Braden压疮风险评估量表在ICU病人压疮管理中的应用

[目的]探讨Braden压疮风险评估量表在重症监护室(ICU)病人压疮预防中的应用.[方法]将2009年1月-12月ICU收治的1086例病人作为对照组,采取2h翻身1次、气垫床减压等护理措施;将2010年1月-12月ICU收治的1165例病人作为干预组,根据Braden压疮风险评估量表评分结果制定压疮预防与治疗方案.比较两组病人住院期间压疮的发生率.[结果]对照组压疮发生率为1.10％,干预组为0.26％,两组发生率比较,差异有统计学意义(P＜0.05).[结论]ICU病人护理中应用Braden压疮风险评估量表,并根据评估结果实施干预能提高预防压疮的有效性.     

神经外科卧床病人压疮预防的护理干预

[目的]总结神经外科卧床病人压疮预防的护理干预。[方法]采用Braden量表对130例神经外科卧床病人进行压疮危险因素评估,根据评估结果采取早期护理干预措施。[结果]130例病人住院期间发生Ⅰ期压疮1例。[结论]采用Braden量表对神经外科卧床病人进行压疮危险因素评估并采取早期护理干预,可以有效预防压疮的发生。     

神经外科卧床病人压疮预防的护理干预

[目的]总结神经外科卧床病人压疮预防的护理干预。[方法]采用Braden量表对130例神经外科卧床病人进行压疮危险因素评估,根据评估结果采取早期护理干预措施。[结果]130例病人住院期间发生Ⅰ期压疮1例。[结论]采用Braden量表对神经外科卧床病人进行压疮危险因素评估并采取早期护理干预,可以有效预防压疮的发生。     

骨科压疮危险因素量化评估表的设计与临床应用

[目的]探讨一种适合骨科病人病情特点的压疮预测评估工具，方便临床护士的操作应用，最大限度降低骨科压疮的发生率。[方法]根据骨科压疮危险因素，设计骨科压疮危险因素评估表、建立骨科病人皮肤情况交接班记录单。按入院顺序随机将625例病人分成两组，对照组324例采用Braden量表评估加分组护理，实验组301例采用“骨科病人压疮危险因素量化评估表”评估加分组护理（护理方法同对照组）。[结果]压疮发生率：观察组为1．33％（4／301），对照组为4．32％（14／324），两组比较有统计学意义（72=4、99，P〈0．05）；两组压疮分期比较，差异也有统计学意义（Uc=2．23，P〈0、05）。[结论]．‘骨科压疮危险因素量化评估表”较Braden量表更适合于骨科压疮的风险预测，能有效控制骨科卧床病人压疮的发生率，提高临床护理质量。     

老年重症患者压疮相关因素探讨与护理干预

目的：探讨Braden危险因素评估量表及护理干预措施在预防老年重症患者压疮中的作用。方法选择我科185例老年重症患者为研究对象,按照入院次序随机分为对照组和观察组（对照组90例,观察组95例）,对照组采用常规的护理方法,观察组在对照组的基础上采用Braden危险因素评估量表对患者进行评估监测,并及时有针对性的给予护理干预。分析比较两组患者压疮发生率及对护理质量的满意度。结果观察组压疮的发生率明显低于对照组,患者对护理工作的满意率明显优于对照组,两组比较差异皆有统计学意义（ P＜0．05）。结论应用Braden危险因素评估量表并采取护理干预措施能预防压疮的发生。     

护理干预对 ICU 患者压疮发生的影响及相关因素分析

目的：探讨护理干预对ICU患者压疮发生的预防作用及相关因素。方法选择2013年12月至2014年12月在ICU病房住院治疗的患者160例,随机分为观察组80例。对照组80例,观察组患者给予心理、防潮、保暖和皮肤保护等护理干预,对照组给予常规护理。比较两组患者压疮发生率、住院时间,分析压疮发生的相关因素。结果观察组压疮发生率,住院时间明显低于对照组（P＜0.05）。观察组患者pH,PaCO2,SBP, DBP,MAP与对照组比较差异具有统计学意义（ P＜0.05）,观察组Braden量表评分较干预前及对照组均明显升高（ P＜0.05）。相关因素分析发现,患者感染、年龄、住院时间、Braden评分与压疮发生有关。结论护理干预可以显著降低ICU患者压疮发生率,同时压疮的发生需要结合多方法考虑对患者进行治疗及干预,降低压疮发生率。     

Braden压疮风险评估表在骨科压疮高危患者中的应用

目的探讨Braden压疮风险评估量表应用于骨科压疮高危患者压疮预防的效果。方法将234例骨科住院患者随机分为实验组和对照组,每组各117例,对照组给予常规压疮预防护理,实验组在对照组基础上采用Braden评分量表进行评估,并对评分结果为13—14分的中度危险及得分小于该分的高度危险患者给予针对性预防措施。比较两组患者压疮发生情况。结果对照组117例患者中发生压疮10例,压疮发生率为8．7％,实验组发生压疮2例,压疮发生率为1．7％,组问比较差异有统计学意义（χ2=4．435,P〈0．05）。结论根据Braden评分量表对高危患者进行风险评估并采取针对性的护理措施能有效地降低压疮发生率,值得在临床推广应用。     

围手术期患者难免性压疮的护理干预

目的：探讨护理干预在围手术期难免性压疮发生中的应用效果。方法建立完善的压疮预防管理制度,采用压疮评估工具评估高危患者,干预组由压疮小组进行风险评估及预警并上报护理部,实施相应护理措施,及时评价干预效果。结果对照组47例患者,发生压疮6例,压疮发生率12．77％,干预组51例,发生压疮1例,压疮发生率1．96％,两组压疮发生率比较有统计学意义（ P＜0．05）。结论在护理干预过程中,压疮小组应用Braden评分方法,对高危患者正确评估,及时预警上报,保证干预措施落实到位,是预防难免性压疮的有效手段。     

集束化护理策略在院内预防骨科病人压疮中的应用

[目的]探讨集束化护理策略在院内预防骨科病人压疮中的应用。[方法]将2011年1月—2012年12月收治的2366例骨科病人作为对照组,采取常规预防压疮护理,将2013年1月—2014年8月收治的2401例骨科病人作为观察组,采取集束化护理策略预防压疮护理。比较两组病人压疮的发生率、病人陪护压疮知识掌握情况和病人满意度。[结果]观察组病人陪护相关压疮知识掌握、对护理工作满意度优于对照组(P <0.05);观察组发生压疮2例,对照组发生压疮21例,两组病人压疮发生率比较,差异有统计学意义(P <0.05)。[结论]在院内预防骨科病人压疮中应用集束化护理策略可规范护士预防压疮行为、提高预防压疮的效果、提高护理质量。     

新型压疮防护系统对压疮高危风险病人的防护作用的研究

[目的]探讨新型压疮防护系统对压疮高风险病人的压疮预防性作用。[方法]选取吉林省人民医院2015年2月—2017年2月具有压疮高风险(Braden评分12分)的住院病人126例,首先给予常规压疮预防护理45例作为对照组,后81例病人给予新型压疮防护系统作为预防性的措施为实验组,通过观察两组的皮肤情况,统计病人的压疮发生率和评价病人的舒适度。[结果]实验组病人住院第2天、住院第7天压疮发生率低于对照组,差异有统计学意义。[结论]新型压疮防护系统能降低压疮高风险病人的压疮发生率。     

Intracranial pressure. Intracranial pressure monitoring

Based on the data on the current literature, the authors present the basic physiological and pathophysiological aspects of measurement of intracranial pressure and discuss indications for its monitoring and clinical value.     

Plasma osmotic pressure and oncotic pressure

Water distribution in the body fluid is controlled by osmotic pressure and oncotic pressure of plasma. Lower plasma osmotic pressure induces intracellular edema, while lower plasma oncotic pressure induces extracellular edema. The increase in osmo-active substance in plasma induces increase in plasma volume (or extracellular fluid), and then results in extracellular edema.     

Systolic pressure variation and pulse pressure variation during modifications of arterial pressure

OBJECTIVE: This study was performed to investigate the effect of vasopressor therapy on systolic pressure variation (SPV) and pulse pressure variation (PPV) compared to experimentally measured left ventricular stroke volume variation (SVV). DESIGN AND SETTING: Prospective study in a university laboratory. SUBJECTS: Twelve anesthetized and mechanically ventilated pigs. INTERVENTIONS: Increase in mean arterial pressure (by 100%) using phenylephrine and decrease (by 38%) using adenosine. MEASUREMENTS AND RESULTS: SPV and PPV were calculated and compared to SVV derived from aortic blood flow measurements. SPV was significantly affected by changes in arterial pressure [4.6% (1.5) vs. 6.3% (2.1), p[Symbol: see text]<[Symbol: see text]0.05, increased vs. decreased arterial pressure], whereas PPV did not change during modifications of arterial pressure. During baseline conditions and decreased afterload, correlation with SVV was good both for SPV (r[Symbol: see text]=[Symbol: see text]0.892 and r[Symbol: see text]=[Symbol: see text]0.859, respectively) and for PPV (r[Symbol: see text]=[Symbol: see text]0.870 and r[Symbol: see text]=[Symbol: see text]0.871, respectively) (all p[Symbol: see text]<[Symbol: see text]0.001). Correlation with SVV was only moderate during increased arterial pressure (r[Symbol: see text]=[Symbol: see text]0.683 for SPV and r[Symbol: see text]=[Symbol: see text]0.732 for PPV, p[Symbol: see text]<[Symbol: see text]0.05). CONCLUSION: For guiding fluid therapy in patients under vasopressor support, PPV seems superior to SPV.     

Pulmonary artery pressure versus pulmonary capillary wedge pressure and central venous pressure in shock

Evidence is presented from 43 dogs and 30 patients that under conditions of severe hemorrhagic, traumatic or septic shock, there may be partial obstruction of the pulmonary microcirculation due to disseminated intravascular coagulation (DIC) particularly in the pulmonary venules. This may cause the left atrial pressure to fall and the pulmonary artery pressure to rise, in some cases drastically. Pulmonary edema may result. This dangerous rise in pulmonary artery pressure is not reflected by the wedged pulmonary artery catheter which will monitor only the status of the left heart. Central venous pressure (CVP) may remain within normal limits even after pulmonary artery pressure has risen to dangerous levels with the development of pulmonary edema. It is only with right ventricle failure against the high pulmonary pressure that CVP rises. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Wedged pulmonary artery pressures monitor the left heart but may be misleading if taken alone. Central venous pressure gives a delayed response to fluid overload.     

Intracranial pressure and cerebral perfusion pressure in near-drowning

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of profound neurologic insult rather than its cause.     

Heel pressure ulcers and ankle brachial pressure index

There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.     

Effect of positive end-expiratory pressure on intra-abdominal pressure

Massive elevation of intra-abdominal pressure (IAP) causes renal, cardiovascular, and respiratory dysfunction. Positive end-expiratory pressure (PEEP) markedly increases the detrimental effect of IAP on the cardiovascular system. The purpose of this study was to determine the effect of PEEP on IAP. In 15 patients requiring mechanical ventilation, IAP was measured, after 15-minute equilibration intervals, at PEEP levels of 0, 5, 10, and 15 cm H2O. Parametric analysis with multiple paired t tests and nonparametric analysis with Spearman's rho and Kendall's tau tests were used to determine correlation between PEEP and IAP. All patients were male. The mean age was 39 years (range, 18-77). Ten patients had just had laparotomy. No correlation was found between PEEP and IAP. We conclude that PEEP of 15 cm H2O or less has no effect on IAP, and we discuss the clinical implications.     

Positive end-expiratory pressure increases intraocular pressure in cats

BACKGROUND AND METHODS: The purpose of the present study was to examine the effect of various levels of positive end-expiratory pressure on intraocular pressure in cats. Fourteen healthy adult cats (2.6 to 3.7 kg) without evidence of ocular disease were anesthetized with pentobarbital, paralyzed, and placed on mechanical ventilation. Direct continuous measurements of heart rate (HR), mean arterial pressure (MAP), CVP, CSF pressure, and intraocular pressure were recorded at zero end-expiratory pressure, and at 5, 10, and 15 cm H2O positive end-expiratory pressure, applied in random order. MAIN RESULTS: There were no significant changes in pHa, Paco2, HR, MAP, hematocrit, and temperature. Intraocular pressure increased significantly from 17 (during zero end-expiratory pressure) to 20 mm Hg at 10 cm H2O positive end-expiratory pressure; at 15 cm H2O positive end-expiratory pressure, intraocular pressure increased significantly to 21 mm Hg. CVP and CSF pressure increased significantly in parallel with intraocular pressure at 5, 10, and 15 cm H2O positive end-expiratory pressure. CONCLUSIONS: We speculate that similar responses occur in man, and may be undesirable in patients with already increased intraocular pressure, when higher levels of positive end-expiratory pressure are used.