norton量表对患者进行压疮高危筛查和评估。     

Continuous monitoring of interface pressure distribution in intensive care patients for pressure ulcer prevention

Title.  Continuous monitoring of interface pressure distribution in intensive care patients for pressure ulcer prevention.
Aim.  This paper is a report of a study conducted to examine whether continuous interface pressure monitoring of postoperative patients in an intensive care unit is feasible in clinical practice.
Background.  The interface pressure between skin and surfaces is generally evaluated for pressure ulcer prevention. However, the intensity and duration of interface pressure necessary for pressure ulcer development remains unclear because the conventional interface pressure sensors are unsuitable for continuous monitoring in clinical settings.
Methods.  A total of 30 postoperative patients in an intensive care unit participated in this study in 2006–2007. A sensor was built into a thermoelastic polymer mattress. The whole-body interface pressure was recorded for up to 48 hours. Pressure ulcer development was observed during the morning bed-bath. For analysis, the intensity and duration of the maximal interface pressure was evaluated.
Findings.  The mean age of the study group was 62·0 ± 15·4 years. Two participants developed stage I pressure ulcer and blanchable redness at the sacrum. The longest duration of pressures greater than 100 mmHg were 487·0, 273·5 and 275·7 minutes in the pressure ulcer, blanchable redness and no redness groups respectively.
Conclusion.  Continuous monitoring of the intensity and duration of whole-body interface pressure using the KINOTEX sensor is feasible in intensive care patients.     

压力治疗在下肢静脉溃疡治疗中的应用研究

从压力治疗的类型、评估监测、病人的依从性3方面对压力治疗在下肢静脉溃疡治疗中的应用现状进行综述,提出应规范压力治疗,以提高下肢静脉溃疡的治愈率,为临床压力治疗及护理提供借鉴和依据。     

压疮管理小组在压疮护理中的作用

目的探讨压疮管理小组在压疮护理中的作用。方法成立压疮管理小组,确立管理目标,实施专项理论培训,制订压疮危险评估表和压疮情况报告表,建立管理流程。结果压疮管理小组成立2年内,共收治院外带入压疮患者134例,治愈104例,好转19例,治愈及好转率为91.79%,实现了院内压疮零发生。结论压疮管理小组的建立对压疮护理管理具有积极的督促作用,能为临床护士提供新的理论和方法,有效降低压疮的发生。     

压疮预报评估表在压疮预防监控中的应用

目的将压疮预报评估表应用于压疮的预防监控。方法建立压疮预报评估表并进行入院评估,从而采取预防监控措施。结果最大限度地降低了压疮的发生率,促进了出院前压疮的愈合。结论压疮预报评估表应用于压疮的预防监控是科学的管理方法。     

Histological examination of pressure ulcer tissue in terminally ill cancer patients

Aim: It is a common belief that terminally ill cancer patients have a reduced tissue tolerance that makes them more susceptible than other patients to developing pressure ulcers. However, the actual changes at the tissue level caused by pressure loading in terminally ill cancer patients are unknown, so we examined the relationship between the macroscopic and microscopic features of the tissues of such patients with and without pressure ulcers. Methods: The pressure ulcers of four patients were macroscopically evaluated until the time of death, after which informed consent of the family was obtained to examine the underlying skin tissue histologically. Samples were taken from several sites on the abdomen, which does not experience pressure loading, and from the sacral area. Two of the subjects had no observable pressure ulcers and the other two had a stage I and stage II (National Pressure Ulcer Advisory Panel classification) pressure ulcer, respectively. The samples were processed, stained and examined by using light and transmission electron microscopy. Results: The non‐pressure ulcer samples showed degenerated keratinocytes, leakage of erythrocytes from the capillaries in the dermal papillae, vascular inflammation, and edema. The samples from the stage I and II ulcers had the additional changes of dilated capillaries and vascular inflammation in and around the wound area. Conclusion: Terminally ill cancer patients have damaged skin tissue and inflammation that are not evident by macroscopic examination.     

生肌愈疡颗粒联合奥美拉唑对老年性消化性溃疡愈合质量及复发的影响

目的:观察生肌愈疡颗粒联合奥美拉唑对老年性消化性溃疡愈合质量及复发的影响。方法:选取80例老年性消化性溃疡患者,随机分为观察组与对照组各40例,观察组服用生肌愈疡颗粒加奥美拉唑,对照组单独服用奥美拉唑。两组幽门螺旋杆菌(Hp)阳性者先予三联根除疗法10 d,10 d后服用上述药物开始观察,两组均以6周为1个疗程。疗程结束后复查胃镜,观察Hp根除情况并评价内镜下再生黏膜成熟度及组织学再生黏膜成熟度,治疗6个月和1年后分别观察两组溃疡复发情况。结果:经治疗后,观察组内镜下再生黏膜成熟度Sc期占75.0%,组织学再生黏膜成熟度优级占82.5%,均明显高于对照组42.5%及40.0%;观察组Hp根除率达88.0%,明显高于对照组60.7%,差异有统计学意义(P0.05)。经治疗1年后,观察组溃疡复发率为5.3%,远低于对照组25.8%,差异有统计学意义(P0.05)。结论:生肌愈疡颗粒与奥美拉唑联用,能够有效地提高老年性消化性溃疡的愈合质量,降低其复发率,在临床上值得推广。     

Pressure ulcer risk screening in hospitals and nursing homes with a general nursing assessment tool: evaluation of the care dependency scale

Rationale In view of an increasing necessity for systematic assessments, nursing practice would benefit from a simplification of assessment procedures. These assessments should be scientifically based. Aims To evaluate the possibility of assessing pressure ulcer risk as well as care dependency simultaneously with a standardized instrument for nursing homes and hospitals. Methods Care dependency was measured with the Care Dependency Scale (CDS). The quantitative analyses were accomplished with data from a cross‐sectional study that was performed in 2005 in 39 German nursing homes and 37 hospitals with a total of more than 10 000 participants. The scale's construct validity was calculated with Pearson's r, and predictive validity was evaluated by computing sensitivity and specificity values and the area under the curve (AUC). Item‐level analyses included calculations of odds ratios, relative risks and logistic regression analyses. Results Construct validity of the CDS was r = 0.79 (P < 0.01) in nursing homes and r = 0.89 (P < 0.01) in hospitals. AUC was 0.80 in hospitals and 0.65 in nursing homes. Analyses on item level identified ‘mobility’ as a key item in both settings and additional differing key items for nursing homes and hospitals. Conclusions The CDS is a well‐functioning tool for pressure ulcer risk detection in hospitals. For this purpose, the most appropriate cut‐off point is 69 while special regard is given to the items ‘continence’, ‘mobility’ and ‘hygiene’. In nursing homes the usefulness of the CDS for pressure ulcer risk detection is limited. Here, the most appropriate cut‐off point is 41 and attention is given to the items ‘mobility’, ‘getting (un)dressed’, ‘hygiene’ and ‘avoidance of danger’.     

对患者进行压疮危险因素评估的方法与体会

目的提高对压疮危险因素的评估能力,最大限度降低压疮发生率。方法应用压疮危险因素评估表对354例住院患者进行评估,建立科学管理制度,制定压疮预防管理方法。结果提高了护理人员对压疮风险预测能力,明显降低了压疮发生率(P<0.01)。结论压疮危险因素评估表的应用,可以有效降低患者压疮的发生。     

Validation of pressure ulcer risk assessment scales: a critique

AIM: The aim of this paper is to present critical analysis of the validation methods of pressure ulcer risk assessment scales. BACKGROUND: The validation of pressure ulcer risk assessment scales remains a topic of considerable debate and uncertainty. The Braden scale and Norton scale are the most frequently used. Sensitivity and specificity are the recommended and most commonly used epidemiological tools to evaluate the validity of those risk assessment scales. DISCUSSION: The use of preventive measures influences both the sensitivity and specificity of the scales. Analysis of published studies on risk assessment scales reveals that, although some patients received preventive measures and others did not, this was not taken into account. Consequently, generalization of those results is not possible. Some possible alternative designs for studying the validity of risk assessment scales are discussed. CONCLUSIONS: Currently available risk assessment scales are of only limited value, and there use will result in many patients being falsely identified as at risk or not at risk. Sensitivity and specificity criteria are not the most appropriate tools to validate risk assessment scales. A risk assessment scale should be evaluated in combination with the preventive measures used.