聚力关键风险管控的综合管理在神经重症监护室失禁相关性皮炎患者中的应用效果

叶凯丽; 高笑侠; 杨建静; 杨承雅; 陈晓青

doi:10.16766/j.cnki.issn.1674-4152.003356

聚力关键风险管控的综合管理在神经重症监护室失禁相关性皮炎患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003356

1.
温州医科大学附属第一医院重症医学科，浙江温州 325015
2.
温州医科大学附属第一医院神经外科

基金项目:

浙江省温州市科学技术局基础性医疗卫生科技项目 Y20210493

浙江省基础公益研究计划项目 LQ20H090005

详细信息

通讯作者:
叶凯丽，E-mail：yekaili6988@163.com

中图分类号: R473.74
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- 被引次数: 0
出版历程
- 收稿日期: 2023-08-22
- 网络出版日期: 2024-03-09

The application of comprehensive management of key risk control in Neurological Intensive Care Unit patients with incontinence-associated dermatitis

1.
Intensive Care Unit, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China

摘要

摘要: 目的探讨聚力关键风险管控的综合管理在神经重症患者失禁相关性皮炎(IAD)中的应用效果，以期能降低神经重症患者IAD的发生率，改善患者临床结局。方法以2021年1—12月温州医科大学附属第一医院神经重症病房的152例住院患者为对照组，以2022年1—12月住院的137例患者为观察组。对照组实施常规皮肤护理，观察组实施聚力关键风险管控的综合管理。比较2组患者IAD发生率、发生时间、持续时间、IAD严重程度，以及皮肤风险评估合格率和IAD分级评估动态更新合格率。结果观察组的IAD发生率为7.30%(10/137)，对照组为25.66%(39/152)，差异有统计学意义(P < 0.05)。观察组IAD的发生时间为(6.72±1.59)d，明显晚于对照组[(4.21±0.81)d, P < 0.05]；持续时间为(3.45±0.51)d，明显短于对照组[(7.67±1.34)d，P < 0.05]；严重程度较轻(P < 0.05)。2组皮肤风险评估情况比较差异有统计学意义(P < 0.05)。2组IAD分级评估动态更新情况比较差异有统计学意义(P < 0.05)。结论聚力关键风险管控的综合管理可降低神经重症患者的IAD发生率，延长发生时间，缩短持续时间，减轻IAD严重程度，值得临床推广与应用。
- 风险管控 /
- 综合管理 /
- 失禁相关性皮炎 /
- 神经重症患者
Abstract: Objective To explore the application effect of comprehensive management of key risk control in Neurological Intensive Care Unit patients with incontinence-associated dermatitis (IAD). Methods The patients in the Neurological Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January to December 2021 were taken as the control group, and the inpatients from January to December 2022 were taken as the observation group. The control group implemented routine skin care, and the observation group carried out comprehensive management of key risk control. The incidence of IAD, time of occurrence, duration, severity of IAD, and the qualification rate of skin risk assessment and dynamic renewal of IAD grade assessment were compared between the two groups. Results The incidence of IAD was 7.30% (10/137) in the observation group and 25.66% (39/152) in the control group, with a significant difference (P < 0.05). The mean time of IAD in the observation group was (6.72±1.59)d, Which was significantly later than the control group [(4.21±0.81) d, P < 0.05]; the mean duration of (3.45±0.51) d was significantly shorter [(7.67±1.34)d, P < 0.05]; and the severity was less severe (P < 0.05). There were significant differences in skin risk assessment and the dynamic update status of IAD between the two groups (P < 0.05). Conclusion The comprehensive management of key risk control can reduce the incidence of IAD, prolong the occurrence time, shorten the duration, and reduce the severity, which is worthy of clinical promotion and application.
- Key risk control /
- Comprehensive management /
- Incontinence-associated dermatitis /
- Neurological intensive care unit patients

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图 1 Neuro-ICU失禁患者皮肤护理流程图

Figure 1. Flow chart of skin care for NICU patients with incontinence

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表 1 重症患者IAD综合管理学习目标表

Table 1. Learning objective table for comprehensive management of IAD in severe patients

序号	医护人员版	家庭照护者版
1	掌握失禁性皮炎定义及分级方法	强化照护者预防的理念失禁性皮炎的护理，重在预防
2	掌握失禁危险因素风险的评估[会阴评估工具(perineal assessment tool，PAT)评分表]	局部皮肤进行预防性护理，尽可能去除存在相关因素的影响(清洁、保湿，及使用皮肤保护剂或保湿剂)
3	掌握失禁性皮炎的护理流程(预防措施落实时机、用具或方法的选择)	接受多方位照顾者健康宣教知识(宣传册、微信公众号、视频播放等)
4	了解重症失禁性皮炎的流行病学及发生机制
5	熟悉重症失禁性皮炎的新进展
6	开展神经重症失禁性皮炎个案分享沙龙

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表 2 2组神经重症患者基本资料比较

Table 2. Comparison of basic data between two groups of neurologically severe patients

组别	例数	年龄(x±s, 岁)	性别(例)		入院GCS评分 (x±s, 分)	入住Neuro-ICU时间(x±s, d)	糖尿病史(例)		主要诊断(例)			低蛋白血症(例)
组别	例数	年龄(x±s, 岁)	男性	女性	入院GCS评分 (x±s, 分)	入住Neuro-ICU时间(x±s, d)	是	否	脑卒中	脑外伤	其他	是	否
对照组	152	60.03±10.78	91	61	6.32±1.36	25.26±4.59	86	66	98	40	14	30	122
观察组	137	58.89±10.12	75	62	6.13±1.20	24.67±4.62	74	63	84	37	16	31	106
统计量		0.927^a	0.774^b		1.262^a	1.087^a	0.192^b		0.550^b			0.362^b
P值		0.355	0.379		0.208	0.278	0.661		0.760			0.547
注：^a为t值，^b为χ²值。

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表 3 2组神经重症患者IAD发生率、发生时间、持续时间和严重程度比较

Table 3. Comparison of IAD incidence, occurrence time, duration and severity between two groups of neurologically severe patients

组别	例数	IAD发生 [例(%)]	发生时间 (x±s, d)	持续时间 (x±s, d)	IAD严重程度(例)
组别	例数	IAD发生 [例(%)]	发生时间 (x±s, d)	持续时间 (x±s, d)	轻度	中度	重度
对照组	152	39(25.66)	4.21±0.81	7.67±1.34	27	9	3
观察组	137	10(7.30)	6.72±1.59	3.45±0.51	9	1	0
统计量		17.247^a	16.632^b	34.468^b	2.853^c
P值		< 0.001	< 0.001	< 0.001	0.011
注：^a为χ²值，^b为t值，^c为Z值。

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表 4 2组神经重症患者皮肤风险评估合格率和IAD分级评估动态更新率比较[例(%)]

Table 4. Comparison of qualified rate of skin risk assessment and dynamic update rate of IAD grade assessment in two groups of neurologically severe patients[cases (%)]

组别	皮肤风险评估				IAD分级评估动态更新
组别	例数	完全合格	部分合格	不合格	例数	完全合格	部分合格	不合格
对照组	152	52(34.2)	71(46.7)	29(19.1)	39	22(56.4)	11(28.2)	6(15.4)
观察组	137	85(62.0)	40(29.2)	12(8.8)	10	9(90.0)	1(10.0)	0
Z值	-5.143				-5.832
P值	< 0.001				< 0.001

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