Braden评估表在神经内科卧床患者压疮预防中的应用

目的 评价Braden评估表对神经内科卧床患者压疮的预测效果,探讨压疮分组预防措施效果.方法 选取400例新人院、首次评估无压疮的神经内科卧床患者,应用Braden评估表动态评估发生压疮的危险性,将400例患者按评分分为高危、中危、低危及无危组4组各100例,并分别将高危、中危、低危组随机分为实验组和对照组各50例;对照组采取常规干预措施,高危实验组使用气垫床,中危实验组使用海绵床垫,低危实验组每4 h翻身1次,其他预防措施同对照组,无危险组不采取任何干预措施.结果 Braden评估表在首次和末次评分时ROC曲线下面积分别为0.771和0.828,诊断界值取17分时其对应灵敏度、特异度、阳性预测值、阴性预测值等指标均能达到较高水平.在分组干预中,高、中、低危实验组分别与对照组比较,各组压疮发生率均无显著差异.结论 Braden评估表对神经内科卧床患者压疮发生有较好的预测效果,17分是较理想的诊断界值.对神经内科压疮高危者采用气挚床、中度危险者采用海绵垫,压疮发生率降低不显著.低危者可采取每4 h翻身1次的方法以减少资源的消耗.     

Braden量表在预防老年长期卧床住院患者压疮中的应用

目的探讨Braden压疮风险评估量表对老年长期卧床住院患者压疮的预防效果。方法将88例老年长期卧床患者随机分为实验组和对照组,每组44例。对照组采用每2 h翻身1次等常规的压疮预防措施;实验组在对照组基础上采用Braden压疮风险评估量表进行评估,并根据不同的评估结果给予相应的针对性干预措施。比较2组患者的压疮发生率。结果对照组中有2例发生压疮,压疮发生率4.5%,实验组无压疮发生,组间差异具有统计学意义(P0.05)。结论对老年长期卧床住院患者采取有效的压疮预防和护理措施能够显著降低压疮发生率,提高患者的生存质量。     

压疮预防管理对长期卧床患者的实施效果评价

【】　目的 探讨社区卫生服务中心的长期卧床患者压疮的预防性管理的效果。方法 选取社区卫生服务中心长期卧床患者140例为研究对象,其中70例为对照组,另70例作为干预组。对照组给予病区常规护理,干预组除了常规护理外,建立压疮预防管理小组,采用Braden压疮评估量表筛选评估长期卧床患者的风险程度,根据评估分成低中高危的三组采取相应的预防措施,4周以后比较和评价二组对象的压疮发生情况。结果 二组对象的压疮发生率有显著差异P值＜0.01。结论 对长期卧床患者实施压疮预防管理,能有效地降低长期卧床患者压疮发生率。     

Braden评分预测神经科患者压疮的准确性及影响准确性因素的分析

目的探讨Braden评估表对神经科患者压疮发生危险预测的有效性,并分析在Braden评估表评估危险程度相同的情况下,其他相关因素对压疮发生的影响,以提高预防压疮的有效性。方法对135例神经科压疮患者应用Braden评估表进行评分,并收集包括年龄、意识状态、血清白蛋白、活动方式、体位等13个相关因素以及压疮分期状况。分析该评估表对预测压疮的准确性,及影响准确性的因素。结果135例患者中,Braden评分为极高危或高危者94例占69.63%,中危者31例占22.96%,低危者10例占7.41%,无危者无。相关性分析提示:血清白蛋白值与Braden评分成正相关(r=0.25,P<0.05),意识状态与Braden评分为显著负相关(r=-0.61,P<0.01),压疮严重程度与Braden评分成负相关(r=-0.210,P<0.05)。其他因素与Braden评分无显著相关性(P>0.05)。结论Braden评估表能有效地预测神经科患者发生压疮的危险性;对Braden评分具有相同危险者,血清白蛋白水平越低、意识障碍越重,其发生压疮的危险性越高。     

Braden量表在神经内科压疮预防中的应用

目的评价Braden量表在神经内科的应用意义。方法将Braden量表应用于2011年8月-10月住院患者,统计其压疮发生的低、中、高、极高危患者,并根据评分结果进行分层管理。结果该期间共评估2435例患者,无危险者1630例（66．94％）,低危者485例（19．92％）,中危者148例（6．08％）,高危者98例（4．02％）,极高危者74例（3．04％）。无院内可避免压疮发生,也未发生由皮肤护理引发的护患纠纷。结论Braden量表的使用提高了护士对发生压疮危险的早期判断能力,工作更有针对性,更利于压疮的分层管理。     

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。     

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.     

Braden评分预测神经科患者压疮的准确性及影响准确性因素的分析

目的 探讨Braden评估表对神经科患者压疮发生危险预测的有效性，并分析在Braden评估表评估危险程度相同的情况下，其他相关因素对压疮发生的影响，以提高预防压疮的有效性。方法 对135例神经科压疮患者应用Braden评估表进行评分，并收集包括年龄、意识状态、血清白蛋白、活动方式、体位等13个相关因素以及压疮分期状况。分析该评估表对预测压疮的准确性，及影响准确性的因素。结果135例患者中，Braden评分为极高危或高危者94例占69．63％，中危者31例占22。96％，低危者10例占7．41％，无危者无。相关性分析提示：血清白蛋白值与Braden评分成正相关（r=0.25，P〈0.05），意识状态与Braden评分为显著负相关（r=-0．61，P〈0．01），压疮严重程度与Braden评分成负相关（r=-0.210，P〈0.05）。其他因素与Braden评分无显著相关性（P〉0．05）。结论 Braden评估表能有效地预测神经科患者发生压疮的危险性；对Braden评分具有相同危险者，血清白蛋白水平越低、意识障碍越重，其发生压疮的危险性越高。     

压力性损伤防护软件在神经内科高危压疮患者防护中的应用

目的探讨压力性损伤防护软件在神经内科高危压疮患者防护中的应用效果,提高高危压疮患者的防护质量。方法 2018年1月-7月将本科室收治的高危压疮患者随机分成对照组62例和试验组64例。对照组患者采取常规护理措施对高危压疮患者进行防护,试验组患者采用本院开发的具有基本信息、风险评估、伤口记录和防护建议4大功能模块的压力性损伤防护护理软件,对高危压疮患者进行防护。观察两组患者住院期间压疮发生率及首次Braden量表风险评估时间。结果两组患者压疮发生率、Braden量表风险评估时间比较,均P0.05,差异具有统计学意义,试验组患者压疮发生率明显低于对照组,Braden量表风险评估时间明显短于对照组。结论压力性损伤防护软件的应用,减少神经内科高危压疮的发生率,缩短了风险评估时间,有利于提高压疮的防护质量,值得临床推广应用。     

Braden计分表在神经内科预防压疮的应用

[目的]探讨Braden计分表在神经内科预防压疮中的应用。[方法]应用Braden计分表作为评估工具,通过对新入神经内科病人进行评估,根据分值采用不同的预防措施。[结果]第1个季度评估预报高危病人214例,其中院内发生难免压疮3例,预测实际发生率为1.40%;第2个季度评估预报高危病人232例,其中院内发生难免压疮8例,预测实际发生率为3.44%。[结论]Braden计分表评估表应用于神经内科临床预防压疮具有可靠性、有效性。     

动态与静态空气床垫预防神经内科卧床患者压疮效果的比较

目的比较静态空气床垫与动态空气床垫对预防神经内科卧床患者压疮发生的效果。方法便利选取2012年5-8月南京军区南京总医院的神经内科患者90例,根据随机数字表法分为静态空气床垫组和动态空气床垫组各45例,两组均每2h翻身1次,预期观察14d,比较两组患者的压疮发生率、压疮严重度、Braden压疮危险评估结果及成本效益。结果两组患者观察期内压疮发生率均为0;Braden压疮危险评估结果分别为(14.45±2.07)分和(14.25±2.49)分,差异无统计学意义(P0.05);静态空气床垫价格比动态空气床垫价格低350元,且无医疗耗电;静态空气床垫和动态空气床垫的平均护理时间分别为(8.87±3.03)、(9.00±3.10)d,平均每人翻身次数分别为(108±37.16)、(106±36.33)次,差异均无统计学意义(P0.05)。结论静态空气床垫与动态空气床垫比较,其预防压疮的效果相当,但成本投入少于动态空气床垫。     

Waterlow计分表在神经内科预防压疮中的应用

目的评价Waterlow计分表对神经内科卧床患者压疮的预测效果。方法应用Waterlow计分表作为评估工具,通过对新入神经内科患者进行评估,根据分值采用不同的预防措施。结果 2014年神经内科压疮高危患者上报率显著增加(P0.01),高危患者院内压疮发生率显著下降(P0.01)。结论 Waterlow计分表应用于神经内科临床预防压疮具有可靠性、有效性。     

Pressure ulcers: validation of two risk assessment scales

Aims and objectives. To compare the predictive value of two pressure ulcer risk assessment scales (Braden and Norton) and of clinical judgement. To evaluate the impact of effective preventive measures on the predictive validity of the two risk assessment scales. Methods. Of the 1772 participating older patients, 314 were randomly selected and assigned to the ‘turning’ group; 1458 patients were assigned to the ‘non‐turning’ group. Using the Braden and the Norton scale the pressure ulcer risk was scored twice weekly during a four‐week period. Clinical assessment was monitored daily. The patients at risk in the ‘turning’ group (Braden score <17 or Norton score <12) were randomly assigned to a two‐hour turning schedule or to a four‐hour turning schedule in combination with a pressure‐reducing mattress. The ‘non‐turning’ group received preventive care based on the clinical judgement of the nurses. Results. The diagnostic accuracy was similar for both scales. If nurses act according to risk assessment scales, 80% of the patients would unnecessarily receive preventive measures. The use of effective preventive measures decreased the predictive value of the risk assessment scales. Nurses predicted pressure ulcer development less well than the Braden and the Norton scale. Only activity, sensory perception, skin condition and existence of old pressure ulcers were significant predictors of pressure ulcer lesions. Relevance to clinical practice. The effectiveness of the Norton and Braden scales is very low. Much needless work is done and expensive material is wrongly allocated. The use of effective preventive measures decreases the predictive value of the risk assessment scales. Although the performance of the risk assessment scales is poor, using a risk assessment tool seems to be a better alternative than relying on the clinical judgement of the nurses.     

Braden量表预测压疮诊断界值及危险因素的研究

目的探讨Braden量表不同分界值的灵敏度、特异度、阳性预测值以及压疮发生的相关危险因素。方法将2011年4月至2013年6月住院的65 926例患者中发生压疮的380例患者应用Braden量表进行压疮风险评估。结果①当Braden量表分界值为14分时,其灵敏度、特异度具有最好的平衡性。②神志、白蛋白、中重度水肿、休克(应用血管活性药物)与压疮发生有关。结论应用Braden量表对住院患者的压疮危险因素进行评估时结合压疮发生的相关危险因素,可以使Braden量表有更好的灵敏性、特异性,从而采取相应措施,有效降低住院患者的压疮发生率。     

Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial

Aims and objectives. To evaluate whether postponing preventive measures until non‐blanchable erythema appears will actually lead to an increase in incidence of pressure ulcers (grades 2–4) when compared with the standard risk assessment method. Background. To distinguish patients at risk for pressure ulcers from those not at risk, risk assessment scales are recommended. These scales have limited predictive validity. The prevention of further deterioration of non‐blanchable erythema (grade 1 pressure ulcer) instead of the standard way of assigning prevention could be a possible new approach. Design. Randomized‐controlled trial. Methods. Patients admitted to surgical, internal or geriatric wards (n = 1617) were included. They were randomly assigned to an experimental and a control group. In the experimental group (n = 826), prevention was started when non‐blanchable erythema appeared, in the control group (n = 791) when the Braden score was <17 or when non‐blanchable erythema appeared. In both groups, patients received identical prevention, either by using a polyethylene–urethane mattress in combination with turning every four hours or by using an alternating pressure air mattress. Pressure points were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. The Braden scale was scored every three days. Results. In the experimental group, 16% of patients received preventive measures, in the control group 32%. The pressure ulcer incidence (grades 2–4) was not significantly different between the experimental (6·8%) and control group (6·7%). Conclusion. Significantly fewer patients need preventive measures when prevention is postponed until non‐blanchable erythema appears and those patients did not develop more pressure ulcers than patients who received prevention based on the standard risk assessment method. Relevance to clinical practice. Using the appearance of non‐blanchable erythema to allocate preventive measures leads to a considerable reduction of patients in need of prevention without resulting in an increase in pressure ulcers.     

老年神经内科住院患者的压疮危险因素分析及护理对策

目的探讨老年神经内科住院患者的压疮危险因素及相关护理干预对策。方法回顾性分析在老年神经内科住院治疗的100例高龄患者的临床资料,评估每位患者的年龄、营养状况、合并症、医疗器械相关性因素(留置胃管、导尿管、PICC管、气管插管、呼吸机管路等及使用心电监护仪器等)以及Norton量表,将2015年2—12月的51例患者纳入对照组,将2016年1—9月的49例患者纳入观察组,对照组采用常规护理,观察组在此基础上由压疮监控管理小组制定管理流程,护理人员接受压疮知识培训后对患者实施个性化、预见性护理措施,比较2组Norton量表评分、压疮发生率以及患者满意度等。结果老年性痴呆、医疗器械相关性因素、低BMI以及贫血是高龄患者发生压疮的独立危险因素;观察组Norton评分、压疮发生率均低于对照组(P0.05);观察组患者及家属满意度高于对照组(P0.05)。结论老年性痴呆、医疗器械相关性因素、低BMI以及贫血是高龄患者发生压疮的独立危险因素,对老年神经内科住院压疮高危患者采取监控管理及预见性护理措施,可有效降低压疮风险和发生率,提高患者及家属满意度。     

Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting

Aims and objectives. To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting. Background. Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed. Design. A prospective cohort study. Method. A total of 197 subjects in a 106‐bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected. Results. Out of 197 subjects, 18 patients (9·1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0·736 and for the Braden scale was 0·648. The modified Braden cut‐off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = ?1·544, OR=0·214, p = 0·016), body build for height (Beta = ?0·755, OR = 0·470, p = 0·030) and skin type (Beta = ?1·527, OR = 0·217, p = 0·002) were significantly predictive of pressure ulcer development. Conclusion. The modified Braden scale is more predictive of pressure ulcer development than the Braden scale. Relevance to clinical practice. The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.     

基于Cubbin and Jackson量表评估的综合护理干预在神经内科长期卧床老年患者压疮管理中的应用效果

目的探讨基于Cubbin and Jackson量表评估的综合护理干预在神经内科长期卧床老年患者压疮管理中的应用效果。方法将90例长期卧床老年患者根据随机数字表法分为对照组与研究组,各45例。对照组给予常规压疮护理管理,研究组给予基于Cubbin and Jackson量表评估的综合护理干预。比较两组护理效果。结果干预7 d和出院时,两组ET-1水平均降低,NO水平均升高,且研究组优于对照组(P<0.05)。出院时,研究组的压疮危险度评分高于干预前及对照组(P<0.05)。研究组的压疮发生情况、护理满意度优于对照组(P<0.05)。结论基于Cubbin and Jackson量表评估的综合护理干预可有效预防神经内科长期卧床老年患者体内血管缺血再灌注性损伤,减少压疮形成,提高患者护理满意度。