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].     

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.     

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.     

The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers

BACKGROUND: Turning is considered to be an effective way of preventing pressure ulcers, however almost no research has been undertaken on this method. AIM: The aim of the study was to investigate the effect of four different preventative regimes involving either frequent turning (2, 3 hourly) or the use of a pressure-reducing mattress in combination with less frequent turning (4, 6 hourly). SUBJECTS: 838 geriatric nursing home patients participated in the study. METHODS: During 28 days, four different turning schemes were used: turning every 2 h on a standard institutional (SI) mattress (n = 65), turning every 3 h on a SI mattress (n = 65), turning every 4 h on a viscoelastic foam (VE) mattress (n = 67), and turning every 6h on a VE mattress (n = 65). The remaining patients (n = 576) received standard preventive care. MAIN RESULTS: The incidence of non-blanchable erythema (34.8-38.1%) was not different between the groups. The incidence of grade II and higher pressure ulcers in the 4h interval group was 3.0%, compared with incidence figures in the other groups varying between 14.3% and 24.1%. CONCLUSIONS: Turning every 4 h on a VE mattress resulted in a significant reduction in the number of pressure ulcer lesions and makes turning a feasible preventive method in terms of effort and cost.     

压疮预防管理的实施及效果评价

目的 加强对压疮的预防性管理,有效地降低压疮的发生.方法 建立完善的压疮预防管理制度,采用压疮评估工具筛选高危患者,并对高危患者采取相应的预防措施,比较实施压疮预防管理前后压疮高危者年压疮发生率.结果 2010年压疮高危者年压疮发生率,明显低于2009年,P＜0.01,差异有显著意义.结论 对压疮高危患者实施压疮预防管理,能有效地降低压疮发生率.     

不同间隔时间静态空气垫对卧床患者皮肤减压效果的比较

目的：探讨静态空气床垫不同间隔时间对卧床患者压疮防治效果的影响。方法采用便利抽样及自身对照的方法,选择骨科患者100例,患者均取平卧位,采用全电脑压力传感器（ Xsensor测压毯）平铺于患者身下,卧普通床垫2 h后及平卧静态空气垫2,3,4 h后,对其两侧足跟部、骶尾部的平均压强峰值进行测量比较,并监测每例患者卧床期间的皮肤完整性和压疮发生情况。结果卧普通床垫2h后发生Ⅰ期压疮3例,发生部位为左足跟1例、骶尾部2例,压疮发生率为3％;卧静态空气床垫2,3,4 h后患者未见压疮发生,皮肤完整率为100％;平卧普通床垫2 h与平卧静态空气床垫2 h后患者左足跟部平均压强峰值分别为（185．03±11．34）,（69．13±9．64）mmHg;右足跟部平均压强峰值分别为（176．03±18．64）,（76．40±11．52）mmHg;骶尾部平均压强峰值分别为（253．03±28．64）,（100．23±18．36）mmHg,两组比较,差异有统计学意义（t值分别为7．126,6．287,4．235;P＜0．05）。平卧静态空气床垫2,3,4 h,足跟部、骶尾部受压皮肤平均压强峰值的变化比较,差异无统计学意义（F值分别为5．863,3．128,4．852;P＞0．05）。结论静态空气床垫能有效降低卧床患者受压部位的表面垂直压力,翻身间隔时间可延长至4 h1次,这样既减轻频繁翻身给患者带来的痛苦,同时也减轻了护理人员的劳动强度。     

护士压疮预防行为与影响因素的调查研究

目的 调查护士压疮预防行为,探讨护士压疮预防行为的影响因素。方法 采用横断面调查方法,使用自行设计的压疮预防行为自评表对护士的压疮预防行为进行调查。结果 压疮预防行为平均得分为（43.97 ± 8.95）分,标准得分由高到低的维度为压疮风险评估（6.98 ± 1.69）分,失禁护理（6.66 ± 1.51）分,健康教育（9.61 ± 2.50）分,体位与体位变换（9.21 ± 2.19）分,减压装置使用（11.51 ± 3.20）分。压疮高危科室（Z=-2.379,P<0.05）、职称(χ²=11.601,P<0.01)、是否学习过压疮知识（Z=2.474,P<0.05）、最近一次学习时间（Z=-2.399,P<0.05）、护理患者例数（χ²=17.338,P<0.01）不同,压疮预防行为得分有差异。多重线性回归分析显示,最近一次学习压疮知识时间是压疮预防行为的影响因素,可以解释预防行为15.5%的变异量。结论 护士压疮预防行为有待提高,最近一次学习压疮知识的时间会影响护士的预防行为,学习时间距目前越长,护士预防行为越差,应该加强护士压疮预防知识的学习频率。     

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。     

Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial

BackgroundPressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking.ObjectiveTo evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting.DesignPragmatic randomised controlled trial.SettingA geriatric/internal medical ward with 26 beds in a Swedish university hospital.Participants190 patients were recruited (intervention: n = 91; control: n = 99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4 pm and Friday 4 pm, and expected to stay in the ward ≥3 days.InterventionThe continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body–mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care.ResultsNo significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34–3.79).ConclusionsThis study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.