-
医疗器械相关性压力性损伤(medical device related pressure ulcer,MDR PU),是指由于体外医疗器械产生的压力而造成的皮肤和/或皮下组织(包括黏膜)的局部损伤,损伤形状往往与器械压迫处形状一致[1]。国外[2-7]研究中,不同文献报道的MDR PU数据差异较大,现患率在0.4%~46.7%。国内研究中,麦燕婷等[8]调查了ICU中MDR PU的发生率,结果为2.47%,以2期和3期压力性损伤为主。侯晓敏[9]发现MDR PU在神经外科手术病人中的发生率为1.96%。造口手术后病人通常需要佩戴造口袋,如若对造口产品的护理方法不当,极易造成造口周围皮肤持续受压,从而引起MDR PU,为病人及其家庭带来较大的痛苦和经济负担。此前,已有学者关注到造口相关医疗器械引起MDR PU的问题,但对于整合大数据、大样本的肠造口MDR PU的现况调查报道较少[10-11]。本文旨在通过全面回顾2016-2018年于我院造口门诊首次随访并发生MDR PU的病人资料,分析发生现状,总结发生原因及相关处理方法,并提出有针对性的防治措施,以期进一步降低肠造口MDR PU的发生率。现作报道。
-
PU的发生率在936例使用造口产品的研究对象中有26例携支撑棒就诊,445例使用造口腰带,844例使用尾夹,92例使用免尾夹造口袋或闭口袋。2例其他原因系固定支撑棒的别针压迫皮肤引起。各造口相关产品导致MDR PU的发生率见表 1。
造口产品 n 发生例数 发生率/% 支撑棒 26 20 76.92 造口腰带 445 38 8.54 造口底盘 936 12 1.28 尾夹 844 4 0.47 其他 936 2 0.21 表 1 造口相关产品导致MDR PU的发生率
-
PU的现状及成因在936例使用造口产品的研究对象中发生不同分期MDR PU共76例,发生率为8.01%。其中,1期压力性损伤51例,大小为1.5 cm×1.2 cm~4.5 cm×2.3 cm;2期压力性损伤16例,大小为0.5 cm×1.3 cm~1.2 cm×3.0 cm,3期压力性损伤2例,大小为0.6 cm×0.7 cm×0.2 cm~1 cm×0.9 cm×0.3 cm。不同分期MDR PU的病人成因的发生率见表 2。
分期 支撑棒 造口腰带 造口底盘 尾夹 其他 合计 χ2 P 1期 13 31 10 4 0 58 12.54 > 0.05 2期 5 7 2 0 2 16 3期 2 0 0 0 0 2 合计 20 38 12 4 2 76 表 2 不同分期MDR PU的病人成因分析(n)
-
PU的治疗结果所有1~3期MDR PU病人通过接受造口治疗师专业的评估后,消除皮肤受压因素,根据创面的不同表现合理运用新型敷料及造口底盘的修剪技巧,制定并实施有针对性的伤口护理干预,促进伤口愈合。76例MDR PU病人均在3~17 d愈合,取得满意结果。
造口门诊医疗器械相关性压力性损伤的现状调查及对策
Investigation and countermeasure of medical device-related pressure ulcer in the stoma care clinic
-
摘要:
目的调查造口门诊发生医疗器械相关性压力性损伤现状,并进行原因分析及对策探讨。 方法选取于造口护理门诊首次随访的949例肠造口病人,对其中发生医疗器械相关性压力性损伤的病人临床资料进行回顾性分析,调查现状,寻求原因并给予针对性的措施。 结果发生不同分期医疗器械相关性压力性损伤共76例,发生率为8.01%。其中,腰带相关性38例,发生率为8.54%;支撑棒相关性20例,发生率为75.92%;底盘相关性12例,发生率为1.28%;尾夹相关性4例,发生率为0.47%。其他原因2例,发生率为0.21%。不同分期医疗器械相关性压力性损伤的成因差异分析无统计学意义。76例1~3期压力性损伤创面经护理后创面愈合,愈合时间3~17 d。护理人员对医疗器械相关性压力性损伤的防治意识不强,健康教育不充分,病人和照护者知识缺乏,医疗器械材质和局部微环境改变是主要原因。 结论医疗器械相关性压力性损伤重在预防,需加强护理人员相关知识的培训,早期干预,制定个性化的造口居家护理健康教育。对已发生的压力性损伤,根据TIME原则选择合适的敷料及措施处理,促进创面愈合。 Abstract:ObjectiveTo investigate the current situation of medical device-related pressure ulcer in the stoma care clinic, and to analyze the causes and discuss the countermeasures. MethodsA total of 949 cases of enterostomy patients who were followed up for the first time in the stoma care clinic were selected. The clinical data of patients with medical device-related pressure ulcer were retrospectively analyzed to investigate the current situation, look for the causes and provide targeted measures. ResultsThere were 76 cases of medical device-related pressure ulcer in different stages, the incidence was 8.01%. Among them, there were 38 cases of ostomy belt correlation, the incidence was 8.54%; 20 cases of rubber support correlation, the incidence was 75.92%; 12 cases of ostomy barrier correlation, the incidence was 1.28%; 4 cases of tail clip correlation, the incidence was 0.47%. There were 2 cases with other causes, and the incidence was 0.21%. There was no significant difference in the causes of medical device-related pressure ulcer in different stages. A total of 76 cases with 1-3 stage of wounds were healed, with healing time of 3-17 d. The main reasons were that the nurses' awareness of medical device-related pressure ulcer was not strong, the patients and caregivers did not have adequate health education and knowledge, and medical device material and local microenvironment changed. ConclusionsThe prevention of medical device-related pressure ulcer is the most important. It is necessary to strengthen the training of the related knowledge for the nurses. The early intervention and making personal health education are also essential. Appropriate dressings and measures should be selected to treat the wounds in order to promote the wound healing according to the principle of TIME. -
Key words:
- stoma /
- pressure ulcer /
- medical device
-
表 1 造口相关产品导致MDR PU的发生率
造口产品 n 发生例数 发生率/% 支撑棒 26 20 76.92 造口腰带 445 38 8.54 造口底盘 936 12 1.28 尾夹 844 4 0.47 其他 936 2 0.21 表 2 不同分期MDR PU的病人成因分析(n)
分期 支撑棒 造口腰带 造口底盘 尾夹 其他 合计 χ2 P 1期 13 31 10 4 0 58 12.54 > 0.05 2期 5 7 2 0 2 16 3期 2 0 0 0 0 2 合计 20 38 12 4 2 76 -
[1] European Pressure Ulcer Advisory Panel, International Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcer/injury: clinical practice guideline[S]. EPUAP/IPIAP/PPPIA: 2019. [2] KAYSER SA, VAN GILDER CA, AYELLO EA, et al. Prevalence and analysis of medical device-related pressure injuries: results from the international pressure ulcer prevalence survey[J]. Adv Skin Wound Care, 2018, 31(6): 276. doi: 10.1097/01.ASW.0000532475.11971.aa [3] MEHTA C, ALI M, MEHTA Y, et al. MDRPU-an uncommonly recognized common problem in ICU: a point prevalence study[J]. J Tissue Viability, 2019, 28(1): 35. doi: 10.1016/j.jtv.2018.12.002 [4] AMIRAH MF, RASHEED AM, PARAMEASWARI PJ, et al. A cross-sectional study on medical device-related pressure injuries among critically ill patients in Riyadh, Kingdom of Saudi Arabia[J]. World Counc Enterost Therap J, 2017, 37(1): 8. [5] HOBSON DB, CHANG TY, ABOAGYE JK, et al. Prevalence of graduated compression stocking-associated pressure injuries in surgical intensive care units[J]. J Crit Care, 2017(40): 1. [6] ARNOLD-LONG M, AYER M, BORCHERT K. Medical device-related pressure injuries in long-term acute care hospital setting[J]. J Wound Ostomy Continence Nurs, 2017, 44(4): 325. doi: 10.1097/WON.0000000000000347 [7] CLARK M, SEMPLE MJ, IVINS N, et al. National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study[J]. BMJ Open, 2017, 7(8): e15616. [8] 麦燕婷, 郭泽霞, 王佳月. 1054例ICU患者器械性压疮的调查及对策分析[J]. 西南国防医药, 2018, 28(5): 500. doi: 10.3969/j.issn.1004-0188.2018.05.042 [9] 侯晓敏. 神经外科手术患者医疗器械相关性压疮的发生原因分析及对策[J]. 中华现代护理杂志, 2017, 23(1): 57. [10] 聂红霞, 何瑞仙, 郑薇, 等. 肠造口医疗器械相关性压疮分析及护理对策[J]. 护士进修杂志, 2017, 32(10): 923. [11] 徐洪莲, 郝建玲, 陈静, 等. 10例造口底盘医疗器械相关性压疮的原因分析及对策[J]. 中国护理管理, 2016, 16(5): 585. [12] 乔彩虹, 杨辉, 曹慧丽. ICU医疗器械相关性压力性损伤的风险评估及护理干预研究进展[J]. 护理研究, 2021, 35(18): 3308. doi: 10.12102/j.issn.1009-6493.2021.18.021 [13] 李梦华. 特重度烧伤患者医疗器械相关性压疮的原因分析及对策[J]. 饮食保健, 2017, 4(26): 147. doi: 10.3969/j.issn.2095-8439.2017.26.183 [14] 胡爱玲, 郑美春, 李伟娟. 现代伤口与肠造口临床护理实践[M]. 北京: 中国协和医科大学出版社, 2010: 10. [15] 潘文亮, 段晓侠, 张秀军. 早期压力性损伤防护流程对降低脑卒中病人压力性损伤发生的成效分析[J]. 蚌埠医学院学报, 2018, 43(8): 1088. [16] 程欢. 3例食道癌术后医疗器械相关性压疮的原因分析及预防[J]. 当代护士(下旬刊), 2018, 25(2): 171. [17] 曹子璇, 魏亚倩, 章晋, 等. 成人住院患者医疗器械相关性压力性损伤流行特征的Meta分析[J]. 中国护理管理, 2020, 20(5): 707. doi: 10.3969/j.issn.1672-1756.2020.05.015 [18] 陈慧玲, 王淑东. Waterlow压力性损伤量表与Braden压力性量表在预测ICU病人压疮预防中的价值[J]. 蚌埠医学院学报, 2020, 45(8): 1107.