肠内营养预防和治疗压疮效果的Meta分析

目的系统评价肠内营养预防和辅助治疗压疮的效果,为指导压疮患者合理补充营养提供循证依据。方法计算机检索Cochrane图书馆(2014年第1期)、CINAHL、MEDLINE、EMbase、CBMdisc、CNKI和万方数据库中符合纳入标准的随机对照试验。由3名研究者按纳入和排除标准独立筛选文献并对其质量进行评价及提取资料,对符合质量标准的随机对照试验采用Rev Man 5.0统计软件包进行Meta分析。结果纳入14篇随机对照试验共计1 851例患者,6篇涉及肠内营养预防压疮的研究,11篇涉及肠内营养辅助治疗压疮的研究,其中3篇随机对照试验均涉及到压疮的预防和治疗。Meta分析结果显示,肠内营养可明显降低压疮发生率(RR=0.84,P=0.006),缩小压疮面积(SMD=-1.23,P=0.000),不增加压疮患者的不良反应发生率(RR=0.82,P=0.69);但不能提高压疮治愈率(RR=1.46,P=0.05)及不能降低压疮患者的病死率(RR=1.57,P=0.06)。结论肠内营养能降低压疮发生率、收缩压疮面积,对压疮愈合有促进作用,但不能提高压疮治愈率及降低病死率。     

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     

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。     

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。     

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。     

Differences in prevalence of pressure ulcers between the Netherlands and Germany--associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes

Aim. This study compares pressure ulcer prevalence and prevention activities in nursing homes and hospitals within two European countries. Background. Over three years stable differences have been found between the Netherlands (NL) and Germany (GER) with higher pressure ulcer rates in the NL. As previous analyses have shown, the differences cannot be entirely explained by differences in the population’s vulnerability to pressure ulcers because they still remain after risk adjustment. Therefore, the differences in prevalence must be caused by other factors. The purpose of this study is to analyse if any potential differences in preventive activities can account for the varying occurrence of pressure ulcers. Method. In both countries, nation-wide surveys were conducted annually using the same standardised questionnaires. Trained nurses examined all consenting patients of the voluntarily participating facilities. This examination included a skin assessment of the entire body. Data regarding risk factors, prevention and details about wounds were then collected. Results. In-patients of 29 German (n = 2531) and 71 Dutch (n = 10 098) nursing homes and 39 German (n = 8515) and 60 Dutch (n = 10 237) hospitals were investigated. The use of pressure-reducing devices was more common in the NL than in GER, but all other interventions were more frequently provided to German risk patients than to their Dutch counterparts. The pressure ulcer prevalence was significantly higher in the Dutch sample. After adjusting for gender, age, Braden Score and prevention, the probability of having a pressure ulcer was 8·1 times higher for Dutch nursing home residents than for German residents. Conclusion. Some of the variance in pressure ulcer prevalence between the two countries can be explained by varying pressure ulcer prevention. However, some remarkable differences still remain unexplained. Relevance to clinical practice. The extent of pressure ulcer prevention, especially repositioning and nutrition intervention provided to patients at risk, is not in accordance with international guidelines.     

An exploration of the occurrence of pressure ulcers in a British spinal injuries unit

Spinal cord injury (SCI) is associated with increased risk of pressure ulcers, but there are few published data about this in the United Kingdom (UK). This article represents a quantitative exploration of the occurrence of pressure ulcers in a UK spinal injuries unit (SIU). The technique used is a retrospective review of records: details of 144 completed first admissions for SCI between 1998 and 2000 were entered on to a database (SPSS) for analysis. Thirty-two per cent of patients already had pressure ulcers on admission to the SIU, while a total of 56% experienced an ulcer at some stage between injury and discharge from the SIU. Four pressure ulcer risk assessment scales were used (Waterlow, Braden, Norton and SCIPUS-A). These appeared to have moderate predictive power in this population. Pressure ulcers were found to be associated with increased length of hospital stay, density of lesion, surgical stabilization of neck injury before transfer to the SIU, tracheostomy on admission to the SIU and delayed transfer to the SIU after injury. Implications for practice are discussed.     

中医药在压疮护理中的应用及研究现状

文章对中医药在国内压疮护理中的应用现状进行归纳,从中医药对压疮的理论研究现状、中药制剂在压疮护理中的应用、针灸、穴位按摩、饮食调护等其他中医疗法在压疮护理中的应用等方面进行综述,旨在为中医药在压疮护理中的应用提供参考。     

Reproducibility of bladder pressure measurements in critically ill patients

Objective Intra-abdominal hypertension is an independent cause of multiorgan failure and directly effects other physiological measurements, making it an important factor in the management of critically ill patients, but no clinical studies have investigated the reproducibility of intra-abdominal pressure (IAP) measurement to ensure diagnostic accuracy. This study evaluated the intraobserver and interobserver variability of bladder pressure measurements. Design and setting Prospective, observational study in a university-based adult surgical intensive care unit. Patients Critically ill patients undergoing intra-abdominal pressure readings, measured by nursing staff. Measurements and results The study compared patient IAP measurements obtained by the same nurse (intraobserver variation) and between two different nurses (interobserver variation) in critical care patients with clinical indications for IAP monitoring. Data related to the nursing technique and performance were observed and collected for each IAP measurement obtained. Good correlation of bladder pressure measurements between the same and different individuals was found. Intraobserver and interobserver Pearson's correlations for measured IAP were 0.934 and 0.950, respectively. A unit protocol for IAP measurement standardization was modified based on observational data collected. Conclusions Intra-abdominal pressure can be accurately and reliably measured in critically ill patients by utilizing a standardized measurement device combined with a standardized clinical protocol.     

Predicting the risk of pressure ulcers in critically ill patients.

BACKGROUND: Critically ill patients are at high risk for pressure ulcers. OBJECTIVES: To determine the contributions of the Braden subscales in predicting pressure ulcers in critically ill patients and to investigate how often the Braden scale should be completed to assess the risk for pressure ulcers in critically ill patients. METHOD: The Braden scale was used to assess repeatedly 136 adult patients without pressure ulcers in a medical intensive care unit, a surgical intensive care unit, and a noninvasive respiratory care unit, and the patients' skin was inspected routinely for pressure ulcers. RESULTS: A total of 36 pressure ulcers, most commonly on the sacrum or coccyx and the heels (15 stage 1, 20 stage 2, 1 stage 3), developed in 17 patients (12%). In 14 (82%) of the 17, the ulcers developed within 72 hours of admission to the intensive care unit. The risk for pressure ulcers increased as the mean sensory perception (P = .01) and the mean total Braden (P = .046) scores decreased. The mean sensory perception scores obtained at 12 and 36 hours after admission also had a significant relationship to the risk for pressure ulcers (P = .03). CONCLUSIONS: Patients in intensive care units have an increased risk for pressure ulcers. Although waiting until 12 hours after a patient's admission to the intensive care unit to obtain the initial Braden rating may be reasonable (with the second rating obtained 36 hours after admission), additional research is needed before this practice can be recommended.     

肿瘤患者压力性损伤患病率的系统评价

目的 系统评价肿瘤患者压力性损伤的患病率,为压力性损伤的防治决策提供依据.方法 计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、EMbase、Cochrane Library、Web Of Science,收集有关肿瘤患者压力性损伤患病情况的相关研究.检索时限从建库至2019年9月,经逐层筛...     

压疮预警管理项目设计及其实施

目的:探讨压疮预警管理项目内容设计及其在全院实施的方法。方法:分析预警管理思想的核心要素和环节,根据压疮管理中存在的问题和要实现的目标,设计了压疮预警管理项目的5个基本要素。2007年5月至2009年4月以小组工作模式和团队合作的方法在全院实施压疮预警项目管理。评价指标:比较实施压疮预警管理前后2年全院压疮危险评估计分的病例数及其符合率,使用减压床垫数及其准确率和压疮预防措施执行优秀、良好、合格和不合格的护理单元。结果:实施压疮预警管理项目后第2年全院使用Braden计分表预测评估压疮危险的数量及其符合率、减压床垫使用的数量较第一年明显提高(P=0.004-0.000);压疮预防措施执行良好和优秀的护理单元较第一年也显著增加(P=0.000)。结论:在全院实施压疮预警管理项目提高了临床护士压疮危险预测的准确率及预防措施的规范性,以小组工作模式和团队合作的方法是一种有效可行的方法。     

Predictors of pressure injury development in critically ill adults: A retrospective cohort study

ObjectiveThe purpose of this research was to identify predictors of pressure injury, using data from the electronic health records of critically ill adults.MethodologyA retrospective cohort study was conducted using logistic regression models to examine risk factors adjusted for age, gender, race/ethnicity and length of stay.SettingThe study cohort included 1587 adults in intensive care units within an urban academic medical centre.Main Outcome MeasuresThe presence or absence of a hospital-acquired pressure injury was determined during monthly skin integrity prevalence surveys. All pressure injuries were independently confirmed by two Certified Wound Care Nurses.ResultsEighty-one (5.1%) of the 1587 cohort patients developed pressure injuries. After adjusting for confounders, the clinical variables associated with pressure injury development included mean arterial pressure <60 mmHg and lowest Total Braden score up to two weeks prior to the date of HAPI development or date of prevalence survey for the comparison group.ConclusionsThis study provides a more comprehensive understanding about pressure injury risk in critically ill adults, identifying extrinsic and intrinsic factors associated with pressure injury development. Prospective multisite studies are needed to further examine these potential contributors to pressure injury development within the context of adherence to prevention interventions.     

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。     

Alternating pressure air mattresses as prevention for pressure ulcers: a literature review

OBJECTIVES: The purpose of this paper is to examine and synthesise the literature on alternating pressure air mattresses (APAMs) as a preventive measure for pressure ulcers. DESIGN: Literature review. DATA SOURCES: PubMed, Cinahl, Central, Embase, and Medline databases were searched to identify original and relevant articles. Additional publications were retrieved from the references cited in the publications identified during the electronic database search. RESULTS: Thirty-five studies were included. Effectiveness and comfort of APAMs were the main focuses of the studies evaluating APAMs. Pressure ulcer incidence, contact interface pressure, and blood perfusion were the most frequently used outcome measures to evaluate the effectiveness of APAMs. Fifteen randomised controlled trials (RCTs) analysed the pressure ulcer incidence. One RCT compared a standard hospital mattress with an APAM and found that the APAM was a more effective preventive measure. RCTs comparing APAMs with constant-low-air mattresses resulted in conflicting evidence. There was also no clear evidence as to which type of APAM performed better. All RCTs had methodological flaws. The use of contact interface pressure and blood perfusion measurements to evaluate the effectiveness of APAMs is questionable. Comfort of APAMs was the primary outcome measure in only four studies. Different methods for assessment were used and different types of APAMs were evaluated. Better measures for comfort are needed. A few studies discussed technical problems associated with APAMs. Educating nurses in the correct use of APAMs is advisable. CONCLUSION: Taking into account the methodological issues, we can conclude that APAMs are likely to be more effective than standard hospital mattresses. Contact interface pressure and blood perfusion give only a hypothetical conclusion about APAMs' effectiveness. Additional large, high-quality RCTs are needed. No conclusions can be drawn regarding the comfort of APAMs. A number of technical problems associated with APAMs are related to nurses' improper use of the devices.     

美皮康贴膜预防无创正压机械通气患者面部压疮的效果观察

目的探讨美皮康贴膜预防无创正压机械通气（non-invasive positive pressure ventilation,NPPV）患者面部压疮的效果。方法选择2008年1月～2010年3月需行NPPV的患者102例,随机分为对照组53例与观察组49例。对照组采用传统方法护理面部受压皮肤,观察组在传统方法护理基础上,使用美皮康贴膜保护面部受压皮肤。观察两组患者面部压疮发生率。结果对照组面部压疮发生率为44.9%,观察组面部压疮发生率为9.4%,两组比较,P〈0.01,差异具有统计学意义。结论美皮康贴膜能保护NPPV患者的面部皮肤,有效防止面部压疮的发生,值得临床推广应用。