集束化护理策略在院内预防骨科患者压疮中的应用观察

目的探讨集束化护理干预在骨科患者压疮的预防效果。方法随机选取2015年1月~2016年1月我院收治的骨科患者200例,按抽签方式分为实验组和对照组各100例,对照组实施常规压疮护理干预措施,实验组实施有效的集束化护理干预措施,并对两组患者的压疮发生率、患者对压疮相关知识的掌握程度、患者及其家属对护理工作的满意度、住院时间进行比较。结果实验组的压疮发生率明显低于对照组(P0.05);压疮相关知识掌握程度,实验组明显高于对照组(P0.05);而且实验组患者及家属对护理工作的满意度显著高于对照组(P0.05),住院时间显著低于对照组(P0.05)。结论在骨科临床中,对患者实施有效的集束化护理干预能提高患者相关疾病知识,提高临床护理效果,降低压疮发生率,有利提高患者满意度。     

集束化护理在ICU患者压疮管理中的效果观察

目的:探讨集束化护理在ICU患者压疮管理中的效果。方法:将2009年1月至2010年12月收治的97例压疮高危患者作为对照组,将2011年1月至2012年12月收治的104例压疮高危患者作为观察组,均排除下肢动脉病变者。对照组采取压疮常规护理方法,观察组采取集束化护理方法,2周后评价的各自的压疮发生率、发生时间及程度。结果:对照组各期压疮发生共29例(29.90%),观察组各期压疮发生共13例(12.50%),两组患者压疮发生率相比,差异有统计学意义(X2=9.190;P<0.05);对照组患者压疮发生时间明显早于观察组,两者相比,差异有统计学意义(t=8.598;P<0.05)。结论:在ICU压疮护理中运用集束化护理策略效果明显,大大降低了患者发生压疮的几率及程度,值得推广运用。     

局部用药治疗溃疡期压疮的观察与体会

目的：比较不同的方法对压疮的临床疗效。方法：根据病人的性别、年龄、病情、营养状况和压疮的部位,疮缘大小、疮面深度、肉芽色泽,用随机法将病人分为A、B两组,用不同的处理方法同样的评估标准对患者进行评估。结果：在传统基础上给子硫糖铝、654-2按100：1剂量比研成粉末,用适量生理盐水调成糊状,湿敷疮面,能改善局部血流,促进肉芽生长。结论：应用硫糖铝、654-2治疗溃疡期压疮有效,确切的临床治疗效果,值得推广应用。     

压疮预警干预程序对预防老年患者术中压疮的效果观察

目的探讨压疮预警干预程序对老年手术患者术中压疮发生率的影响。方法选择2013年10月~2014年4月在我院行手术治疗的老年患者146例随机分为观察组和对照组各73例,对照组给予常规手术室护理模式进行护理,观察组于术前使用压疮预警评分表对患者皮肤状况进行评估,并根据评估情况按压疮预警干预程序实施相应护理措施,术后第3、6天分别观察比较两组患者的压疮发生情况。结果观察组患者的压疮发生率明显低于对照组,两组比较差异有统计学意义(P0.05)。结论应用压疮预警干预程序实施相应的护理措施可有效预防老年患者术中压疮的发生。     

合理翻身的间隔时间在神经内科压疮预防护理中的作用

近10年来,国内外对压疮的预防有了长足的进步,但发病率并没有下降的趋势。压疮的预防至今仍是护理学领域的难题。神经内科收治的患者以瘫痪、昏迷、危重、年老者为多,是压疮发生的高危科室。如何预防压疮,一直都是护理研究的课题。我科将2007年1月～2009年1月收治的Norton评分〈14分病情允许翻身的156例脑卒中偏瘫患者以随机分组的方式观察合理安排翻身间隔时间对预防压疮的作用,现报告如下。     

肝胆外科压疮程序化护理的实施及效果评价

目的探讨肝胆外科压疮程序化护理的方法及效果。方法选取2014年12月~2015年12月我院肝胆外科收治的患者90例,随机分为观察组和对照组各45例。对照组给予常规护理,观察组给予压疮程序化护理,观察比较两组的护理效果。结果观察组压疮发生率为2.2%,压疮好转时间为(4.23±2.08)天,满意度为97.8%;对照组压疮发生率为20.0%,压疮好转时间为(14.65±3.06)天,满意度为72.2%。组间比较观察组均优于对照组,差异有统计学意义(P0.05)。结论压疮程序化护理用于肝胆外科患者中,能显著降低压疮的发生率,提高护理满意度。     

延续护理对改善老年压疮高危感染患者照顾者 居家护理行为的研究

目的探讨延续护理对改善老年压疮高危感染患者照顾者居家护理行为的影响,为临床提供参考依据。方法选择我院肿瘤科2015年7月至2018年8月收治的100例老年压疮高危患者作为研究对象,通过红篮球随机抽取的方式分成试验组(50例)和对照组(50例)。试验组和对照组分别采取延续护理和常规护理,结果采取对比分析,对比两组患者的压疮感染发生率、护理满意率。结果试验组患者的压疮感染发生率远远低于对照组(2%vs 14%),两组患者比较差异有统计学意义(P0.05);试验组患者照顾者居家护理行为得分、护理满意率(90.32±10.92 vs 78.47±10.16,96%vs 78%)均高于对照组,差异具有统计学意义(P0.05);试验组患者的疾病不确定感评分为(56.76±10.98)分,远远低于对照组的(89.06±10.22)分(P0.05),差异有统计学意义,说明延续护理具有较好的应用价值。结论延续护理对改善老年压疮高危感染患者照顾者居家护理行为具有积极影响,可有效提高照顾者的护理能力,减少压疮的发生,减少患者的疾病不确定感,值得在护理实践中应用和推广。     

气垫床在预防压疮中的效果评价

目的：探讨气垫床在预防压疮中的应用,为减少住院患者压疮的发生提供科学依据,提高患者生存质量。方法：选择我院2011年6月-2012年6月住院患者116例为研究对象,对患者进行褥疮风险评估后将116例患者随机分为两组,一组患者使用气垫床,另一组患者普通褥疮预防和护理,对两组患者发生褥疮的情况进行比较。结果：普通组患者发生压疮26例,对照组患者发生压疮5例,经卡方比较,对照组好于普通组,P〈0.05。结论：气垫床的使用不仅可以很好的杜绝压疮的发生,还可以提高患者的生存质量。     

有关麝香生肌膏于压疮护理之中的应用效果探究

目的:探究有关设想生肌膏在压疮护理中的疗效和应用前景。方法:针对我社区医院从2011年6月至2013年6月收治的24名压疮患者进行随机分成2组,每组12人。其中观察组采取麝香生肌膏换药,对照组采取凡士林作为换药,一个疗程之后,比对两组换药对于压疮的创面愈合的治疗效果,分别考察创面的愈合时间、愈合的效果、压疮患者疼痛的持续时间等指标,并采用统计学方法进行比对分析,当P<0.05时,认为有统计学意义。结果:施用麝香生肌膏的观察组无论是从创面的愈合程度、愈合时间还是在压疮患者的疼痛感持续时间上效果都要比对照更佳,两者的比较具有统计学意义(P<0.05)。结论:在临床的压疮治疗上,采用麝香生肌膏更有利于创面的愈合和痊愈,大大缩短了患者的疼痛时间,适合在临床上推广。     

紫草油治疗压疮的护理观察

目的观察紫草油治疗压疮的临床疗效,为压疮的护理提供新的思路和方法。方法将60例压疮患者随机分为对照组和治疗组各30例,对照组采用常规护理和康复新换药,治疗组采用常规护理和紫草油换药,治疗后评价两组疗效的差异。结果两组均能促进压疮创面愈合,治疗组总有效率优于对照组(P0.05)。结论紫草油治疗压疮的临床效果显著,值得推广应用。     

血清Alb、Mb及MEWS、Waterlow评分对重症监护病房患者压力性损伤的预测价值

摘要 目的：探讨血清白蛋白（Alb）、肌红蛋白（Mb）及改良早期预警评分（MEWS）、Waterlow评分对重症监护病房（ICU）患者压力性损伤（PI）的预测价值。方法：选取2021年6月～2022年12月在新疆维吾尔自治区人民医院ICU住院的患者120例,根据是否发生PI分为PI组43例和非PI组77例。ICU患者PI的影响因素采用多因素Logistic回归分析,血清Alb、Mb及MEWS、Waterlow评分对ICU患者PI的预测价值采用受试者工作特征（ROC）曲线分析。结果：PI组年龄大于非PI组,机械通气比例、体温、Mb、MEWS、Waterlow评分高于非PI组,住院时间长于非PI组,Alb低于非PI组（P＜0.05）。住院时间延长和Mb升高、MEWS增加、Waterlow评分增加为ICU患者PI的独立危险因素,Alb升高为其独立保护因素（P＜0.05）。血清Alb、Mb及MEWS、Waterlow评分四项联合预测ICU患者PI的曲线下面积大于各指标预测（P＜0.05）。结论：血清Alb水平降低和Mb、MEWS、Waterlow评分升高与ICU患者PI发生独立相关,血清Alb、Mb及MEWS、Waterlow评分联合对ICU患者PI具有良好预测价值。     

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers

ObjectiveTo evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers.DesignProspective cohort study.SettingTwo large hospitals in the Netherlands.Participants1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000.Results135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). The area under the receiver operating characteristic curve was 0.56 (0.51 to 0.61) for the Norton scale, 0.55 (0.49 to 0.60) for the Braden scale, and 0.61 (0.56 to 0.66) for the Waterlow scale; the areas for the subpopulation, excluding patients who received preventive measures without developing pressure ulcers and excluding surgical patients, were 0.71 (0.65 to 0.77), 0.71 (0.64 to 0.78), and 0.68 (0.61 to 0.74), respectively. In this subpopulation, using the recommended cut-off points, the positive predictive value was 7.0% for the Norton, 7.8% for the Braden, and 5.3% for the Waterlow scale.ConclusionAlthough risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed.

What is already known on this topic

The incidence of pressure ulcers in hospitalised patients varies between 2.7% and 29.5%Guidelines for prevention of pressure ulcers base the allocation of labour and resource intensive measures on the outcome of risk assessment scalesMost risk assessment scales are based on expert opinion or literature review and have not been evaluatedThe sensitivity and specificity of risk assessment scales vary

What this study adds

The effectiveness of available risk assessment scales is limitedUse of the outcome of risk assessment scales leads to inefficient allocation of preventive measures     

Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound

The thickness of soft tissues over the sacrum of elderly hospital in-patients has been measured using B-mode ultrasound. Forty patients were scanned, of which nine had recognizable superficial pressure sores at the sacrum. No correlation was found between the depth of soft tissue and either age or Norton score. Patients with sores had less soft tissue over the sacrum (p < 0.025). Excluding one patient whose sacral sore appeared to be the final stage of the healing process, the remaining eight all had less than 8.5 mm of sacral soft tissue cover. Five patients without sacral sores also had less than 8.5 mm of sacral soft tissue cover. However, a combination of the presence of incontinence and the depth of sacral soft tissue cover identified seven of the eight patients with sacral sores with no inclusion of patients without sores.     

预防压疮管理路径表的设计与应用

目的：探讨压疮管理的方法和路径。方法：制定并应用神经外科压疮管理路径表。选择2010年3月至2011年3月神经外科入院的1400例患者,分为对照组与观察组,观察组755例,入院后常规护理基础上应用路径表;对照组为645例,常规护理。结果：对照组645例患者中,发生压疮例数Ⅱ期压疮5例;观察组755例患者中,发生Ⅰ期压疮1例。P〈0．05,有显著统计学意义。结论：应用压疮管理路径表可以预防神经外科患者压疮的发生,有效降低患者压疮发生率。     

预防压疮管理路径表的设计与应用

目的:探讨压疮管理的方法和路径。方法:制定并应用神经外科压疮管理路径表。选择2010年3月至2011年3月神经外科入院的1400例患者,分为对照组与观察组,观察组755例,入院后常规护理基础上应用路径表;对照组为645例,常规护理。结果:对照组645例患者中,发生压疮例数Ⅱ期压疮5例;观察组755例患者中,发生Ⅰ期压疮1例。P<0.05,有显著统计学意义。结论:应用压疮管理路径表可以预防神经外科患者压疮的发生,有效降低患者压疮发生率。     

Surgical reconstruction of pediatric pressure sores: long-term outcome.

The long-term outcome after the surgical repair of pressure sores in the adult population has been well studied. Recurrence rates from 25 to 80 percent have been reported, despite improvements in surgical repair and mechanical support devices. Such high recurrence rates have led many investigators to question the rationale for the surgical closure of pressure sores. There are no published long-term data that document pressure sore recurrence after surgical treatment in the pediatric population. A retrospective analysis of all patients who underwent surgical reconstruction of grade III and IV pressure sores at the Children's Hospital of Philadelphia from 1987 to 1999 was performed. During this 12-year period, 19 consecutive patients with a mean age of 16.2 years were operated on for 25 pressure sores. Follow-up was obtained for 15 patients (79 percent), who underwent repair for 20 pressure sores. Mean postoperative follow-up was 5.3 years (range, 11 months to 11 years). Mean age at the time of surgery was 16.5 years. The overall pressure sore recurrence rate was 5 percent (1 of 20 sores). Overall patient recurrence (previous patient who developed a new sore) was 20 percent (3 of 15 patients). In contrast to the recurrence rates reported for the surgical repair of pressure sores in the adult population, the recurrence rate of 5 percent in the pediatric population is significantly lower. This demonstrates that the surgical reconstruction of pressure sores in the pediatric patient can be successful and provide long-term skin integrity.     

心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者血压的影响

目的:研究心理干预联合氟哌噻吨美利曲辛片对老年高血压伴焦虑抑郁患者的血压影响。方法:选取2013年4月到2014年4月某院收治的老年高血压伴焦虑抑郁的患者110例,按照随机数字表法将患者分为研究组和对照组,每组55例,对照组给予常规降压治疗,研究组在对照组的基础上给予心理干预,同时服用氟哌噻吨美利曲辛片,治疗时间均为8周,应用抑郁自评量表(HAMD)和汉密尔顿焦虑自评量表(HAMA)的评分来评价患者的抑郁状态,比较两组降压疗效、HAMD评分、HAMA评分以及不良反应。结果:研究组降压总有效率94.5%(52/55),对照组降压总有效率为67.3%(37/55),两组比较差异具有统计学意义(x2=12.952,P=0.013);研究组治疗后HAMA评分和HAMD评分分别为(10.5±0.6)分、(11.9±1.1)分显著低于治疗前的(20.8±0.4)分、(31.2±0.7)分,与治疗前比较差异具有统计学意义(t=9.923,10.628,P=0.025,0.019),与对照组比较差异具有统计学意义(t=9.823,11.628,P=0.023,0.016);两组不良反应比较差异无统计学意义(x2=5.492,P=0.072)。结论:心理干预联合氟哌噻吨美利曲辛片治疗老年高血压伴焦虑抑郁者具有较好的降压效果,能改善患者焦虑抑郁状态,且无严重不良反应。     

正念冥想对妇科肿瘤手术患者应激反应的影响

目的:探讨正念冥想对妇科肿瘤手术患者应激反应的效果。方法:将70例手术患者分为试验组(正念冥想组)、对照组(空白对照组),各35例。采用焦虑自评量表(SAS)对两组患者不同时间点的焦虑水平进行测试,比较两组患者不同时间点的心率和血压,静脉采血测定去甲肾上腺素(NE)、皮质醇(COS)。结果:两组不同测量时间及组间的焦虑评分、血压、心率比较,差异均有统计学意义(P0.05);试验组患者血浆NE值明显降低(P0.05),COS值亦有所下降(P0.05)。结论:正念冥想能有效减轻妇科肿瘤手术患者的焦虑,稳定血压和心率,减轻应激反应。     

Gluteal perforator flaps for coverage of pressure sores at various locations

Flap coverage is essential for successful treatment of pressure sores, and musculocutaneous flaps have been preferred universally. Development of perforator flaps supplied by musculocutaneous perforators has allowed reconstructive surgeons to harvest flaps without including muscles. Perforator flaps have enhanced the possibility of donor sites because a flap can be supplied by any musculocutaneous perforator, and donor-site morbidity is also reduced. Between November of 1998 and June of 2002, the authors used 35 gluteal perforator flaps in 32 consecutive patients for coverage of pressure sores located at sacral (n = 22), ischial (n = 7), and trochanteric (n = 6) regions. The mean age of the patients was 53.1 years (range, 5 to 87 years), and there were 16 male and 16 female patients. All flaps in this series were supplied by musculocutaneous arteries arising from gluteal muscles. Patients were followed up for a mean period of 13.6 months. Wound dehiscence was observed in two patients and treated by secondary closure. Three patients died during the follow-up period. All flaps survived except one that had undergone total necrosis, and only one recurrence was noted during the follow-up period. Gluteal perforator flaps are safe and reliable options for coverage of pressure sores located at different locations. Freedom in flap design and low donor-site morbidity make gluteal perforator flaps an excellent choice for pressure sore coverage.