【摘要】：研究背景壓瘡,又稱壓力性損傷,是發(fā)生在皮膚和/或潛在皮下軟組織的局限性損傷,通常發(fā)生在骨隆突處或與醫(yī)療或其他醫(yī)療設(shè)備有關(guān)的損傷。壓瘡是臨床常見的護理并發(fā)癥,美國每年有大約100萬的患者發(fā)生壓瘡,每年用于治療壓瘡的醫(yī)療費用高達16億美金,美國近10年的調(diào)查研究顯示壓瘡的患病率在綜合性醫(yī)院為10%-18%, 一旦患者發(fā)生壓瘡,不但給患者帶來了痛苦,而且增加了社會、家庭的經(jīng)濟負擔,同時給護理和治療帶來了極大的困難。壓瘡多發(fā)于年老虛弱或者長期臥床的患者,各個醫(yī)療機構(gòu)將患者壓瘡的現(xiàn)患率,特別是醫(yī)院內(nèi)獲得性壓瘡的發(fā)生率作為評價護理質(zhì)量的指標,為此美國、荷蘭、澳大利亞等國家相繼開展了全國的現(xiàn)患率調(diào)研。研究目的獲得綜合性醫(yī)院住院成人患者的壓瘡現(xiàn)患率和醫(yī)院獲得性壓瘡的發(fā)生率,為臨床醫(yī)護人員制定下一步的預(yù)防策略提供依據(jù)。資料與方法經(jīng)培訓(xùn)合格后分配到各個科室進行調(diào)查的壓瘡聯(lián)絡(luò)員在統(tǒng)一的時間,采用相同的流程、方法及壓瘡分期判定標準,對樣本醫(yī)院的成人住院患者進行橫斷面調(diào)查,嚴格按照護理部制定的統(tǒng)一標準填寫調(diào)查表及統(tǒng)計數(shù)據(jù);①調(diào)研對象為年齡≥18歲的所有住院患者,性別、病種不限;②排除標準:血液動力學(xué)不穩(wěn)定,無法現(xiàn)場檢查皮膚的患者以及兒科、門診的患者;拒絕參與調(diào)研者;③數(shù)據(jù)庫建立:所有調(diào)查表經(jīng)核對后,剔除有缺失值的調(diào)查表;④統(tǒng)計學(xué)處理:使用SPSS18.0中文版進行統(tǒng)計分析,現(xiàn)患率統(tǒng)計采用描述性分析,使用率、百分比、均數(shù)和標準差。主要結(jié)果2016年4次調(diào)研共入組患者17066位,調(diào)研共篩選出327例壓瘡患者,其中醫(yī)院獲得性壓瘡的患者有13位,壓瘡患者的壓瘡總數(shù)共計587處,壓瘡患者人均患有1.79處壓瘡。①壓瘡現(xiàn)患率及醫(yī)院獲得性壓瘡發(fā)生率:樣本醫(yī)院的壓瘡現(xiàn)患率為1.92%,醫(yī)院獲得性壓瘡的發(fā)生率為0.07%;②不同年齡段壓瘡現(xiàn)患率為:18歲-40歲壓瘡現(xiàn)患率0.42%、41歲-60歲壓瘡現(xiàn)患率0.82%、61歲-80歲壓瘡現(xiàn)患率3.02%、80歲壓瘡現(xiàn)患率為7.61%;③壓瘡分期分布為:Ⅰ期壓瘡占比36.80%, Ⅱ期壓瘡占比40.89%, Ⅲ期壓瘡占6.30%, ⅣV期壓瘡占0.85%,可疑深部組織創(chuàng)傷占6.81%,不可分期占8.35%;④壓瘡的首發(fā)部位是骶尾部;⑤不同科室現(xiàn)患率:壓瘡現(xiàn)患率在監(jiān)護室最高為18.13%,內(nèi)科患者的現(xiàn)患率為2.38%,外科患者的現(xiàn)患率為1.40%,綜合科患者的現(xiàn)患率為0.97%,綜合科患者的現(xiàn)患率是最低的;⑥在327例壓瘡患者中,使用壓瘡敷料的患者占比70.03%;每2小時一次的翻身措施落實率為94.80%。⑦醫(yī)院新發(fā)生壓瘡的患者為13例,所患有壓瘡的總數(shù)量為22處,新發(fā)生壓瘡的患者人均患有1.68處壓瘡。其中Ⅰ期壓瘡7處,Ⅱ期壓瘡15處;患有3處壓瘡的患者有2位,患有2處壓瘡的患者有5位,患有1處壓瘡的患者有6位;男性患者8位,女性患者5位。結(jié)論①2016年4次調(diào)研結(jié)果顯示樣本醫(yī)院的壓瘡現(xiàn)患率為1.92%,醫(yī)院獲得性壓瘡的發(fā)生率為0.07%;壓瘡患者的現(xiàn)患率隨著住院患者年齡的增大而逐步升高;最常見的壓瘡分期為Ⅱ期;骶尾部是壓瘡重點防護部位;監(jiān)護室的壓瘡現(xiàn)患率最高;②2016年度的4次調(diào)研結(jié)果可以指導(dǎo)醫(yī)院壓瘡預(yù)防措施的制訂與實施,并且能夠為其他相關(guān)研究提供初步的基線數(shù)據(jù)。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R47

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