基于指南的两种失禁护理方案用于老年COVID-19伴失禁患者的效果分析  

Effectiveness Analysis of Two Incontinence Care Plans Based on Guidelines for Elderly COVID-19 Patients with Incontinence

作　　者：蒋琪霞 谢郝婷 王华军 李秀芸 朱玉玲 王亚玲 闵艳 王珂 JIANG Qixia;XIE Haoting;WANG Huajun;LI Xiuyun;ZHU Yuling;WANG Yaling;MIN Yan;WANG Ke(Department of Burns and Plastic Surgery,Eastern Theater General Hospital,PLA,Nanjing 210002,China;Nursing Department,Daping Hospital,Amy Medical University,PLA,Chongqing 400042,China;Department of Neurology,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211112,China;Department of Neurosurgery,Eastern Theater General Hospital,PLA,Nanjing 210002,China)

机构地区：[1]中国人民解放军东部战区总医院烧伤整形科,江苏省南京市210002 [2]中国人民解放军陆军特色医学中心(大坪医院)护理部,重庆市400042 [3]南京医科大学附属逸夫医院神经内科,江苏省南京市211112 [4]中国人民解放军东部战区总医院神经外科,江苏省南京市210002

出　　处：《中国全科医学》2024年第18期2212-2217,2224,共7页Chinese General Practice

基　　金：军队保健专项课题(21BJZ38);上海王正国创伤医学发展基金会课题(WZGF20200101)。

摘　　要：背景老年人是新型冠状病毒感染(COVID-19)和伴失禁的高发人群,也是失禁相关性皮炎(IAD)的易患人群,如何做好失禁护理以提高预防和治疗IAD的有效性一直在探索中。目的探讨基于指南的两种失禁护理方案用于老年COVID-19伴失禁患者的应用效果,为做好此类患者的失禁护理和预防IAD提供参考依据。方法采用探索性干预研究设计,于2022-12-26—2023-03-30在中国人民解放军东部战区总医院、中国人民解放军陆军特色医学中心和南京医科大学附属逸夫医院3所医院的外科和内科选取符合条件的老年COVID-19患者60例为研究对象。将研究对象非随机分为干预组和对照组,其中中国人民解放军东部战区总医院30例患者纳入干预组,另外两家医院30例患者纳入对照组。同时将两组中的IAD患者分别纳入干预亚组和对照亚组。分析老年COVID-19伴失禁患者的病情特点和失禁类型,基于指南推荐,改良修订了评估失禁和皮肤状况(A)、识别和管理危险因素(I)、管理失禁(M),皮肤护理(S)“AIMS四步改良失禁”护理方案(简称AIMS护理方案)。干预组采用改良AIMS护理方案,对照组采用结构化皮肤护理方案,均连续干预至少14 d,每班检查皮肤,采用国际标准判断是否发生IAD以及变化。主要结局指标为两组患者IAD的发生率,次要结局指标为IAD愈合率和愈合时间。收集记录两组患者干预前后的相关临床资料并进行比较。结果两组患者一般资料包括性别、年龄、失禁类型、失禁频次、慢性病共病、血清白蛋白、血红蛋白、血糖、脉氧浓度、Braden计分比较,差异均无统计学意义(P>0.05)。60例老年病毒性肺炎伴失禁患者IAD发生率为33.3%(20/60),其中对照组IAD发生率为43.3%(13/30),干预组IAD发生率为23.3%(7/30);两组患者IAD发生率比较,差异无统计学意义(P>0.05)。两亚组患者IAD分级、愈合率比较,差异均无统计学意义(P>0.05);�Background The elderly are at high risk for COVID-19 and incontinence,as well as a vulnerable population for incontinence-associated dermatitis(IAD).There has been a continuous exploration of how to provide good incontinence care to improve the effectiveness of preventing and treating IAD.Objective To investigate the effectiveness of two incontinence care plans based on guidelines for elderly COVID-19 patients with incontinence,in order to provide a reference basis for good incontinence care and prevention of IAD in such patients.Methods Using an exploratory intervention study design,60 eligible patients with COVID-19 were selected as the study subjects from the surgical and internal medicine departments of Eastern Theater General Hospital,PLA,Daping Hospital,Amy Medical University,PLA,and Sir Run Run Hospital,Nanjing Medical University from December 26,2022 to March 30,2023.The study subjects were nonrandomly divided into the intervention group and control group,with 30 patients from the Eastern Theater Command General Hospital of PLA included in the intervention group and 30 patients from the other two hospitals included in the control group.Patients with IAD in both groups were also included in the intervention and control subgroups.The characteristics and types of incontinence in elderly COVID-19 patients were analyzed,the"AIMS Four Step Improved Incontinence"care plan(AIMS care plan)for the assessing incontinence and skin(A),identifying and managing risk(I),managing incontinence(M),and skin care(S)was modified based on the recommendations of the guidelines.The intervention group adopted the modified AIMS care plan,while the control group adopted a structured skin care plan,with continuous intervention for at least 14 days.The skin was inspected every shift and international standards were used to determine the occurrence of IAD and changes.The primary outcome indicator was the incidence of IAD in both groups of patients,and the secondary outcome indicators were the healing rate and healing time of IAD.The re

关 键 词：肺炎 病毒性 新型冠状病毒感染 大便失禁 尿失禁 失禁相关性皮炎 失禁护理 皮肤护理 老年 

分 类 号：R563.19[医药卫生—呼吸系统] R47[医药卫生—内科学]