皮肤保护剂在失禁患者中的应用效果及相关因素分析

目的 探讨皮肤保护剂在失禁患者中的应用效果,并分析IAD发生的危险因素和保护因素,为临床提供有效的防范依据.方法 将2013年5月至2014年1月入住南通市某三级甲等医院4个监护病区（神经外科ICU、神经内科ICU、急诊ICU、综合ICU）的174例高危失禁患者随机分成3组（A组造口护肤粉,B组鞣酸软膏,C组皮肤保护膜）,予以皮肤保护剂预防性地干预,比较IAD的发生率、发生时间,并对可能引起IAD的相关因素进行多因素Logistic回归分析.结果 发生IAD者32例占18.4％.A组、B组和C组IAD发生率依次为30.4％、10.3％和15.0％,B组lAD的发生率最低,其次为C组和A组,经比较,3组间差异有统计学意义.经两两比较发现,A组与B组之间、A组与C组之间,IAD发生率的差异有统计学意义,B组与C组之间差异无统计学意义.IAD平均发生时间为（7.00±3.91）d,3组患者IAD发生时间比较差异无统计学意义.多因素Logistic回归分析显示,大便性状和失禁频率是高危失禁患者发生IAD的危险因素,使用预防效果较好的皮肤保护剂是其发生的保护因素.结论 在失禁护理过程中,应尽早给予清洁肛周皮肤并使用预防效果较好的皮肤保护剂.

Application effect of skin protectant for the patients with incontinence and its correlated influencing factors

Objective The study is to investigate the effects of skin protectant carried out among the patients with incontinence,analyze the risk factors and protective factors of the occurrence of incontinence-associated dermatitis,and provide effective preventive measures for clinic.Methods From May 2013 to January 2014,174 cases of high-risk patients with incontinence from care units of intensive care unit,neurology intensive care unit,neurosurgery intensive care unit,and emergency intensive care unit of a top three hospital of Nantong were divided into three groups and provided with preventive interventions of skin protectant.Group A used ostomy skin care powder,group B used tannic acid ointment,and group C used Comfeel skin protective film.The incidence rate and time to onset of incontinence-associated dermatitis were compared,and then the relevant factors which might cause the occurrence of incontinence-associated dermatitis underwent Logistic regression analysis.Results 32 cases （18.4%） of patients after application of skin protectants occurred incontinence-associated dermatitis.The incidence rate of IAD in the three experiment groups （group A,group B and group C） were 30.4%,10.3% and 15.0%.The incidence rate of IAD was the lowest in group B,followed by group C and group A.There was a significant difference among the three groups.In the comparison pair match,the differences of incidence rate between group A and group B,group A and group C were statistically significant,but the incidence rate of group B and group C was statistically insignificant.Mean time to onset of incontinence-associated dermatitis was （7.00± 3.91） days.The occurrence time of IAD among the three groups was not statistically significant.Conclusions In the process of incontinence care,it should be given as early as possible to clean the peri-anal skin and apply skin protectant with better preventive effects.