癌症患者临终阶段腹腔穿刺术后伤口周围潮湿相关性皮肤损伤发生现状及影响因素分析  

Current situation and influencing factors of moisture-associated skin damage around the wound after abdominal puncture in cancer patients at the terminal stage

作　　者：宋娟 朱月兰 张玲玲 SONG Juan;ZHU Yuelan;ZHANG Lingling(Department of Oncology,the First People's Hospital of Kunshan,Jiangsu Province,Kunshan 215334,China;Department of Nursing,the First People's Hospital of Kunshan,Jiangsu Province,Kunshan 215334,China)

机构地区：[1]江苏省昆山市第一人民医院肿瘤科,江苏昆山215334 [2]江苏省昆山市第一人民医院护理部,江苏昆山215334

出　　处：《中国当代医药》2024年第11期129-134,共6页China Modern Medicine

基　　金：江苏省昆山市级科技专项(社会发展)指导性项目(KSZ2320);江苏省昆山市一医院院内科技计划项目(KPY-YN037)。

摘　　要：目的调查癌症患者临终阶段腹腔穿刺术后伤口周围潮湿相关性皮肤损伤(MASD)发生状况及影响因素。方法采用便利抽样的方法,选取2020年4月至2023年4月昆山市第一人民医院肿瘤科197例行腹腔穿刺置管引流的住院患者作为研究对象,采用自制一般情况调查表及穿刺周围皮肤评估表对其进行调查,采用单因素和logistic回归分析方法分析影响发生穿刺点渗出和穿刺点皮肤损伤的影响因素。结果197例腹腔穿刺患者中,穿刺点持续渗出者84例(42.64%)。单因素分析结果显示,不同体重指数、白蛋白、随机血糖、NRS 2002评分患者的穿刺点渗液发生差异有统计学意义(P<0.05)。logistic回归分析显示,白蛋白(β=-0.060,OR=0.942,95%CI:0.892~0.995)、随机血糖(β=-0.761,OR=0.467,95%CI:0.249~0.877)是穿刺点伤口渗液的影响因素(P<0.05)。穿刺周围皮肤继发损伤49例(24.87%),其中发生MASD 42例(21.32%)。单因素分析结果显示,不同白蛋白、留置时间、随机血糖、渗液情况患者的伤口周围皮肤损伤发生差异有统计学意义(P<0.05)。logistic回归分析显示随机血糖(β=-1.752,OR=0.173,95%CI:0.074~0.408)、导管留置时间(β=0.103,OR=1.109,95%CI:1.031~1.192)、有无渗液(β=-2.805,OR=0.061,95%CI:0.022~0.163)是穿刺周围皮肤继发损伤的影响因素。结论癌症患者临终阶段行腹腔穿刺术后MASD发生较为普遍,影响患者的舒适度,应采取针对性措施,降低其发生率或及时予以干预。Objective To investigate the occurrence and influencing factors of moisture-associated skin damage(MASD)after abdominal puncture in cancer patients at the terminal stage.Methods From April 2020 to April 2023,convenience sampling was used to select 197 inpatients who underwent abdominal puncture catheter drainage in the Department of Oncology,the First People's Hospital of Kunshan as the research objects.The self-made general questionnaire and skin assessment form around the puncture were used to investigate the patients.Single factor and logistic regression analysis were used to analyze the influencing factors of exudation and skin damage at the puncture point.Results Among 197 patients with abdominal puncture,84 cases(42.64%)had continuous exudation at the puncture point.The results of univariate analysis showed that there were statistically significant differences in the incidence of puncture point exudation among patients with different body mass index,albumin value,random blood glucose and NRS 2002 score(P<0.05).Logistic regression analysis showed that albumin(β=-0.060,OR=0.942,95%CI:0.892-0.995)and random blood glucose(β=-0.761,OR=0.467,95%CI:0.249-0.877)were influencing factors for wound exudation at the puncture point(P<0.05).Forty-nine cases(24.87%)had secondary skin injury around the puncture,including 42 cases(21.32%)of MASD.The results of univariate analysis showed that there were statistically significant differences in the occurrence of skin injury around the wound among patients with different albumin values,indwelling time,random blood glucose and exudation(P<0.05).Logistic regression analysis showed that random blood glucose(β=-1.752,OR=0.173,95%CI:0.074-0.408),catheter in dwelling time(β=0.103,OR=1.109,95%CI:1.031-1.192)and with or without exudation(β=-2.805,OR=0.061,95%CI:0.022-0.163)were influencing risk factors for secondary skin injury around the puncture.Conclusion MASD after abdominal paracentesis in terminal stage of cancer patients is common,which affects the comfort of patients.Targ

关 键 词：腹腔穿刺术 伤口 潮湿 皮炎 皮肤损伤 

分 类 号：R730[医药卫生—肿瘤]