自制水袋配合赛肤润按摩预防脑卒中后压疮的效果观察

目的探讨自制水袋配合赛肤润按摩预防脑卒中后压疮的效果。方法将60例脑卒中后卧床患者随机分为对照组和观察组,每组各30例。对照组患者按常规预防压疮护理方法,观察组患者在对照组基础上使用自制水袋配合赛肤润按摩预防压疮。观察两组患者皮肤潮湿感、压疮发生情况。结果两组患者皮肤潮湿感、压疮发生情况比较,均P<0.05,差异具有统计学意义,观察组患者皮肤潮湿感、压疮预防效果明显优于对照组。结论使用自制水袋配合赛肤润按摩能有效预防脑卒中后卧床患者压疮的发生,值得临床推广应用。     

Review of evidenced-based practice for the prevention of pressure sores in burn patients

Pressure ulcers represent a complex clinical problem, with a reported incidence of 2.7% to 29.5% in hospitalized patients and an etiology that is multifactorial. The prevention of pressure sores in the burn patient population is clearly an area of practice in need of guidelines for care. A multidisciplinary group of advanced burn care professionals have compiled, critiqued, and summarized herein the current evidence of practice in nursing, nutrition, and rehabilitation as it pertains to the prevention of pressure sores after burn injuries. A broad overview of risk factors and assessment scales is described, and current intervention practices and recommendations for care are provided based, whenever possible, on research findings. In addition, research questions are generated in an attempt to move the specialty of burns toward the formal investigation of pressure sores with the ultimate goal being the development of evidence-based practice guidelines.     

压疮监控记录单评分表在ICU老年患者压疮预防中的应用

目的:探讨压疮监控记录单评分表在ICU老年患者压疮预防中的应用效果.方法:将60例ICU老年卧床患者随机分为对照组和观察组各30例,对照组采用经验性判断预防压疮,观察组在此基础上使用压疮监控记录单评分表.观察、比较两组压疮发生率、患者家属对护理服务满意度.结果:观察组压疮发生率低于对照组(P＜0.05),患者家属对护理服务满意度高于对照组(P＜0.05);97.95%的护士认为压疮监控记录单评分表比经验判断更准确.结论:压疮监控记录单评分表能够帮助护士更精准地判断压疮发生的可能性,从而提高护士对ICU老年患者发生压疮的预防效果.     

泡沫敷料在术后预防压疮的应用观察

[目的]探讨泡沫敷料在术后预防压疮的应用。[方法]选择2011年3月—2012年3月我院收治的160例术后需俯卧或侧卧位的病人,随机将160例病人平均分为研究组和观察组,观察组采用海绵垫进行常规方式预防压疮,研究组采用泡沫敷料贴敷预防,观察比较两组病人的皮肤受压情况及压疮发生率。[结果]研究组的压疮发生率为6.25%,观察组为33.75%,研究组的压疮发生率明显少于观察组,差异有统计学意义(P<0.05)。[结论]选用泡沫敷料预防术后病人压疮的出现,明显加强了受压部位的抗压性,减少病人压疮的发生率及相关病发症状,安全可靠。     

Pressure ulcer prevention in intensive care patients: guidelines and practice

Background  Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention.
Design  The design of this study was a cross-sectional study (point prevalence).
Setting  The study setting was intensive care units. The sample consisted of 169 patients – 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards.
Results  The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients.
Conclusions  The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines.     

Pressure sore prevalence within a public health services area

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure‐sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure‐sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.     

PARI-ETLD (Therapeutic Approach and Nursing Research -- Epidemiology and Treatment of Decubitus Lesions

Pressure sores are one of the preferred nursing research topics but, in spite of the large number of studies, most questions related to the prevention and treatment of pressure sores remain unanswered. Well designed clinical trials and on sufficiently large samples are very rare and most treatments are routinely used even without a reliable evidence of their efficacy. The PARI-ETLD trial is the occasion for: a. evaluating the efficacy of the Fitostimoline, in the ri-epitelization of superficial pressure sores; b. starting a clinical trial conducted by nurses; c. building a multicentre nursing network for collecting data on the epidemiology of pressure sores and for evaluating the effectiveness of caring strategies and treatments. The protocol presented, with the data collection forms, is an example of feasibility of clinical trials in the nursing practice and offers examples of ways for overcoming common problems related to the implementation of clinical trials in everyday practice.     

Pressure Sore Prevention in a Rehabilitation Setting: Implementing a Programmatic Approach

The prevalence of pressure sores and the number of patients at risk for developing pressure sores in the rehabilitation setting support the need for designated resources and interventions for both prevention and management. Today's healthcare environment, with increasing patient acuity and decreasing length of stays, requires nurses to have strategies for delivering and documenting care without increasing workload. This article describes an approach that directs nursing activities, incorporates aspects of the Agency for Health Care Policy and Research clinical practice guidelines, and links care processes and outcomes with documentation.     

艾叶散结合中医封包综合治疗仪防治压疮的作用

目的 探讨艾叶散结合中医封包综合治疗仪治疗压疮的作用.方法 ①将48例Ⅰ~Ⅱ期压疮患者随机分为对照组和观察组各24例.对照组采用常规压疮处理方法实施护理;观察组则在采用常规压疮处理方法的基础上加用艾叶散结合中医封包综合治疗仪实施护理,比较两组患者压疮的转归.②将48例卧床的出院患者随机分为对照组和观察组各24例.对照组患者采用定时翻身、保持皮肤清洁、按摩的指导;观察组患者在指导患者加用艾叶散结合中医封包综合治疗仪理疗,比较两组患者发生皮肤压疮的风险.结果 住院患者观察组的治疗效果明显好于对照组,经x2检验比较,差异有统计学意义(P<0.05);出院观察组患者Braden压疮评分19.08分,压疮风险低于对照组,经t检验比较,差异有统计意义(P<0.01).结论 艾叶散结合中医封包综合治疗仪防治压疮层的方法安全、经济、有效,值得基层医院推广应用.     

Setting the standard for pressure sore prevention on a trauma orthopaedic ward

This article describes an innovation used to tackle the problem of high prevalence and severity of pressure sores on an orthopaedic trauma ward. Simple data from the pressure sore prevalence survey were used to build the case and provide the rationale for action. Actions taken included targeting the elderly with hip fractures and having the prevention strategy start in Accident and Emergency (A&E) Department. A standard with a monitoring tool was devised at ward level to review and monitor our practice in pressure sore prevention. This has resulted in the reduction of the prevalence rate of pressure sores on the ward from 21% to 8% over four years. The severity of pressure sores also decreased.     

Monitoring the pressure sore problem in a teaching hospital

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in-patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme     

Pressure sores: evaluation of the systematic use of special surfaces for managing pressure sores in the intensive care unit of the Tarrasa Hospital, Spain

Pressure sores are a major challenge for healthcare systems. Patients admitted to intensive care units are an important risk group for pressure sores. Systematic use of a protocol employing special surfaces to manage pressure is a basic measure for preventing pressure sores in institutionalized patients. In a study carried out in the Intensive Care Unit of the Hospital of Terrassa (Spain), the incidence of pressure sores before and after introducing a prevention protocol that included the systematic use of special surfaces to manage pressure was compared. The incidence of pressure sores in patients admitted in 1998 and 1999 was studied. Sore locations were recorded. The results of three periods were examined: before introducing the protocol (6.4% incidence), after introducing a protocol (1.1%), and after use of the protocol was consolidated (0%). The results of the study suggest that the systematic use of special surfaces to manage pressure, in accordance with a prevention protocol, is a basic measure for reducing the incidence of pressure sores in patients admitted to intensive care units.     

压疮护理新进展

压疮的发生存在多种危险因素,且彼此相互影响。本文结合近年来压疮发展各方面观念的转变,从压疮主要危险因素、发病原理和治疗护理方法等多方面进行综述,认为压疮应重在预防,并体现因素完整性和人群针对性。     

针对性健康教育及合适的翻身方案在预防老年脑卒中患者压疮中的作用

目的探讨针对性健康教育及合适的翻身方案在预防老年脑卒中患者压疮中的作用。方法将纳入本院老年脑卒中患者225例随机分为3组,对照组58例给予常规压疮预防护理及翻身方法;观察I组83例在对照组基础上给予针对性健康教育;观察Ⅱ组84例给予常规护理与针对性健康教育,并进行循环卧位翻身。结果住院期间,观察I组、Ⅱ组的压疮发生率显著低于对照组（P〈0．01）;观察I组及Ⅱ组进行针对性健康教育后,患者及家属对压疮预防知识及技能的知晓率显著提高,P〈0．01;住院期间观察I组及Ⅱ组便秘的发生率显著低于对照组（P〈0．05）。随访期间,对照组压疮发生率显著高于观察I组及Ⅱ组（P〈0．01）。结论针对性健康教育以及循环翻身法在老年脑卒中患者压疮的预防中具有重要意义,值得推广。     

循证护理在心血管内科压疮预防与治疗中的应用

目的:通过循证护理的方法指导心血管内科患者压疮的预防与治疗,采取有效的干预措施提高患者的生活质量。方法:对压疮高风险患者进行临床评估,分析循证护理的问题,制订干预措施。结果:患者的压疮均治愈。结论:循证护理可使压疮的预防和护理取得满意效果,促进患者康复,提高其生活质量。     

失效模式与效应分析在脊髓损伤并截瘫患者预防压疮中的应用

目的 探讨失效模式与效应分析(FMEA)在脊髓损伤并截瘫患者压疮预防护理中的应用效果。 方法 成立FMEA小组,将2010年1～12月收治的48例脊髓损伤并截瘫患者随机分为观察组(24例)和对照组(24例)。对照组进行常规护理,观察组运用FMEA方法对脊髓损伤并截瘫患者可能导致压疮发生的失效模式进行前瞻性原因分析、评估、计算,找出导致压疮4个最高危因素及高危操作步骤,并制定改进措施。 结果 实行改进措施后,观察组压疮发生率低于对照组。 结论 应用FMEA对脊髓损伤并截瘫患者进行评估、分析和采取相关措施,能有效防范风险,降低压疮的发生,提高护理质量,促进患者康复。     

美皮康敷料在心脏手术预防压疮中的应用及效果观察

目的:探讨美皮康敷料在心脏手术中预防压疮的应用效果。方法:将100例心脏手术患者随机分为实验组和对照组各50例,对照组在摆放体位时采取常规预防压疮措施;实验组除上述措施外,于易发生压疮的部位贴美皮康敷料。术后观察两组患者皮肤压疮发生情况。结果:两组压疮发生率比较差异有统计学意义(P<0.05)。结论:将美皮康敷料用于心脏手术中预防压疮,可降低压疮发生率,值得临床推广应用。     

Prevention, treatment and healing of pressure sores in long-term care patients

ABSTRACT Of 515 consecutive patients newly admitted to the long-term medical ward, 16% already had skin lesions which were classified as pressure sores upon arrival in the ward, and 7.6% developed pressure sores during the observation period which was more than three days but not more than 26 weeks. The relation between the condition of the patient and the development of pressure sores and their prevention and treatment was followed with a modified Norton scale. Proportionally more sores progressed which were initially recorded as skin discoloration as compared with the other stages, i.e. epithelial damage, damage to the full thickness of the skin and lesion with a cavity. Preventive measures were not used to a greater extent in those patients who developed pressure sores as compared with those who did not. Preventive measures were used rather as treatment or secondary prevention after a patient had already developed a lesion. The treatment measures were used in many different combinations. In this study no healing effect could be proved for the various treatment measures which were undertaken.