两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分，分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡，且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表；Braden修订版压疮危险评估表的ROC曲线下面积略高于waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果，尤其以Braden修订版效果更优。     

两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分,分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡,且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表;Braden修订版压疮危险评估表的ROC曲线下面积略高于Waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果,尤其以Braden修订版效果更优。     

A critique of ‘at risk’ pressure sore assessment tools

• ? This paper critiques pressure sore risk assessment tools. No attempt is made to describe individual tools in detail as this literature is available elsewhere.
• ? The economic case for risk assessment is presented along with the criteria for an effective risk assessment instrument.
• ? Reliability and validity studies are reviewed in relation to three risk assessment tools: Norton, Waterlow and Braden.
• ? Finally a number of issues related to threshold scores, research design and the need to view pressure sores as a clinical problem rather than a nursing problem are discussed.

     

压疮研究进展

对不同病人群体的压疮发生率、病因与发生机制、危险因素评估方法、压疮的护理进行了综述。     

压疮研究进展

对不同病人群体的压疮发生率、病因与发生机制、危险因素评估方法、压疮的护理进行了综述。     

A risk assessment scale for the prediction of pressure sore development: reliability and validity

BACKGROUND: The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice. AIM: To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale. METHODS: The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value. RESULTS: Two variables were excluded as a result of low item-item and item-total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0.83, respectively. The factor analysis gave three factors, with a total variance explained of 65.1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards. CONCLUSION: The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.     

ICU病人压疮危险因素及其评估工具

ICU病人是压疮的高发人群,同时存在多种危险因素,且彼此相互影响.在压疮危险因素评估方面,国外的研究较多,但目前没有一个量表被严谨的科学研究证明在ICU内应用有较高的效度和信度.国内医护人员对压疮的评估和预防还处于经验性的决策阶段.     

ICU病人压疮危险因素及其评估工具

ICU病人是压疮的高发人群，同时存在多种危险因素，且彼此相互影响。在压疮危险因素评估方面，国外的研究较多，但目前没有一个量表被严谨的科学研究证明在ICU内应用有较高的效度和信度。国内医护人员对压疮的评估和预防还处于经验性的决策阶段。     

术中压疮护理在手术压疮高危患者中的应用

目的术中压疮护理在手术压疮高危患者护理中的应用研究。方法选取本院进行手术的压疮高危患者106例,根据患者接受手术时间的先后分为实验组和对照组各53例,实验组患者术中给予压疮护理措施,对照组患者则遵医嘱给予常规手术护理。结果实验组患者术中压疮的发生率低于对照组,实验组患者手术室护理服务满意率高于对照组,差异具有统计学意义(P0.05)。结论术中压疮护理可降低术中压疮的发生率,提升患者对手术室护理工作的满意度。     

Prediction of pressure sore development

ABSTRACT. The condition of 515 consecutive patients newly admitted to the long-term medical ward was followed weekly during a 26-week maximum observation period. A modified Norton scale consisting of eight variables and constructed as an additive scale was used. Serum albumin level and skin test on admission supplemented the information about the nutritional state. Eighty-three patients (16%) had skin lesions classified as pressure sores on admission and 39 patients (7.6%) developed pressure sores during the observation period. It could be shown that those who developed pressure sores during the observation period, had a lower functional level when they arrived and that this deteriorated up until the time that the pressure sore was recorded. It could also be demonstrated that low serum albumin and anergy, as indicators of poor nutritional status, had value as predictors for the development of pressure lesions. General physical condition, activity, mobility and nutritional status appear to be the most important factors in the development of pressure sores in this study. The systematic planning of care with special emphasis on the four above-named risk factors, can probably decrease the risk for the development of pressure sores.     

The clinical relevance of the waterlow pressure sore risk scale in the ICU

Objective: To evaluate whether the Waterlow pressure sore risk (PSR) scale has prognostic significance for intensive care patients. Design: A prospective study. Setting: The surgical intensive care unit (ICU) of the University Hospital Rotterdam. Patients: Data were evaluated from 594 patients who had been admitted to the ICU during the year 1994. Methods and results: Each patient was assessed daily with respect to their Waterlow PSR score and the development of pressure sores in the sacral region. Actuarial statistical methods were used to analyse the predictive value of the risk score. When a patient had a Waterlow PSR score > 25 on admission, the risk of developing a pressure sore was significantly increased compared to patients with a PSR score < 25. After admission, the daily Waterlow PSR scores obtained were significantly associated with the risk of developing a pressure sore. For each additional point this risk increased by 23 % (95 % confidence interval 17 to 28 %). Conclusions: The Waterlow PSR scale provides the medical and nursing staff at an early stage with reliable information about the risk patients have in developing a pressure sore. Received: 8 August 1997 Accepted: 24 April 1998     

压疮危险因素评估表在癌症晚期患者中的应用

目的探讨诺顿评分联合Waterlow’s压疮危险因素评估表在癌症晚期患者预防压疮中的应用方法与效果。方法对227例癌症晚期患者采用诺顿评分初筛，≤14分的患者使用Waterlow’s压疮危险因素评估表再次评估，根据评估结果采取预防措施。结果患者压疮发生率明显减少。结论联合使用诺顿评分及Waterlow’s压疮危险因素评估表，并及时采取预防措施，可以降低压疮发生率。     

提高护士对结核病患者压疮危险评估准确度的实践与效果

目的提高护士对结核病患者压疮危险因素评估的准确度。方法对2011年1—6月在西安市结核病胸部肿瘤医院住院且Waterlow量表评分≥10分的101例患者的评估结果进行分析,并对2011年7—12月住院且Waterlow量表评分≥10分的108例患者采取完善量表解读、组织培训、加强三级质量控制力度等措施,然后进行评估。结果2011年1—6月,101份评估结果中,27份评分完全符合患者情况,符合率为26．73％;2011年7-12月108份评估结果中,75份评分完全符合患者情况,符合率为69．44％;2011年7—12月的评估结果与1—6月相比,各条目评分符合率均有不同程度提高。结论通过完善量表解读、组织培训、加强三级质量控制等措施,能有效提高护上对住院结核病患者压疮评估的准确度。     

手术患者压疮危险因素评估量表的研制

目的：制定针对手术患者的压疮危险因素评估量表,使手术室压疮护理有科学的评价工具。方法：在文献回顾和专家访谈的基础上,结合临床实践经验,确立备选指标,通过专家会议法自行设计第一轮专家函询问卷,采用德尔菲法对30名专家进行3轮函询。结果：手术患者压疮危险因素评估量表一级指标有患者因素、手术因素、麻醉因素,二级指标分别包括年龄、体质指数（体重/身高2）、受压点皮肤类型、活动能力、神经感觉障碍;手术体位、手术预计时间、术中施加外力、失血量;麻醉方式等。结论：采用手术患者压疮危险因素评估量表对手术患者进行术前评估,依据量表评分采取科学、合理、具有针对性的压疮预防措施,有利于减少围手术期压疮发生率,提高手术患者生活质量。     

负压封闭引流技术治疗溃疡期压疮的效果观察

[目的]探讨负压封闭引流技术治疗溃疡期压疮的临床疗效.[方法]采用非同期对照研究,将2007年8月-2008年4月我科18例(38处压疮)院外带入溃疡期压疮的病人设为对照组,2008年5月-12月从他院、他科转入我科因地震致脊髓损伤而发生溃疡期压疮病人18例(40处压疮)设为实验组.在清创处理后实验组采用负压封闭引流技术,对照组采用外科普通换药方法;对创面肉芽组织生长和愈合效果进行动态观察,评价临床疗效.[结果]经治疗后两组创面愈合总体效果、肉芽组织生长情况和病人满意度比较,差异均有统计学意义(P＜0.05),实验组总有效率明显高于对照组.[结论]负压封闭引流技术治疗溃疡期压疮效果优于外科普通换药,缩短了创面愈合时间,提高了病人满意度,操作简便,省时省力,且无不良反应.     

Clinical evaluation of a new pressure ulcer risk assessment instrument,the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T)

Aim

To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter‐rater and test–retest reliability, convergent validity and data completeness.

Background

Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP‐PG‐0407‐10056).

Design

Observational field test.

Method

For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from four secondary care and four community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE‐T assessments were undertaken. Follow‐up retest was undertaken by the expert nurse. Field notes of PURPOSE‐T use were collected. Data were collected October 2012–January 2013.

Results

The clinical evaluation demonstrated “very good” (kappa) inter‐rater and test–retest agreement for PURPOSE‐T assessment decision overall. The percentage agreement for “problem/no problem” was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs.

Conclusion

The PURPOSE‐T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE‐T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes.     

神经内科老年患者压疮危险因素分析及相关护理措施

目的探讨神经内科老年患者压疮的危险因素和护理措施。方法选取神经内科收治的老年患者675例为研究对象,应用自制压疮危险度评估量表动态评估压疮发生的危险性,并根据不同危险度实施护理干预,应用多因素Logistic回归分析筛选出独立危险因素。结果护理干预包括减少受压、皮肤护理、营养支持和健康宣教。观察期内,82例患者发生压疮,其中Ⅰ期压疮61例(74.3%),Ⅱ期压疮18例(22.0%),Ⅲ期压疮3例(3.7%)。多因素Logistic回归分析结果显示,意识障碍、活动能力和移动能力是压疮的独立危险因素(P0.01)。结论意识障碍、活动能力和移动能力降低是影响神经内科老年患者压疮发生的危险因素,应结合压疮危险度动态评估结果制定预防措施。     

An analysis of the literature pertaining to pressure sore risk-assessment scales

• ? The purpose of this analysis was to determine which pressure sore risk-assessment scale was the most valid and reliable for use outside the elderly setting.
• ? It includes a review of the causes of pressure sores to determine the factors which should be included in a scoring system, an overview of the risk-assessment scales developed and an analysis of the research performed to test their validity and reliability.
• ? The study has shown that the Gosnell, Knoll, and Douglas scales have had little or no validity studies conducted and should therefore not be used in the clinical setting and the Pressure Sore Prediction Score should be used with caution outside an orthopaedic setting. The Waterlow scale has also not been fully validated and the Norton scale requires further validation to make it applicable to patients outside the elderly setting. The Norton scale has been shown to overpredict the risk of pressure sores, but the Waterlow scale may actually overpredict this risk even more.
• ? The Braden scale appears to be the most appropriate to use because it has been tested on a representative sample of patients with a wide age range (14–102). It also has a sensitivity of 100% and a specificity of 64–90% compared with the Norton scale's sensitivity of 88% and specificity of 36%.
• ? The analysis concludes that more research is required on all of the scales to determine validity and reliability outside of the elderly setting and therefore all scales should be used with caution bearing in mind the limitations of each.