减压床垫结合不同翻身频率用于重症患者预防压疮的多中心对照研究  

Different off-loading mattresses with different repositioning intervals for preventing pressure ulcers in critical patients: A randomized controlled trial

作　　者：蒋琪霞[1] 李国宏[2] 刘海英[3] 贾静[4] 黄云娟 陈月娟[6] 朱亚君[7] 刘亚红[8] 范杰梅[9] 刘玉秀[10] 

机构地区：[1]南京军区南京总医院门诊部,南京医学硕士210002 [2]东南大学附属中大医院护理部,南京210009 [3]无锡市第二人民医院护理部,无锡214002 [4]镇江市第一人民医院护理部,镇江212002 [5]无锡人民医院护理部,无锡214043 [6]常熟市第二人民医院护理部,常熟215500 [7]靖江市人民医院护理部,靖江214504 [8]南京军区南京总医院神经内科,南京210002 [9]南京军区南京总医院全军神经外科研究所,南京210002 [10]南京军区南京总医院医务部,南京210002

出　　处：《医学研究生学报》2017年第1期77-82,共6页Journal of Medical Postgraduates

基　　金：南京总医院横向课题(2013NYL014)

摘　　要：目的重症患者是压疮高发人群,使用减压床垫和定时翻身是公认的压疮预防措施,但选择何种减压垫和翻身频率更适合重症患者尚缺乏证据。文中主要通过多中心随机对照研究,比较两种减压垫结合不同翻身频率用于重症患者预防压疮的效果,为重症患者优选减压方案提供依据。方法根据研究方案制定培训内容,包括研究对象、干预和对照方法、观察指标与方法、记录方法,统一培训7所医院的参研人员26人并考核合格。采用非劣效设计,用分层区组随机化方法将1194例患者随机分为试验组与对照组,试验组596例采用凝胶海绵垫+翻身1次/4 h,对照组598例采用动态充气床垫+翻身1次/2 h,连续干预7 d,每日检查皮肤评估判断是否发生压疮及其分期,比较两组压疮发生率。结果 1194例患者干预后压疮总发生率1.09%(13/1194),试验组和对照组的压疮发生率分别为0.34%(2/596)和1.84%(11/598),差异有统计学意义(P=0.012),可推断试验组效果优于对照组。结论重症监护病房患者使用凝胶海绵垫+翻身1次/4 h与采用动态充气床垫+翻身1次/2 h均可使压疮发生率保持在较低水平,鉴于试验组压疮发生率更低,可考虑作为重症监护病房优选减压方案。Objective The incidence rate of pressure ulcer is high in critical patients and off-loading mattresses and repositioning are known as effective interventions for the prevention of pressure ulcers. However,evidence is lacking for selection of the right type of mattresses and suitable interval of repositioning. This study was to compare the effects of two types of off-loading mattresses with two different repositioning intervals in preventing pressure ulcers in critical patients. Methods According to the design of this randomized controlled trial,we made a training plan concerning the participants,methods of intervention and comparison,criteria and methods of observation,and methods of recording,and trained 26 nurses from 7 hospitals. Using non-inferiority design and the method of stratified blocked randomization,we divided 1194 patients with the risk of pressure ulcer into a trial group（ n = 596） and a control group（ n = 598）,a viscoelastic sponge mattress with every-four-hours repositioning used for the former and an automatic aeration mattress with every-two-hours repositioning for the latter,both for 7 successive days. We examined the patients every day,recorded the incidence and stages of pressure ulcer,and compared the data obtained between the two groups of patients. Results The total incidence rate of pressure ulcer was 1.09%（ 13/1194）,significantly lower in the trial than in the control group（ 0.34%[2/596]vs 1.84%[11/598],P= 0.012）. Conclusion A viscoelastic sponge mattress with every-four-hours repositioning is superior to an automatic aeration mattress with every-two-hours repositioning and therefore is preferred to the latter in preventing the incidence of pressure ulcer in critical patients in the ICU.

关 键 词：减压床垫 体位改变 重症监护 压疮 预防与控制 

分 类 号：R472[医药卫生—护理学]