基于防控指引的规范化护理对失禁相关性皮炎的预防研究

饶巧莹; 何珊; 李红; 夏骏丽

doi:10.16766/j.cnki.issn.1674-4152.002435

基于防控指引的规范化护理对失禁相关性皮炎的预防研究

doi: 10.16766/j.cnki.issn.1674-4152.002435

饶巧莹^1, ,,
何珊¹,
李红²,
夏骏丽¹

1.
丽水市中心医院重症医学科，浙江丽水 323000
2.
丽水市中心医院造口伤口门诊

基金项目:

浙江省卫生健康科技计划项目 2021ZH066

详细信息

通讯作者:
饶巧莹, E-mail: raoqiaoying@126.com

中图分类号: R473 R753
计量
- 文章访问数: 150
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- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-23
- 网络出版日期: 2022-08-20

Prevention of incontinence-associated dermatitis by standardised nursing based on the guidelines for prevention and control

1.
Department of Critical Care Medicine, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探究基于ICU失禁相关性皮炎(IAD)防控指引(简称防控指引)的规范化护理对IAD的预防效果。方法选取丽水市中心医院ICU 2019年10月—2020年9月期间收治的155例出现尿便失禁患者，根据随机数字表法分为研究组(79例)和对照组(76例)。对照组给予常规护理干预，研究组在对照组基础上给予基于IAD防控指引的规范化护理干预。观察和比较2组患者IAD发生情况、预后、并发症以及护理满意度。结果研究组患者IAD总发生率(15.19%)明显低于对照组(34.21%)，差异有统计学意义(P＜0.05)；研究组皮损恢复时间、ICU收治时间、总住院时间为[(2.78±0.56)d、(4.98±0.47)d、(7.52±1.32)d]，显著低于对照组[(6.45±1.12)d、(8.46±1.55)d、(9.82±1.97)d]，差异均有统计学意义(t=25.950、19.067、8.569，均P＜0.01)；研究组患者护理总满意度(96.20%)较对照组(67.11%)明显提高，差异有统计学意义(P＜0.05)。结论针对ICU重症尿便失禁患者实施基于IAD防控指引的规范化护理干预可以有效防控IAD及其相关并发症的发生，加快患者病情恢复，同时提高护理满意度。
- 重症监护病房 /
- 失禁性皮炎 /
- 规范化护理 /
- 预防
Abstract: Objective To explore the preventive effect of standardised nursing based on the clinical guideline for prevention and treatment of incontinence-associated dermatitis (IAD) in the ICU. Methods Between October 2019 and September 2020, 155 patients with urinary and faecal incontinence admitted to the ICU of Lishui Central Hospital were selected. Using the random number table method, they were divided into two groups: study group (79 cases) and control group (76 cases). The control group received routine nursing intervention, whereas the study group received standardised nursing intervention based on the clinical guideline for prevention and treatment of IAD. The occurrence of IAD, prognosis, complications and nursing satisfaction of the two groups were compared. Results The total incidence of IAD in the study group was 15.19%, significantly lower than 34.21% in the control group (P < 0.05). The skin lesion recovery time, length of ICU stay and total length of hospital stay of the study group were (2.78±0.56) days, (4.98±0.47) days and (7.52±1.32) days, significantly shorter than those of the control group [(6.45±1.12) days, (8.46±1.55) days and (9.82±1.97) days, respectively, t=25.950, 19.067, 8.569, all P < 0.01]. The nursing satisfaction of the study group (96.20%) was significantly higher than that of the control group (67.11%, P < 0.05). Conclusion Standardised nursing based on the clinical guideline for prevention and treatment of IAD can effectively prevent and control the occurrence of IAD and its related complications, and speed up the recovery of patients whilst improving nursing satisfaction.
- Intensive care unit /
- Incontinence-associated dermatitis /
- Standardised nursing /
- Prevention

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表 1 2组尿便失禁患者干预后失禁性皮炎发生情况比较[例(%)]

Table 1. Comparison of the incidence of incontinence dermatitis between the two groups of patients with urinary incontinence after intervention [cases (%)]

组别	例数	正常	轻度	重度	重度
研究组	79	67(84.81)	9(11.39)	3(3.80)	0
对照组	76	50(65.79)	7(9.21)	15(19.74)	4(5.26)
注：2组失禁性皮炎严重程度比较，Z=9.600，P=0.002。

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表 2 2组尿便失禁患者恢复进程比较(x±s, d)

Table 2. Comparison of the recovery process of 2 groups of patients with urinary incontinence (x±s, d)

组别	例数	皮损恢复时间	ICU收治时间	总住院时间
研究组	79	2.78±0.56	4.98±0.47	7.52±1.32
对照组	76	6.45±1.12	8.46±1.55	9.82±1.97
t值		25.950	19.067	8.569
P值		＜0.001	＜0.001	＜0.001

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表 3 2组尿便失禁患者并发症发生情况比较[例(%)]

Table 3. Comparison of complications in patients with urinary incontinence in two groups [cases (%)]

组别	例数	单一并发症			多种并发症	总发生
组别	例数	压力性损伤	真菌性皮炎	尿路感染	多种并发症	总发生
研究组	79	0	1(1.27)	1(1.27)	0	2(2.53)
对照组	76	3(3.95)	6(7.89)	3(3.95)	0	12(15.79)
注：2组并发症总发生率比较，χ²=8.287，P=0.004。

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表 4 2组尿便失禁患者护理满意度比较[例(%)]

Table 4. Comparison of nursing satisfaction of two groups of patients with urinary incontinence [cases (%)]

组别	例数	非常满意	满意	不满意	总满意度
研究组	79	37(46.84)	39(49.37)	3(3.80)	76(96.20)
对照组	76	22(28.95)	29(38.16)	25(32.89)	51(67.11)
注：2组总满意度比较，χ²=22.157，P＜0.001。

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参考文献(16)

[1]	陈月红, 霍蕊, 徐鑫星, 等. 品管圈对降低胃肠外科患者失禁性皮炎发生率的影响[J]. 中华全科医学, 2016, 14(12): 2132-2135. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.050 CHEN Y H, HUO R, XU X X, et al. Role of quality control circles in reducing the incidence of incontinent dermatitis in patients with gastrointestinal surgery[J]. Chinese Journal of General Practice, 2016, 14(12): 2132-2135. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.050
[2]	VOEGELI D. Prevention and management of incontinence-associated dermatitis[J]. Br J Nurs, 2017, 26(20): 1128-1132. doi: 10.12968/bjon.2017.26.20.1128
[3]	张宇, 张晓雪, 赵晓维, 等. 危重症患者失禁性皮炎的发生现况及其影响因素[J]. 解放军护理杂志, 2018, 35(16): 16-21, 26. doi: 10.3969/j.issn.1008-9993.2018.16.003 ZHANG Y, ZHANG X X, ZHAO X W, et al. Incidence and Influencing Factors of Incontinence-Associated Dermatitis among Intensive Care Unit Patients[J]. Nursing Journal of Chinese People's Liberation Army, 2018, 35(16): 16-21, 26. doi: 10.3969/j.issn.1008-9993.2018.16.003
[4]	BEECKMAN D. A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence, knowledge gaps and next steps[J]. J Tissue Viability, 2017, 6(1): 47-56.
[5]	COYER F, CAMPBELL J. Incontinence-associated dermatitis in the critically ill patient: An intensive care perspective[J]. Nurs Crit Care, 2018, 23(4): 198-206. doi: 10.1111/nicc.12331
[6]	赵翠松, 崔妙龄, 应燕萍, 等. 基于指标管控对失禁性皮炎预防管理实践[J]. 中国实用护理杂志, 2019, 35(14): 1099-1103. doi: 10.3760/cma.j.issn.1672-7088.2019.14.014 ZHAO C S, CUI M L, YING Y P, et al. Prevention and management practice of incontinence dermatitis based on index management[J]. Chinese Journal of Practical Nursing, 2019, 35(14): 1099-1103. doi: 10.3760/cma.j.issn.1672-7088.2019.14.014
[7]	黄琼蕾, 金瑛. 失禁相关性皮炎患者中西医护理研究进展[J]. 中华现代护理杂志, 2020, 26(9): 1121-1126. doi: 10.3760/cma.j.cn115682-20190626-02265 HUANG Q L, JIN Y. Research progress of traditional Chinese and western medicine nursing for patients with incontinence-associated dermatitis[J]. Chinese Journal of Modern Nursing, 2020, 26(9): 1121-1126. doi: 10.3760/cma.j.cn115682-20190626-02265
[8]	陈立萍, 朱文, 裴小芹, 等. 失禁相关性皮炎干预工具的汉化及信效度检验[J]. 中华现代护理杂志, 2020, 26(9): 1127-1130. doi: 10.3760/cma.j.cn115682-20191028-03888 CHEN L P, ZHU W, PEI X Q, et al. Reliability and validity of the Chinese version of the Incontinence-Associated Dermatitis Intervention Tool[J]. Chinese Journal of Modern Nursing, 2020, 26(9): 1127-1130. doi: 10.3760/cma.j.cn115682-20191028-03888
[9]	童莉, 张颖洁, 焦永倩, 等. 全面流程管理在老年患者失禁相关性皮炎防治中的应用[J]. 中国护理管理, 2019, 19(5): 765-768. doi: 10.3969/j.issn.1672-1756.2019.05.026 TONG L, ZHANG Y J, JIAO Y Q, et al. The application of comprehensive process management in the prevention and control of incontinence associated dermatitis[J]. Chinese Nursing Management, 2019, 19(5): 765-768. doi: 10.3969/j.issn.1672-1756.2019.05.026
[10]	田丽. 专科护士主导的多学科系统化管理模式在成人失禁相关性皮炎护理实践中的应用[J]. 中国护理管理, 2019, 19(S1): 174-176. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL2019S1069.htm TIAN L. The application of multidisciplinary systematic management mode led by specialized nurses in the nursing practice of adult incontinence-related dermatitis[J]. Chinese Nursing Management, 2019, 19(S1): 174-176. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL2019S1069.htm
[11]	张丽. 失禁性皮炎标准化护理流程在神经内科失禁患者中的应用[J]. 中国药物与临床, 2019, 19(1): 181-182. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201901096.htm ZHANG L, et al. Application of standardized nursing process of incontinence dermatitis in incontinence patients in neurology department[J]. Chinese Remedies & Clinics, 2019, 19(1): 181-182. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201901096.htm
[12]	麦志晖, 陈满波, 夏懿, 等. 规范化皮肤护理在降低ICU患者失禁性皮炎发生率中的应用效果[J]. 中华现代护理杂志, 2018, 24(16): 1927-1928. doi: 10.3760/cma.j.issn.1674-2907.2018.16.017 MAI Z H, CHEN M B, XIA Y, et al. Preventive effect of standardized skin care on reducing the incidence of incontinence-associated dermatitis in ICU patients[J]. Chinese Journal of Modern Nursing, 2018, 24(16): 1927-1928. doi: 10.3760/cma.j.issn.1674-2907.2018.16.017
[13]	张晓雪, 王欣然. ICU护士失禁性皮炎知信行及知识来源与需求调查[J]. 中国护理管理, 2017, 17(8): 1119-1122. doi: 10.3969/j.issn.1672-1756.2017.08.026 ZHANG X X, WANG X R. Incontinence-Associated Dermatitis: knowledge, attitude and practice of ICU nurses in China[J]. Chinese Nursing Management, 2017, 17(8): 1119-1122. doi: 10.3969/j.issn.1672-1756.2017.08.026
[14]	吕巧萍, 贾勤, 孙香爱, 等. 信息化管理在老年患者失禁性皮炎护理中的应用及效果观察[J]. 中华现代护理杂志, 2020, 26(23): 3166-3169. doi: 10.3760/cma.j.cn115682-20191203-04418 LYU Q P, JIA Q, SUN A X, et al. Application and effect of information management in nursing of incontinence associated dermatitis among elderly patients[J]. Chinese Journal of Modern Nursing, 2020, 26(23): 3166-3169. doi: 10.3760/cma.j.cn115682-20191203-04418
[15]	林根芳, 贾勤, 杜丽萍, 等. 课题达成型品管圈在失禁相关性皮炎防护体系构建中的应用效果[J]. 护士进修杂志, 2020, 35(9): 803-806. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202009010.htm LIN G F, JIA Q, DU L P, et al. To explore the application effect of quality control circle in the construction of protection system for incontinence-associated dermatitis[J]. Journal of Nurses Training, 2020, 35(9): 803-806. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202009010.htm
[16]	康宙清, 杨颖, 季蕊, 等. 失禁相关性皮炎标准化预防及护理指引在老年失禁患者中的应用[J]. 安徽医药, 2018, 22(6): 1199-1203. doi: 10.3969/j.issn.1009-6469.2018.06.052 KANG Z Q, YANG Y, JI R, et al. Application of incontinence-associated dermatitis standardized prevention and nursing guidance for elderly patients with incontinence[J]. Anhui Medical and Pharmaceutical Journal, 2018, 22(6): 1199-1203. doi: 10.3969/j.issn.1009-6469.2018.06.052