一例预防压力性溃疡最佳翻身策略的循证实践

目的结合1例临床病例,采用循证医学方法,筛选预防压力性溃疡（压疮）的最佳翻身策略。方法依据PICO原则和患者情况,提出个性化的临床问题后,计算机检索NGC、DARE、CDSR、CCTR、MEDLINE、PubMed和CBM,收集预防压力性溃疡（压疮）翻身方法的高质量临床证据。结果最终共纳人1篇临床实践指南、1篇系统评价和3个随机对照试验。根据最终检索结果、患者病情和患者及家属意愿,采用卧于黏弹性泡沫减压床并每4小时翻身1次,使用仰卧位与仰卧位向左向右倾斜30。交替的翻身方法。患者住院期间,骶尾部4-6cm。一度压疮部位清洁干燥,未有破溃,其他色素沉着部位也未有压疮发生。结论运用循证医学方法可为患者提供既科学又考虑患者个体化要求的护理。     

老年住院患者压力性溃疡的预防

压力性溃疡是常见的与年龄相关性疾病,常规的预防措施包括治疗、使用减压装置,以及定期改变患体位.在法国,已不再对骨隆突部位进行“按摩”以减少压力性溃疡的发生率.有人提出应用局部制剂临床效果更显.为确定老年住院患压力性溃疡的实际发生率，以及局部制剂对预防压力性溃疡的效果，并了解压力性溃疡发生相关的危险因素及危险部位，欧盟压力性溃疡委员会、法国压力性溃疡委员会对此进行了多中心的对照临床观察研究。     

波浪床结合创面封闭负压引流及延期减张缝合治疗Ⅳ期压力性溃疡的临床研究

目的 观察波浪床、创面封闭负压引流及延期减压缝合治疗Ⅳ期压力性溃疡（PU）的效果。方法 将46例符合人选标准的Ⅳ期PU患者随机分成治疗组和对照组，每组23例。2组患者在实施原发病常规治疗的基础上，治疗组采用波浪床、创面封闭负压引流及延期减张缝合进行治疗，对照组采用传统疗法进行治疗。每日测量PU的大小，并按压力性溃疡愈合评估表3（Push Tool 3．0）评分；每周一取创面肉芽进行光镜及电镜检查。结果 治疗第50天时，治疗组Push Tool 3．0评分与对照组相比，差异有统计学意义（P〈0．01）。治疗50d后，治疗组PU的光镜及电镜下改变较对照组明显改善。结论 波浪床结合创面封闭负压引流及延期减张缝合可加速PU愈合，改善其光镜及电镜下改变。     

波浪床联合封闭式负压引流治疗1例多发性压力性溃疡患者的护理

压力性溃疡（pressure ulcer）,又名压疮、压迫性溃疡、褥疮,是身体体表尤其是骨突部位受长时间过高压力作用导致血流受阻而产生的皮肤和深层组织坏死[1]。压力性溃疡是长期卧床患者所面临的并发症之一,是目前临床护理工作的难题之一。     

应用安舒妥贴膜对压疮行早期预防的疗效观察

压疮又称压力性溃疡,是因神经营养紊乱及血液循环障碍、局部组织持续缺血、营养不良而发生的组织坏死,是危重症患者常见的并发症之一.住院患者的发生率为5.1%～32.1%[1].     

简易翻身枕、翻身褥用于卧床患者预防压疮的效果研究

目的 探讨简易翻身枕、翻身褥用于卧床患者预防压疮的效果.方法 将自行研制的简易翻身枕、翻身褥用于1300例易患压疮患者,观察应用效果.结果 1300例患者出院时均皮肤完好,无压疮发生.结论 简易翻身枕、翻身褥确为一种预防压疮的有效方法,具有一定的应用价值,值得推广.     

Alternating pressure air mattresses as prevention for pressure ulcers: a literature review

OBJECTIVES: The purpose of this paper is to examine and synthesise the literature on alternating pressure air mattresses (APAMs) as a preventive measure for pressure ulcers. DESIGN: Literature review. DATA SOURCES: PubMed, Cinahl, Central, Embase, and Medline databases were searched to identify original and relevant articles. Additional publications were retrieved from the references cited in the publications identified during the electronic database search. RESULTS: Thirty-five studies were included. Effectiveness and comfort of APAMs were the main focuses of the studies evaluating APAMs. Pressure ulcer incidence, contact interface pressure, and blood perfusion were the most frequently used outcome measures to evaluate the effectiveness of APAMs. Fifteen randomised controlled trials (RCTs) analysed the pressure ulcer incidence. One RCT compared a standard hospital mattress with an APAM and found that the APAM was a more effective preventive measure. RCTs comparing APAMs with constant-low-air mattresses resulted in conflicting evidence. There was also no clear evidence as to which type of APAM performed better. All RCTs had methodological flaws. The use of contact interface pressure and blood perfusion measurements to evaluate the effectiveness of APAMs is questionable. Comfort of APAMs was the primary outcome measure in only four studies. Different methods for assessment were used and different types of APAMs were evaluated. Better measures for comfort are needed. A few studies discussed technical problems associated with APAMs. Educating nurses in the correct use of APAMs is advisable. CONCLUSION: Taking into account the methodological issues, we can conclude that APAMs are likely to be more effective than standard hospital mattresses. Contact interface pressure and blood perfusion give only a hypothetical conclusion about APAMs' effectiveness. Additional large, high-quality RCTs are needed. No conclusions can be drawn regarding the comfort of APAMs. A number of technical problems associated with APAMs are related to nurses' improper use of the devices.     

行军散外敷受压部位在压疮预防中的应用效果

目的:观察行军散外敷受压部位在压疮预防中的效果。方法:选择2010年1月～2012年12月我科住院期间经Braden压疮危险评估量表评估有压疮发生危险患者196例,随机等分成观察组和对照组,观察组采用定期翻身、局部减压、受压部位行军散24 h持续外敷法预防压疮,对照组采用定期翻身、局部减压、受压部位50%红花酒精按摩每天4次预防压疮,观察两组患者在住院期间压疮发生例数。结果:观察组高危患者压疮发生率3.06%,对照组高危患者压疮发生率14.29%。两组患者压疮发生率比较差异具有统计学意义(P0.05)。结论:采用行军散外敷受压部位在早期压疮预防中起着积极作用,有效降低压疮发生。     

外科高危科室压疮预防新进展的调查分析

目的:了解外科高危科室护士对压疮预防新进展的知识掌握情况和护理态度。方法:采用问卷调查法对4个外科高危科室护士进行调查。结果:外科高危科室护士对压疮预防新进展认知较差。不同科室护士的压疮预防新进展得分差异有统计学意义(P0.05)。结论:应对外科高危科室护士提供压疮预防新进展教育及培训,以提高压疮预防护理水平。     

减压床翻身间隔时间对预防压疮效果的系统评价

目的：系统评价减压床不同翻身间隔时间对临床住院病人预防压疮的有效性。方法计算机检索Co‐chrane、JBI、Medline、PubMed、Embase、EBSCO CINAHL、CBM、重庆维普和万方数据库,查找关于使用减压床翻身间隔时间对预防压疮的相关研究文献,检索时限均从建库至2015年1月14日。由3位评价员按纳入与排除标准独立筛选文献、提取资料并评价文献质量后,采用RevM an 5．1软件进行M eta分析。结果共纳入6项研究,882例患者。Meta分析结果显示：与传统2 h翻身方法相比,采用4 h翻身方法对预防压疮发生的差异无统计学意义,RR＝1．95,95％,CI（0．63,6．02）,P＝0．25。与6 h翻身相比,4 h翻身在预防Ⅱ期及Ⅱ期以上压疮的发生情况方面RR＝0．16,95％,CI（0．06,0．41）,P＝0．001,差异有统计学意义。结论现有证据表明,对于预防Ⅱ期及Ⅱ期以上压疮的发生情况,4h翻身法优于6h翻身法。在所有压疮发生情况方面,2h翻身与4h翻身对预防压疮的效果无显著差异。从成本效益角度着眼,4h翻身法可减轻护士工作量及提高工作效率等。     

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury

Purpose. To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention.

Method. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis.

Results. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositionings, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositionings, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs.

Conclusions. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.     

压疮预防指南临床应用的效果分析

目的 评价<成人压疮预测和预防实践指南>对指导和规范护士预防压疮的效果.方法 对2008年5月至2010年4月在住院期间有压疮发生危险的成人患者11808例进行观察分析.2008年5月至2009年4月共2081例为对照组,按照<医疗护理常规>第4版中的预防压疮常规实施护理;2009年5月至2010年4月共9727例为观察组,按照2009年出版的<成人压疮预测和预防实践指南>实施护理.观察两组院内获得性压疮发生例数及压疮分期.结果 两组院内获得性压疮例数和Ⅲ期压疮发生数有显著差异.结论 <成人压疮预测和预防实践指南>的应用可有效降低压疮发生率和压疮严重度,规范护士预防压疮的护理行为.     

Economic assessment of pressure sore prevention using a computerized mattress system in patients with spinal cord injury

Purpose. To assess the economic profitability of a new computerized mattress system in patients with spinal cord injuries (SCI) by comparison with two other alternatives, as an example of the use of a quantitative approach for decision-making in choosing between alternatives for sore prevention.

Method. The cost of achieving one day without signs of impending pressure sore was compared between the alternative options using cost minimization analysis. Savings in nursing costs for the three options were calculated for cost-benefit analysis.

Results. A foam mattress system is significantly cheaper than the other examined alternatives, and if the nursing manpower cost is constant and the nursing staff is capable of performing sufficient repositionings, this system would achieve the desired medical outcome at a minimal cost. However, if the nursing staff cannot perform sufficient repositionings, or if the use of nursing manpower can be adjusted to the actual need, then it is the computerized mattress system that achieves the desired outcome at the minimal cost. In this case, less than 20 New Israeli Shekels (NIS) per day spent on the equipment save NIS 45 per day in labor costs.

Conclusions. The economic evaluation indicates that the computerized mattress system is advisable for patients with SCI who require assistance for repositioning, but its profitability depends on the employment terms of the nursing manpower. In addition, other possible alternative pressure management systems should be examined, and additional research may be needed to determine the optimal combination of such systems for a spinal cord rehabilitation department.     

瘫痪患者褥疮危险因素的动态评估与干预

目的　探讨瘫痪患者褥疮高危因素的动态评估在预防干预中的作用。方法　将 86例瘫痪患者随机分为主动预防组即采用褥疮危险因素动态评估指导下的预防和被动预防组即常规的预防护理 ,观察并比较两组在住院期间褥疮发生率、资源利用的有效性。结果　被动预防组发生褥疮初期 5例 (11 6 3% ) ,褥疮Ⅱ期 2例 (4 6 5 % ) ;主动预防组仅有 1例褥疮初期。结论　经动态评估对褥疮高危患者实行重点预防既节省资源又提高了预防干预的有效性。