【摘要】 目的 探讨整体护理在压疮治疗中的应用和效果。 方法 2006年1月-2009年11月对98例压疮患者采用整体护理程序，从评估、提出护理诊断、实施护理措施以及评价作用效果四个方面对患者进行护理。 结果 50例压疮完全愈合，38例压疮经过护理后达到显效标准，10例压疮经过护理后好转。 结论 整体护理应用于压疮患者可取得满意的效果。【Abstract】 Objective To assess the application and effects of holistic nursing in the treatment of pressure sore. Methods Ninety-eight patients with pressure sores were treated from January 2006 to November 2009 in this department, accompanying with the holistic nursing which includes assessment, proposed nursing diagnosis, implementation and evaluation of the effect. Results Fifty patients were completely healed, 38 patients showed obvious effect and 10 patients relieved slightly. Conclusion The holistic nursing has satisfactory effects on the patients with pressure sores.
目的:探讨纯中药制剂化腐生肌散治疗Ⅱ期以上压疮的治疗效果。方法:采用2005年2月至2009年1月北戴河医院及内蒙古民族大学附属医院住院和门诊Ⅱ期以上压疮患者106例,共178处,随机分为治疗组和对照组。治疗组通过应用化腐生肌散与对照组抗生素贴敷治疗Ⅱ期以上压疮相对比。 结果: 两组对比,化腐生肌散组治愈率、有效率较抗生素组差异有显著性意义(Plt;005),且明显缩短愈合时间(Plt;001)。结论: 化腐生肌散治疗Ⅱ期以上压疮, 治疗效果明显,治愈率高,缩短治疗时间,无毒副作用,减少了患者的痛苦,值得推广。
ObjectiveTo understand the application of the Braden pressure ulcer risk-factor assessment scale in the nursing staff, in order to provide reference for clinical nurses to standardize the use of Braden assessment scale and facilitate the hospital to develop training programs on pressure ulcer related knowledge. MethodsStratified cluster sampling method was applied in February 2015. Using the self-designed questionnaire of “Application of Braden pressure ulcer risk-factor assessment scale in the nursing staff ”, we conducted a survey on 198 clinical nurses, and the survey results were scrutinized. The difficulty level of using Braden assessment scale in the nurses was analyzed based on their different demographic characteristics. We also analyzed the items which were most difficult to judge for the nurses and nurses’ learning needs for knowledge on Braden assessment scale. ResultsA total of 168 (84.85%) nurses found it difficult in using Braden scale for the evaluation of pressure ulcer. The most difficult items to judge for the nurses were friction force, shear force and feeling. Nurses in departments with pressure ulcer as a common symptom of the patients could better use the Braden pressure ulcer risk-factor scale, compared with those in departments where pressure ulcer was uncommon (P＜ 0.05) . A total of 189 (95.46%) nurses thought it necessary to carry out a unified quantitative standard analysis of six risk factors in the Braden scale. Conclusions The poor mastery of the assessment standards for Braden scale in the nurses causes various degrees of difficulty in applying the scale, which can influence the accuracy of assessment. It is important to train the nurses on pressure ulcer risk factor assessment in order to raise the clinical assessment accuracy.
ObjectiveTo research on the types of pathogenic bacteria in wound infection and analyze the effectiveness of long-term use of nano-silver dressing in the treatment of pressure ulcers, in order to provide references for the management of pressure ulcer wound. MethodsFifty-five patients (60 wounds) with stage Ⅲ-Ⅳ pressure ulcer wound treated in all departments between September 2011 and August 2015 were chosen to be our study subjects. Under overall intervention, all the wounds were assessed by the same method, cleansed and debrided, after which nano-silver antimicrobial dressing was used to intervene until the wound healed or the end of 8 weeks. The wounds which were not healed were treated with wet dressing therapy until wound healing. The detection rate of pathogenic bacteria before intervention and 2, 4 and 8 weeks after intervention, change of pressure ulcer healing score and the rate of wound healing were observed. ResultsBefore the intervention, 12 kinds of pathogenic bacteria were detected, including mainly Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase negative Staphylococci. The detection rate of pathogenic bacteria was 92.73% (51/55). With the use of nano-silver dressing during different time periods, the detection rate of pathogenic bacteria and the total score of pressure ulcer were lowered by varying degrees (P<0.01). Four and 8 weeks after intervention, wound bed improved significantly and the detection rate of pathogenic bacteria decreased faster. The healing rate during the intervention period was 23.64% (13/55). ConclusionThe incidence of pressure ulcer wound infection is high. The use of nano-silver wound dressing can effectively remove pathogenic bacteria and promote wound healing.
Assisting immobile individuals with regular repositioning to adjust pressure distribution on key prominences such as the back and buttocks is the most effective measure for preventing pressure ulcers. However, compared to active self-repositioning, passive assisted repositioning results in distinct variations in force distribution on different body parts. This incongruity can affect the comfort of repositioning and potentially lead to a risk of secondary injury, for certain trauma or critically ill patients. Therefore, it is of considerable practical importance to study the passive turning comfort and the optimal turning strategy. Initially, in this study, the load-bearing characteristics of various joints during passive repositioning were examined, and a wedge-shaped airbag configuration was proposed. The airbags coupled layout on the mattress was equivalently represented as a spring-damping system, with essential model parameters determined using experimental techniques. Subsequently, different assisted repositioning strategies were devised by adjusting force application positions and sequences. A human-mattress force-coupled simulation model was developed based on rigid human body structure and equivalent flexible springs. This model provided the force distribution across the primary pressure points on the human body. Finally, assisted repositioning experiments were conducted with 15 participants. The passive repositioning effectiveness and pressure redistribution was validated based on the simulation results, experimental data, and questionnaire responses. Furthermore, the mechanical factors influencing comfort during passive assisted repositioning were elucidated, providing a theoretical foundation for subsequent mattress design and optimization of repositioning strategies.
ObjectiveTo investigate the clinical effectiveness of high-glucose insulin mixture on the local treatment of patients with grade Ⅱ and Ⅲ pressure ulcers. MethodsA total of 124 patients with grade Ⅱ and Ⅲ pressure ulcers treated between January 2011 and June 2012 were randomly divided into three groups: saline group (group A, n=41), high-glucose insulin mixture group (group B, n=41) and modern dressing group (group C, n=42). We observed and compared the treatment effects among the three groups using both measurements of traditional evaluation criteria and pressure ulcer scale for healing (PUSH) after a week of dressing. ResultsThe overall treatment effects among the three groups were significantly different (χ2=30.453, P<0.001). The results of pairwise comparisons was that the treatment effect was significantly different between group B or C and group A (P<0.01), but the treatment effect was not statistically different between group B and C (P>0.05). Subgroup analysis for patients with grade Ⅱ or Ⅲ pressure ulcers also came to the similar results. ConclusionBoth high-glucose insulin mixture and modern dressing have significant effects on patients with grade Ⅱ and Ⅲ pressure ulcers. However, the high-glucose insulin mixture costs less and is worthy of extensive promotion.
目的 为老年股骨颈骨折的患者制定合理的循证护理方案。 方法 在充分了解老年股骨颈患者病情的基础上，根据PICO原则，提出临床问题并转化为易于检索的形式，于2012年5月检索了Cochrane系统评价数据库（CDSR）、Cochrane对照试验注册中心（CCTR）、效果评论摘要数据库（DARE）、Medline、国家指南网（NGC）、PubMed 网站、中国生物医学文献数据库（CBM）以及复旦大学JBI循证护理中心，获取并评价相关的系统评价、随机对照试验以及临床指南。 结果 共检索到3篇系统评价、2篇临床随机对照试验和1篇临床实践指南。根据检索的结果，与患者及家属沟通后，选用Braden量表对患者进行压疮评估；指导患者每2小时翻身；进行腰背肌的锻炼，2～4 h/次，第1天5遍/次，之后逐渐递增为10～20遍/次；指导摄入高能量、高蛋白食物。1周后，患者机体状况良好，顺利接受手术治疗。 结论 采取循证护理的方法可以为患者提供科学、个性化的护理。