侧卧位开胸手术患者发生压疮的原因分析及护理干预

总结了侧卧位开胸手术患者发生压疮的原因及护理干预,术中压疮的发生与患者的年龄、体重指数、Braden 评分、手术时间及术中出血量等因素相关,护理干预包括重视术前压疮风险评估、合理安置患者体位、减少出血量等。认为应针对各项相关因素,制定严格的防压疮流程并实施相应的护理干预,可以降低侧卧位开胸手术患者的压疮发生率。     

冠状动脉搭桥手术41例压疮的预防对策

目的探讨冠状动脉搭桥手术中患者压疮相关因素及预防对策。方法应用修订版Braden评分法分析41例冠状动脉搭桥手术中患者压疮相关因素。结果高龄、精神紧张、急性应激、低温、高血糖(≥8 mmol/L)、手术时间等是冠状动脉搭桥手术中患者发生压疮的高危因素。结论术前正确评估冠状动脉搭桥患者手术中发生压疮的高危因素,积极采取预防措施加以干预,可有效地减少冠状动脉搭桥手术患者术中压疮的发生。     

侧卧位开胸术患者术中压疮的危险因素分析与护理对策

目的探讨侧卧位开胸术患者术中发生皮肤急性压疮的高危因素,并提出相应的护理对策。方法回顾124例侧卧位开胸术患者的术前基础资料和术中资料,比较分析手术过程中发生皮肤压疮的26例患者和无压疮的98例患者的年龄、质量指数、血清总蛋白、血红蛋白、血糖、Braden评分、手术持续时间、术中低血压持续时间、低血氧饱和度持续时间、术中出血量、输液量等因素与压疮的相关性。结果侧卧位开胸术患者术中压疮发生率为20．96％,最常见部位为腋下侧胸壁,占50．O％;单因素分析发现除年龄因素外的10个因素均与压疮发生有密切关系（P〈0．05）;Logistic多元回归分析提示手术持续时间、Braden评分和术中出血量是术中压疮发生最重要的危险因素（P〈0．05）。结论手术时间、Braden评分和出血量是侧卧位开胸术患者术中急性压疮发生的独立高危因素,制定针对性的护理对策可降低术中压疮的发生。     

Braden评分法在预防胸腰椎骨折并发压疮患者中的应用

目的:探讨Braden评分法护理干预对预防胸腰椎骨折患者压疮发生的疗效。方法:将138例胸腰椎骨折患者按入院先后顺序随机分为对照组65例和实验组73例,对照组采用传统分级护理方法护理,实验组应用Braden评分法预测胸腰椎骨折卧床患者压疮发生的潜在危险度,根据分值进行分级护理。结果:实验组发生压疮1例,对照组发生压疮6例,两组比较差异有统计学意义(P<0.05)。结论:采用Braden评分法预警干预护理能有效降低胸腰椎骨折卧床患者压疮的发生率。     

护理干预在预防不稳定性骨盆骨折患者压疮中的应用

目的 探讨护理干预在预防不稳定性骨盆骨折患者压疮中的效果.方法 应用Braden评分法对39例不稳定性骨盆骨折患者进行压疮预警风险评估,根据其分值进行早期周密的护理干预.结果 39例不稳定性骨盆骨折患者均未发生压疮,护理效果满意.结论 采用Braden评分法对患者进行预警风险评估、早期护理干预能有效降低不稳定性骨盆骨折患者的压疮发病率.     

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。     

护理干预在预防不稳定性骨盆骨折患者压疮中的应用

目的探讨护理干预在预防不稳定性骨盆骨折患者压疮中的效果。方法应用Braden评分法对39例不稳定性骨盆骨折患者进行压疮预警风险评估,根据其分值进行早期周密的护理干预。结果39例不稳定性骨盆骨折患者均未发生压疮,护理效果满意。结论采用Braden评分法对患者进行预警风险评估、早期护理干预能有效降低不稳定性骨盆骨折患者的压疮发病率。     

术中压疮护理单在手术室压疮高危病人护理中的应用

[目的]探讨术中压疮护理单在手术室压疮高危病人护理中的应用效果。[方法]选择实施术中压疮护理单后1 105例高危压疮手术病人为观察组,制订手术室术中压疮护理单,内容有术中压疮高危因素评估、术中压疮6步集束防护措施、针对性地进行术中压疮风险量化评估表,并进行1个月的相关知识培训与督导。选择术中压疮护理单实施前1 113例高危压疮手术病人为对照组进行效果比较,并对手术科室护士进行满意度调查。[结果]观察组术中压疮发生率明显低于对照组(P<0.05);手术科室护士满意度在术中压疮护理单使用前后比较差异有统计学意义(P<0.01)。[结论]制订并应用术中压疮护理单,手术室护士按步骤落实术中压疮集束干预措施,针对性地进行术中压疮风险量化评估,指导病房护士进行高危风险压疮重点防护,使手术室与病房护士共同努力将术中压疮降至最低。     

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。     

压疮预警体系在老年患者髋关节置换手术中的应用

目的探讨应用压疮预警体系预防老年患者髋关节置换术中压疮的效果。方法使用压疮预警体系表对236例老年髋关节置换术中术前患者的皮肤状况进行评分,根据评分实行压疮预警体系及相应护理措施预防术中压疮,观察术后两周内皮肤情况。结果观察组术后访视中有3例发生Ⅰ期压疮,压疮发生率为2.54%;对照组术中压疮发生率为11.01%,观察组的压疮发生率显著低于对照组,差异有统计学意义(P0.05)。观察组的患者满意度显著高于对照组,差异有统计学意义(P0.05)。结论使用压疮预警体系评分表能够及时评估压疮发生的危险因素,有效地预防老年患者髋关节置换术中压疮的发生,提高患者的满意度。     

Incidence of pressure ulcers in a neurologic intensive care unit

OBJECTIVES: To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. DESIGN: Cohort study of patients with no preexisting ulcers with a 3-month enrollment period. SETTING: The neurologic intensive care unit and the neurologic intermediate unit at a primary care/referral hospital with a level I trauma center. PATIENTS: A total of 186 patients entered the study. INTERVENTION: Within 12 hrs of admittance, initial assessment, photographs, and Braden score were completed. Patients were re-examined every 4 days or at discharge from the unit, whichever came first. MAIN OUTCOME MEASURES: Determining risk factors for pressure ulcers, performing detailed statistical analyses, and testing the usefulness of the Braden score as a predictor of pressure ulcer risk. RESULTS: Twenty-three of 186 patients developed at least one pressure ulcer (incidence = 12.4%) after an average stay of 6.4 days. The Braden scale, which measures six characteristics of skin condition and patient status, proved to be a primary predictor of ulcer development. No ulcers developed in the 69 patients whose Braden score was 16 or higher. The likelihood of developing a pressure sore was predicted mathematically from the Braden score. However, being underweight was a significant and distinct factor in pressure ulcer development. CONCLUSIONS: Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of < or = 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of < or = 13 and/or a low body mass index at admission.     

2种压疮评估量表在患儿中的应用研究

目的 评价并比较Braden Q和Braden 2种压疮评估量表在儿科重症患者中的应用效果,探索区分患儿发生压疮风险的临界值.方法 采用多中心前瞻性队列研究设计,研究地点为3家儿童医院的重症监护室,派遣2名临床护士充当数据收集员,分别负责量表评分和皮肤评估,两者分别独立进行.结果 本次研究收集样本145例,实际发生压疮9例,发生率为6.2%.Braden Q量表和Braden量表的预测临界值分别是17分和14分;而两者的ROC曲线(受试者工作特征曲线)下面积分别为0.481和0.398.结论 Braden Q量表更加适用于儿科患者,且需要进一步研究改进量表.     

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。     

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.     

自制神经外科压疮危险因素评估量表与Braden量表信度与效度的比较研究

目的 更准确地评估神经外科患者发生压疮的危险性,降低压疮发生率.方法 采用两个评估量表(即自制神经外科压疮危险因素评估量表和Braden量表)评估500例神经外科患者的压疮危险因素,并进行信度和效度的比较.结果 自制神经外科压疮危险因素评估量表的Cronbach's α为0.941,Braden量表的Cronbach's α为0.743.因子分析结果显示,两个量表的结构效度与原设想的基本一致.预测效度显示,当自制神经外科压疮危险因素评估量表的诊断界值取16分时,灵敏度和特异度分别为89%和78%;当Braden量表取18分时,灵敏度和特异度分别为78%和58%.结论 两种量表均具有较好的内部一致性信度、结构效度和预测效度,但自制神经外科压疮危险因素评估量表优于Braden量表,是适合神经外科患者人群的压疮危险评估工具.     

根因分析法在降低Braden评分不超过16分的老年患者压疮发生率中的应用研究

目的探讨根因分析法对降低Braden评分不超过16分的老年患者压疮发生率的效果。方法成立根因分析小组,运用根因分析法对2015年4-5月发生在老年科的12例压疮患者逐一进行追踪,调查导致患者发生压疮的原因,寻找近端原因、剖析出根本原因,进而制订改进措施并实施于2015年7-9月的228例次Braden评分不超过16分的老年患者。比较实施前后患者压疮发生率。结果通过护理干预,Braden评分不超过16分的老年患者压疮发生率从开展前的6.06%降到开展后的2.19%,差异有统计学意义(P0.01)。结论采用根因分析法可以有效对Braden评分不超过16分的老年患者的皮肤进行安全管理,从而降低老年患者压疮发生率,提升护理质量。     

Using the Braden Q Scale to Predict Pressure Ulcer Risk in pediatric patients

The Braden Q Scale for Predicting Pediatric Pressure Ulcer Risk (Braden Q Scale) is a widely used, valid, and reliable pediatric-specific pressure ulcer risk assessment tool. Since its original publication, requests for clarification on how best to use the tool across the wide spectrum of pediatric patients commonly cared for in health care systems have been received. Common clarifications focus on using the Braden Q Scale as originally designed; specifically, not using untested derivations of the tool, and not using the Braden Q Scale to predict medical device-related pressure damage. The purpose of this article is to provide practical information on how best to use the Braden Q Scale and how to score a pediatric patient's risk for pressure ulcers. Accurate assessment of patient risk for pressure ulcers is the first step in guiding appropriate nursing interventions that prevent pressure ulcers. Patient assessment, scoring, and common clinical scenarios are presented.     

高龄患者发生压疮的风险评估与预防

目的评估高龄患者发生压疮的风险性，并针对其风险进行分层护理干预，以期减少压疮的发生。方法对127例高龄患者运用Braden量表进行评分，评估其压疮发生的风险性，并按危险程度分组，分别采取针对性护理措施，观察患者压疮发生的情况。结果人院24h内，127例患者Braden量表总评分为6～18分，平均（11．1±3．5）分，其中高危组患者最多，占37．8％；极高危组占18．1％；低危组占21．3％。经过护理干预后，患者在住院第7、28天极高危和高危组患者明显减少，且Braden评分提高。127例患者中共有7例在院内发生压疮，其中6例发生在人院2周内，1例在人院4周后发生，经治疗均痊愈。结论Braden量表预测显示高龄患者有发生压疮高危险性；通过针对性护理干预可显著降低压疮的发生。     

ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性研究

【目的】分析 ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性。【方法】113例ICU患者分为压疮组（26例）与非压疮组（87例）。比较两组患者入院时的一般情况、氧合作用与血流灌注指标,并对有意义的指标进行进一步的 Logistic回归分析。【结果】压疮的多发部位为骶尾部、臀部及肩胛部,大多数压疮患者的分期为Ⅰ期或Ⅱ期;压疮组平均年龄及入院诊断为呼吸系统疾病与外伤患者的比例明显高于非压疮组（P＜0．05）;压疮组与非压疮组动脉血酸碱度（pH）、动脉二氧化碳分压（PaCO2）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及Braden评分比较有统计学意义（P ＜0．05）;多因素分析结果显示高龄（β＝1．637,OR＝5．140）、呼吸系统疾病（β＝1．592,OR＝4．914）、外伤（β＝1．748,OR＝5．743）是 ICU患者发生压疮的危险因素,而高 MAP（β＝-1．528,OR＝0．217）、高Braden评分（β＝-1．705,OR＝0．182）是保护因素。【结论】高龄、呼吸系统疾病、外伤是 ICU患者发生压疮的危险因素,而高 MAP、高 Braden评分是保护因素。