新生儿重症监护室患儿压力性损伤现状及相关危险因素分析

冯哲; 王洋; 兰端云; 易靖; 鞠敏

doi:10.16766/j.cnki.issn.1674-4152.002685

新生儿重症监护室患儿压力性损伤现状及相关危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002685

冯哲^1, ,,
王洋¹,
兰端云¹,
易靖¹,
鞠敏²

1.
南阳市中心医院内分泌科，河南南阳 473000
2.
南阳市中心医院新生儿重症监护室

基金项目:

河南省科技攻关项目 192103210073

南阳市科技攻关项目 KJGG20134

详细信息

通讯作者:
冯哲, E-mail: fengzhe8806@163.com

中图分类号: R722R473.72
计量
- 文章访问数: 247
- HTML全文浏览量: 162
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-15
- 网络出版日期: 2022-11-30

Current status and related risk factors of stress injury in children in neonatal intensive care unit

FENG Zhe^{1
, ,},
WANG Yang¹,
LAN Duan-yun¹,
YI Jing¹,
JU Min²

1.
Endocrine Department, Nanyang Central Hospital of Henan Province, Nanyang, Henan 473000, China

摘要

摘要: 目的了解新生儿重症监护室(NICU)压力性损伤的发生现状、分布特点及危险因素。方法选取2019年1—12月南阳市中心医院新生儿重症监护室收治的467例患儿，收集相关人口学资料、病情、压力性损伤发生部位及体征等，对影响患儿发生压力性损伤的相关危险因素进行logistic回归分析。结果在467例患儿中，有79例(93处)发生不同程度的压力性损伤，压力性损伤发生率为16.92%；其中62.37%(58处)的压力性损伤为医疗设备相关，83.87%(78处)损伤程度为1期损伤；压力性损伤高发部位为鼻部[20.43%(19/93)]，其次为骶尾部[17.20%(16/93)]、面颊[11.83%(11/93)]、枕部[10.75%(10/93)]、口部[9.68%(9/93)]、足跟部[7.53%(7/93)]、耳后[6.45%(6/93)]。入住NICU时间≥7 d(OR=3.025，95% CI：1.178~7.729)、机械通气(OR=4.568，95% CI：2.110~9.848)、意识昏迷(OR=4.397，95% CI：1.860~10.351)、嗜睡(OR=5.447，95% CI：2.359~12.578)和病情危重(OR=3.142，95% CI：1.184~8.340)是NICU患儿发生压力性损伤的独立危险因素。结论新生儿重症监护室主要以医疗设备相关性压力性损伤为主，高危诱发因素是多方面的，主要与患儿病情、活动受限、医疗设备使用有关。
- 新生儿 /
- 重症监护病房 /
- 压力性损伤 /
- 危险因素
Abstract: Objective To understand the occurrence, distribution characteristics and risk factors of neonatal intensive care unit (NICU) pressure injuries. Methods Total 467 children admitted to the NICU of Nanyang Central Hospital from January to December 2019 were selected. The relevant demographic data, condition, location and physical signs of pressure injury that affect the risk of pressure injury in children were collected. These factors were analysed by logistic regression. Results Amongst the 467 children, 79 cases (93 places) had different degrees of stress injury, the incidence of stress injury was 16.92%. Among 93 places, 62.37% (58 places) of the stress injuries were related to medical equipment and 83.87% (78 places) of the degree of damage was a phase 1 injury. The high-risk part of the stress injury was the nose [20.43% (19/93)] followed by the appendix [17.20% (16/93)], the cheek [11.83% (11/93)], the occipital [10.75% (10/93)], the mouth [9.68% (9/93)], the heel [7.53% (7/93)], and behind the ears [6.45% (6/93)]. NICU stay ≥7 days (OR=3.025, 95% CI: 1.178-7.729), mechanical ventilation (OR=4.568, 95% CI: 2.110-9.848), unconsciousness (OR=4.397, 95% CI: 1.860-10.351), somnolence (OR=5.447, 95% CI: 2.359-12.578) and critical illness (OR=3.142, 95% CI: 1.184-8.340) were independent risk factors for stress injury in children in the NICU. Conclusion NICU injuries are mainly medical equipment-related stress injuries. The high-risk predisposing factors vary and are related to the child' s condition, restricted activities and use of medical equipment.
- Neonatal /
- Intensive care unit /
- Stress injury /
- Risk factors

HTML全文

表 1 NICU患儿PI发生的单因素分析[例(%)]

Table 1. Univariate analysis of PI in children with NICU[cases(%)]

项目	例数	发生PI(79例)	未发生PI(388例)	χ²值	P值
性别				0.481	0.488
男	253	40(50.63)	213(54.90)
女	214	39(49.37)	175(45.10)
胎龄(周)				47.949	＜0.001
≤37	67	31(39.24)	36(9.28)
＞37	400	48(60.76)	352(90.72)
出生体重(kg)				6.497	0.011
≤1.5	69	19(24.05)	50(12.89)
＞1.5	398	60(75.95)	338(87.11)
入院诊断				0.079	0.994
神经系统疾病	115	19(24.05)	96(24.74)
心血管系统疾病	107	19(24.05)	88(22.68)
呼吸系统疾病	136	23(29.11)	113(29.12)
消化系统疾病	109	18(22.78)	91(23.45)
是否手术				30.213	＜0.001
是	71	28(35.44)	43(11.08)
否	396	51(64.56)	345(88.92)
入住NICU时间(d)				9.041	0.003
≥7	317	65(82.28)	252(64.95)
＜7	150	14(17.72)	136(35.05)
病情严重程度				12.608	＜0.001
危重	183	45(56.96)	138(35.57)
非危重	284	34(43.04)	250(64.43)
意识状态				26.329	＜0.001
清醒	296	31(39.24)	265(68.30)
嗜睡	92	22(27.85)	70(18.04)
昏迷	79	26(32.91)	53(13.66)
呼吸方式				19.391	＜0.001
机械通气	181	48(60.76)	133(34.28)
自主呼吸	286	31(39.24)	255(65.72)

下载: 导出CSV

表 2 79例NICU患儿PI发生部位特征[处(%)]

Table 2. Location characteristics of PI in 79 NICU children[numbers(%)]

部位	骨隆突处PI	医疗设备相关PI	总计
头面部	8(8.60)	50(53.76)	58(62.37)
枕部	7(7.53)	3(3.23)	10(10.75)
前额	0	3(3.23)	3(3.23)
面颊	0	11(11.83)	11(11.83)
口部	0	9(9.68)	9(9.68)
鼻部	0	19(20.43)	19(20.43)
耳部	1(1.08)	5(5.38)	6(6.45)
上肢	1(1.08)	2(2.15)	3(3.23)
上臂	0	2(2.15)	2(2.15)
肘部	1(1.08)	0	1(1.08)
下肢	10(10.75)	2(2.15)	12(12.90)
膝部	0	1(1.08)	1(1.08)
足跟	6(6.45)	1(1.08)	7(7.53)
足踝	4(4.30)	0	4(4.30)
躯干	2(2.15)	2(2.15)	4(4.30)
前胸	0	1(1.08)	1(1.08)
背部	2(2.15)	1(1.08)	3(3.23)
骶尾部	14(15.05)	2(2.15)	16(17.20)
合计	35(37.63)	58(62.37)	93(100.00)

下载: 导出CSV

表 3 变量赋值方法

Table 3. Variable assignment method

变量	赋值方法
胎龄(周)	≤37=0；＞37=1
出生体重(kg)	≤1.5=0；＞1.5=1
是否手术	是=0；否=1
入住NICU时间(d)	≥7=0；＜7=2
病情严重程度	危重=0；非危重=1
意识状态	昏迷(1, 0)；嗜睡(0, 1)；清醒(0, 0)
呼吸方式	机械通气=0；自主呼吸=1

下载: 导出CSV

表 4 NICU患儿PI发生的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of PI in children with NICU

变量	B	SE	Wald χ²	P值	OR值	95% CI
胎龄≤37周	0.643	0.812	0.627	0.428	1.902	0.387~9.266
出生体重≤1.5 kg	0.785	0.931	0.711	0.399	2.192	0.354~13.469
手术	0.854	0.572	2.229	0.135	2.349	0.766~7.207
入住NICU时间≥7 d	1.107	0.481	5.297	0.021	3.025	1.178~7.729
病情危重	1.145	0.498	5.286	0.021	3.142	1.184~8.340
昏迷	1.481	0.439	11.381	0.001	4.397	1.860~10.396
嗜睡	1.695	0.427	15.757	＜0.001	5.447	2.359~12.578
机械通气	1.519	0.394	14.864	＜0.001	4.568	2.110~9.887

下载: 导出CSV

参考文献(16)

[1]	周毅先, 姚香莉, 程功梅, 等. 中文版Braden-Q量表和N/I Braden-Q量表在NICU新生儿压力性损伤风险评估中的应用对比研究[J]. 护士进修杂志, 2020, 35(12): 1093-1096. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202012007.htm ZHOU Y X, YAO X L, CHENG G M, et al. Comparative study of Chinese version of Braden-Q scale and N/I Braden-Q scale in risk assessment of pressure injury in newborns in NICU[J]. Journal of Nurses Training, 2020, 35(12): 1093-1096. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX202012007.htm
[2]	林海芳, 朱柔霖, 陈晓微. NICU患儿压力性损伤的发生特征和影响因素分析[J]. 中国妇幼保健, 2020, 35(5): 874-877. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202005030.htm LIN H F, ZHU R L, CHEN X W. Characteristics and influencing factors of pressure injury in children with NICU[J]. Maternal and Child Health Care of China, 2020, 35(5): 874-877. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202005030.htm
[3]	郭洁, 马洁, 金志鹏. ICU患儿发生医疗器械相关压力性损伤的现状调查[J]. 中华护理教育, 2018, 15(9): 691-693. doi: 10.3761/j.issn.1672-9234.2018.09.011 GUO J, MA J, JIN Z P. A survey of medical device related pressure injury among children in ICU[J]. Chinese Journal of Nursing Education, 2018, 15(9): 691-693. doi: 10.3761/j.issn.1672-9234.2018.09.011
[4]	吴玉洁, 王建平, 吕俊英, 等. 新生儿压力性损伤风险评估现状及评估量表应用分析[J]. 中国实用护理杂志, 2019, 35(36): 2836-2839. WU Y J, WANG J P, LYU J Y, et al. The current situation of risk assessment and scale applicating of neonatal pressure injury[J]. Chinese Journal of Practical Nursing, 2019, 35(36): 2836-2839.
[5]	NATIONAL PRESSURE ULCER ADVISORY PANEL. Consensus conference on pressure ulcer staging[R]. Chicago: Illinois, 2016.
[6]	张丽丹, 黄慧敏, 程玉才, 等. 4种小儿危重死亡评分对危重患儿死亡风险的预测价值[J]. 中华危重病急救医学, 2018, 30(1): 51-56. doi: 10.3760/cma.j.issn.2095-4352.2018.01.010 ZHANG L D, HUANG H M, CHENG Y C, et al. Predictive value of four pediatric scores of critical illness and mortality on evaluating mortality risk in pediatric critical patients[J]. Chinese Critical Care Medicine, 2018, 30(1): 51-56. doi: 10.3760/cma.j.issn.2095-4352.2018.01.010
[7]	穆鑫馨, 王俊杰. 人性化护理干预结合湿性愈合疗法在乳腺癌压疮患者中的应用效果[J]. 中华全科医学, 2017, 15(1): 157-159. doi: 10.16766/j.cnki.issn.1674-4152.2017.01.047 MU X X, WANG J J. Effects of Humanized nursing intervention combined with moist wound healing in treatment of pressure sore of breast cancer patients[J]. Chinese Journal of General Practice, 2017, 15(1): 157-159. doi: 10.16766/j.cnki.issn.1674-4152.2017.01.047
[8]	COYER F, MILES S, GOSLEY S, et al. Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison[J]. Aust Crit Care, 2017, 30(5): 244-250. doi: 10.1016/j.aucc.2016.12.003
[9]	GROSVENOR J, DOWLING M. Prevention of neonatal pressure injuries[J]. J Neonatal Nurs, 2018, 24(3): 122-125. doi: 10.1016/j.jnn.2017.09.004
[10]	叶丽彦, 春晓, 马敬香, 等. 危重症儿童压疮临床特点分析[J]. 中国现代医药杂志, 2018, 20(5): 81-82. doi: 10.3969/j.issn.1672-9463.2018.05.024 YE L Y, CHUN X, MA J X, et al. Clinical characteristics of pressure ulcers in critically ill children[J]. Modern Medicine Journal of China, 2018, 20(5): 81-82. doi: 10.3969/j.issn.1672-9463.2018.05.024
[11]	BAI D L, LIU T W, CHOU H L, et al. Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study[J]. PLoS One, 2020, 15(11): e0241276. DOI: 10.1371/journal.pone.0241276.
[12]	VISSCHER M O, WHITE C C, JONES J M, et al. Face masks for noninvasive ventilation: Fit, excess skin hydration, and pressure ulcers[J]. Respir Care, 2015, 60(11): 1536-1547. doi: 10.4187/respcare.04036
[13]	李思情, 胡爱玲. 新生儿重症监护病房医疗器械相关压力性损伤的研究进展[J]. 华西医学, 2019, 34(2): 218-222. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201902024.htm LI S Q, HU A L. Research progress on medical device-related pressure injury in neonatal intensive care unit[J]. West China Medical Journal, 2019, 34(2): 218-222. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201902024.htm
[14]	LEVY A, KOPPLIN K, GEFEN A. Adjustability and adaptability are critical characteristics of pediatric support surfaces[J]. Adv Wound Care, 2015, 4(10): 615-622. doi: 10.1089/wound.2015.0639
[15]	李环, 江仕爽, 俞群, 等. 重症监护室患儿压力性损伤发生特征及影响因素分析[J]. 中华护理杂志, 2018, 53(3): 261-266. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201803001.htm LI H, JIANG S S, YU Q, et al. Characteristics and risk factors of pressure injuries in patients admitted to the PICU[J]. Chinese Journal of Nursing, 2018, 53(3): 261-266. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201803001.htm
[16]	李艳, 黄永霞. 社区护理管理者对居家压疮规范管理认知的质性研究[J]. 中华全科医学, 2016, 14(12): 2080-2082, 2141. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.034 LI Y, HUANG Y X. A qualitative study of cognition of community nursing administrators on standardized pressure ulcer management at home[J]. Chinese Journal of General Practice, 2016, 14(12): 2080-2082, 2141. doi: 10.16766/j.cnki.issn.1674-4152.2016.12.034