某三级教学医院住院患者压疮现患率研究

发布时间：2018-07-23 20:11

【摘要】：研究背景压疮,又称压力性损伤,是发生在皮肤和/或潜在皮下软组织的局限性损伤,通常发生在骨隆突处或与医疗或其他医疗设备有关的损伤。压疮是临床常见的护理并发症,美国每年有大约100万的患者发生压疮,每年用于治疗压疮的医疗费用高达16亿美金,美国近10年的调查研究显示压疮的患病率在综合性医院为10%-18%, 一旦患者发生压疮,不但给患者带来了痛苦,而且增加了社会、家庭的经济负担,同时给护理和治疗带来了极大的困难。压疮多发于年老虚弱或者长期卧床的患者,各个医疗机构将患者压疮的现患率,特别是医院内获得性压疮的发生率作为评价护理质量的指标,为此美国、荷兰、澳大利亚等国家相继开展了全国的现患率调研。研究目的获得综合性医院住院成人患者的压疮现患率和医院获得性压疮的发生率,为临床医护人员制定下一步的预防策略提供依据。资料与方法经培训合格后分配到各个科室进行调查的压疮联络员在统一的时间,采用相同的流程、方法及压疮分期判定标准,对样本医院的成人住院患者进行横断面调查,严格按照护理部制定的统一标准填写调查表及统计数据;①调研对象为年龄≥18岁的所有住院患者,性别、病种不限;②排除标准:血液动力学不稳定,无法现场检查皮肤的患者以及儿科、门诊的患者;拒绝参与调研者;③数据库建立:所有调查表经核对后,剔除有缺失值的调查表;④统计学处理:使用SPSS18.0中文版进行统计分析,现患率统计采用描述性分析,使用率、百分比、均数和标准差。主要结果2016年4次调研共入组患者17066位,调研共筛选出327例压疮患者,其中医院获得性压疮的患者有13位,压疮患者的压疮总数共计587处,压疮患者人均患有1.79处压疮。①压疮现患率及医院获得性压疮发生率:样本医院的压疮现患率为1.92%,医院获得性压疮的发生率为0.07%;②不同年龄段压疮现患率为:18岁-40岁压疮现患率0.42%、41岁-60岁压疮现患率0.82%、61岁-80岁压疮现患率3.02%、80岁压疮现患率为7.61%;③压疮分期分布为:Ⅰ期压疮占比36.80%, Ⅱ期压疮占比40.89%, Ⅲ期压疮占6.30%, ⅣV期压疮占0.85%,可疑深部组织创伤占6.81%,不可分期占8.35%;④压疮的首发部位是骶尾部;⑤不同科室现患率:压疮现患率在监护室最高为18.13%,内科患者的现患率为2.38%,外科患者的现患率为1.40%,综合科患者的现患率为0.97%,综合科患者的现患率是最低的;⑥在327例压疮患者中,使用压疮敷料的患者占比70.03%;每2小时一次的翻身措施落实率为94.80%。⑦医院新发生压疮的患者为13例,所患有压疮的总数量为22处,新发生压疮的患者人均患有1.68处压疮。其中Ⅰ期压疮7处,Ⅱ期压疮15处;患有3处压疮的患者有2位,患有2处压疮的患者有5位,患有1处压疮的患者有6位;男性患者8位,女性患者5位。结论①2016年4次调研结果显示样本医院的压疮现患率为1.92%,医院获得性压疮的发生率为0.07%;压疮患者的现患率随着住院患者年龄的增大而逐步升高;最常见的压疮分期为Ⅱ期;骶尾部是压疮重点防护部位;监护室的压疮现患率最高;②2016年度的4次调研结果可以指导医院压疮预防措施的制订与实施,并且能够为其他相关研究提供初步的基线数据。
[Abstract]:Background pressure sores, also known as stress injuries, are localized injuries occurring in the skin and / or potential subcutaneous soft tissue, usually occurring at the bone protuberance or with medical or other medical equipment. Pressure sore is a common clinical nursing complication. Pressure sore occurs in about 1 million of the patients each year in the United States and is used to treat pressure sores every year. The cost of medical care is up to $1 billion 600 million. In the past 10 years in the United States, the prevalence rate of pressure sore is 10%-18% in the general hospital. Once the patient has pressure sore, it not only brings pain to the patient, but also increases the social burden of the family and the family's economic burden, and brings great difficulties to the nursing and treatment. In patients in bed, the current rate of pressure sore, especially the incidence of pressure sore in the hospital, was used as an index to evaluate the quality of nursing. In the United States, Holland, Australia and other countries, the prevalence rate of pressure sore in the hospitalized adult patients in a comprehensive hospital was investigated. The incidence of acquired pressure ulcers in the hospital provides the basis for the next step of the prevention strategy for clinical medical staff. The data and methods of pressure sore liaison officers assigned to various departments after training are in the same time, using the same process, method and pressure sore staging to determine the standard for the adult hospitalized patients in the sample hospital. Cross-sectional survey, strictly according to the unified standards set by the nursing department to fill out the questionnaire and statistical data; (1) the subjects were all hospitalized patients aged over 18 years old, sex and disease type; 2. Exclusion criteria: hemodynamic instability, patients who were unable to inspect the skin in the field and patients in the Department of Pediatrics, outpatients; refusing to participate in the survey; (3) data Library establishment: after all the questionnaires were checked, the questionnaire was removed with missing values; (4) statistical analysis: statistical analysis was carried out using the Chinese version of SPSS18.0. The statistical analysis was used by the Chinese version of SPSS18.0. The prevalence rate, the percentage, the average number and the standard deviation were used. In 2016, the main results were 17066 patients in the group, and 327 cases of pressure sores were selected. There were 13 patients with pressure sore in the hospital of traditional Chinese medicine. The total number of pressure sore in the patients with pressure sore was 587. The patients in pressure sore had 1.79 pressure sore per person. (1) the current rate of pressure sore and the incidence of hospital acquired pressure sore: the present rate of pressure sore in the sample hospital was 1.92%, the incidence of hospital acquired pressure sore was 0.07%, and the incidence rate of pressure sore at different age groups was 18 years old -40 The prevalence rate of pressure sore at age of 41 years was 0.42%, the current rate of pressure sore at -60 age of 41 years was 0.82%, the present rate of pressure sore at the age of 61 years was 3.02%, and the present rate of pressure sore at 80 years old was 7.61%. The distribution of pressure sore was 36.80%, II stage pressure sore was 40.89%, stage III pressure sore accounted for 6.30%, stage IV V pressure sores 0.85%, suspected deep tissue trauma accounted for 6.81%, no stages accounted 8.35%; (4) pressure The initial site of sore was sacrococcygeal; 5. The prevalence rate of pressure sores was 18.13% in the intensive care unit, 2.38% in the internal medicine patients, 1.40% in the surgical patients, 0.97% in the comprehensive department and the lowest in the comprehensive department patients; 6. Among the 327 patients with pressure sore, the patients who used pressure sore dressing were occupied. Compared to 70.03%, 13 cases of new pressure ulcers were implemented every 2 hours in 94.80%.. The total number of pressure sore was 22, and the patients with new pressure sores had 1.68 pressure sores. Among them, 7 of pressure sore were in stage I, 15 in stage II pressure sore; 2 in 3 patients with pressure sore and 2 in 2 pressure sore. 2 patients suffered from 2 pressure sores. There were 6 patients with 1 pressure sores, 8 male patients and 5 female patients. Conclusion (1) the results of 4 surveys in 2016 showed that the current rate of pressure sore in the sample hospital was 1.92%, the incidence of hospital acquired pressure sores was 0.07%, and the prevalence rate of pressure sore patients increased step by step with the age of hospitalized patients; the most common pressure sore stage was stage II; sacrococcygeal region. It is the key protective part of pressure sore; the rate of pressure ulcers in the guardianship is the highest; the 4 survey results in 2016 can guide the formulation and implementation of the prevention measures of pressure sore in the hospital, and can provide preliminary baseline data for other related studies.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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