军队医院老年保健对象压力性损伤发生特征及预防现况的多中心研究  

A multicenter study on the occurrence characteristics and prevention status of pressure injuries among eld-erly healthcare recipients in military hospitals

作　　者：蒋琪霞 展颖颖 蒋炜 王亚玲 何燕敏 李丽 宋彩萍 郑喜灿 罗丽琴 白育瑄 JIANG Qixia;ZHAN Yingying;JIANG Wei;WANG Yaling;HE Yanming;LI Li;SONG Caiping;ZHENG Xican;LUO Liqin;BAI Yuxuan(Department of Burn and Plastic Surgery,General Hospital of the Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Qinhuai Medical Area Outpatient Department,General Hospital of the Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Nursing,the Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,Shaanxi,China;Department of Nursing,Army Characteristic Medical Center,PLA,Chongqing 400042,China;Department of Outpatient,the 904th Hospital of the Joint Logistics Support Force,PLA,Wuxi 214000,Jiangsu,China;Department of Nursing,the Third Affiliated Hospital of Naval Medical University,Shanghai 201805,China;Department of Geriatry and Special Service Medicine,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Nursing,the 988th Hospital of the Joint Logistics Support Force,PLA,Zhengzhou 450042,Henan,China;Department of Outpatient,the 923th Hospital of the PLA Joint Logistics Support Force,Nanning 530021,Guangxi,China;Department of Clinical Academic,Zhejiang Top Medical Dressing Limited Company,Wenzhou 325025,Zhejiang,China)

机构地区：[1]东部战区总医院烧伤整形科,南京210002 [2]东部战区总医院秦淮医疗区门诊部,南京210002 [3]空军军医大学第二附属医院护理处,西安710038 [4]解放军陆军特色医学中心护理部,重庆400042 [5]解放军联勤保障部队第九〇四医院门诊部,无锡214000 [6]海军军医大学附属第三医院护理处,上海201805 [7]陆军军医大学第二附属医院老年与特勤医学科,重庆400037 [8]解放军联勤保障部队第九八八医院护理部,郑州450042 [9]解放军联勤保障部队第九二三医院门诊部,南宁530021 [10]浙江医鼎医用敷料有限公司临床学术部,温州325025

出　　处：《医学研究与战创伤救治》2025年第2期186-193,共8页Journal of Medical Research & Combat Trauma Care

基　　金：军队保健专项课题(21BJZ38);军队卫勤保障创新能力生成专项课题(20WQ027)。

摘　　要：目的 调查军队医院老年保健对象的压力性损伤发生特征及预防现况,为制定规范化预防方案提供依据。方法 招募入选8所三级甲等军队医院作为多中心研究单位,纳入住院≥24 h、年龄≥65岁的军队和地方保健对象为研究对象,选择210名培训合格的护士使用一致的调研工具和方法,于2023年5月和7月两个时间点,从一般资料、健康状况、皮肤检查、Braden量表计分、预防措施落实情况五个方面收集资料,发现皮肤损伤采用国际标准判断是否压力性损伤及分期,并根据发生时间判断是否医院获得性压力性损伤,进行统计分析。结果 共调查7638例,获得有效资料7615例,男性和女性分别占比62.59%和37.41%,军队和地方保健对象分别占比10.23%(n=779)和89.77%(n=6836),前者年龄大于后者[(90.11±8.66)岁vs (72.72±6.33)岁,P<0.001],前者失禁率高于后者(13.86%vs 3.58%,P<0.001),前者有压力性损伤发生危险者(Braden计分≤18分)的比例高于后者(55.58%vs 26.18%,P<0.001),前者的减压垫使用率(72.29%)、定时翻身落实率(76.22%)、结构化失禁护理落实率(97.22%)及营养护理落实率(74.67%),均高于后者(P均<0.05),前者压力性损伤现患率高于后者(4.62%vs 2.00%, P<0.001),前者医院获得性压力性损伤发生率高于后者(1.28%vs 0.44%,P<0.001)。两者压力性损伤分期均以2期为主(50.00%和37.23%)。结论 军队保健对象年龄大、失禁率高、处于危险状态者多,因此,压力性损伤现患率及医院获得性压力性损伤发生率较高,预防措施未达100%,是持续质量改进的重点。Objective To investigate the characteristics and preventive status of pressure injuries(PI)among elderly healthcare recipients in military hospitals,and to provide a basis for formulating standardized prevention plans.Methods A multicenter study was performed in 8 tertiary Grade A military hospitals.Military and civilian healthcare recipients who have been hospitalized for≥24 hours and aged≥65 years were included in this study.A total of 210 trained and qualified nurses used consistent research tools and methods to collect data from five aspects:general information,health status,skin examination,Braden scale scoring,and implementation of preventive measures in May and July 2023.International standards were used to determine whether skin injuries were PI and its staging,and hospital acquired pressure injuries(HAPI)were determined based on the time of occurrence.Results A total of 7638 cases were investigated,and 7615 cases were valid for analysis.Male and female accounted for 62.59%and 37.41%,respectively.The military and civilian healthcare recipients accounted for 10.23%(n=779)and 89.77%(n=6836),respectively.The military recipients were older than civilian recipients[(90.11±8.66)years vs(72.72±6.33)years,P<0.001].The military recipients had a higher incontinence rate than the civilian recipients(13.86%vs 3.58%,P<0.001),and a higher proportion of individuals at risk of PI(Braden score≤18)than the civilian recipients(55.58%vs 26.18%,P<0.001).The military recipients had a higher utilization rate of pressure releaving mattresses(72.29%),implementation rate of repositioning(76.22%),implementation rate of structured incontinence care(97.22%),and implementation rate of nutritional care(74.67%)(P<0.05).Compared to civilian recipients,the military recipients had a higher prevalence of pressure injury(4.62%vs 2.00%,P<0.001)and a higher incidence of hospital acquired pressure injury(1.28%vs 0.44%,P<0.001).Both the military recipients and civilian recipients were mainly with stage 2 of pressure injuries(50.00%and 37

关 键 词：军队医院 老年 保健 压力性损伤 横断面研究 

分 类 号：R821[医药卫生—临床医学]