ObjectiveTo enhance nurses'awareness of pressure ulcer management and reduce the incidence of pressure ulcers by using the risk early warning management idea. MethodsWe analyzed the data of patients with pressure ulcers and patients at high risk of pressure ulcers reported through nursing software between January 2009 and December 2011.Then,we timely and actively gave instructions and formulated corrective measures for the weak points in order to optimize pressure ulcer management process. ResultsNurses'awareness of prevention of pressure ulcers was improved,and the number of patients at high risk of pressure ulcers reported was increased year by year.From 2009 to 2011,the ratio of extremely high-risk and high-risk patients to all discharged patients was respectively 0.76%,1.01% and 0.76%;while from 2009 to 2011,the rate of in-hospital pressure ulcers hard to avoid was respectively 0.06%,0.06% and 0.02%. ConclusionBased on pressure ulcers wound team management,training nurses'early warning management idea,assigning corresponding responsibilities and management goals can help to standardize the management of pressure ulcers and raise the discipline level unceasingly.
ObjectiveTo sum up the clinical characteristics,surgical management,and effectiveness of pressure sore of sinus type. MethodsBetween January 2009 and April 2013,17 patients with 19 pressure sores of sinus type after traumatic paraplegia were treated,and the clinical data were analyzed retrospectively.There were 11 males and 6 females with an average age of 27.4 years (range,17-49 years).The median disease duration was 1.5 years (range,6 months to 7 years).Of 17 cases,there were 14 primary cases and 3 recurrent cases; 10 focuses of 8 cases were classified as simple sinus type,and 9 focuses of 9 cases as complex sinus type,which had a false synovial sheath complicated with one to four "second sinus".The pressure sore of sinus type majorly located at the ischial tuberosity.The size of pressure sore ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm,and the length of "second sinus" ranged from 8 to 32 cm with an average of 17 cm.After the false synovial sheath was totally excised,the wound was repaired by local sliding or rhombus flaps at the first or second stage in patients with simple sinus type pressure sore.On the basis of excising the false synovial sheath,the "second sinus" was totally removed in the patients with complex sinus type pressure sore. ResultsWound dehiscence occurred in 1 case of simple sinus type pressure sore at 4 days,which was cured after it was sutured again.Wound infection occurred at 9,17,and 23 days respectively in 3 cases of complex sinus type pressure sore,which was cured after second debridement and necrosis tissues removal.The other wounds healed by first intention,and the flaps totally survived.All patients were followed up 6-12 months (mean,9.3 months).No recurrence was observed. ConclusionAccording to the clinical characteristics,pressure sore of sinus type could be divided into simple sinus type and complex sinus type.The key of successful treatment is to thoroughly excise false synovial sheath and "second sinus".
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。
Objective To investigate the effectiveness of pedicled superior gluteal artery perforator bilateral quadrilobed flaps for repairing large sacrococcygeal pressure sores. Methods Between June 2003 and August 2011, 6 paraplegia patients with large sacrococcygeal pressure sores were repaired with the pedicled superior gluteal artery perforator bilateral quadrilobed flaps. There were 2 males and 4 females with an average age of 45.6 years (range, 37-62 years). The mean disease duration was 8.4 months (range, 3-26 months). According to National Pressure Ulcer Advisory Panel (NPUAP) standard, 6 cases rated as degree IV. The size of pressure sores ranged from 15 cm × 13 cm to 18 cm × 16 cm. The size of flaps ranged from 18 cm × 14 cm to 21 cm × 15 cm. Results After operation, all flaps survived successfully. The wounds healed by first intention in 5 cases; partial dehiscence of incision occurred in 1 case, which was cured after dressing change for 26 days. Six patients were followed up 6-24 months (mean, 12.5 months). The appearance and texture of the flaps were smooth and soft with good elasticity and no ulceration. Conclusion Pedicled superior gluteal artery perforator bilateral quadrilobed flaps can repair large sacrococcygeal pressure sores. The appearance of flaps is smooth and has good compression-resistance effect.
ObjectiveTo investigate the operation and effect of pressure ulcers group (PUG) on the procedure of clinical management of pressure ulcers. MethodsThe in-hospital patients with high-risk pressure ulcers and patients with pressure ulcers from outside of the hospital (n=145) before the founding of PUG in 2011 were regarded as group A, and patients in this group were treated by traditional therapies. After PUG was founded in our hospital in January 2012, 192 patients with high-risk pressure ulcers and from outside of the hospital in 2012 were considered as group B. In addition, group C contained 380 patients treated in 2013. Group B and C were both treated by PUG that developed a management system of pressure ulcers and took active measures to control and prevent pressure ulcers. PUG trained 30 clinical nurse supervisors, who were recommended from relevant clinical departments. The incidence of inevitable pressure ulcer of hospitalized patients, the cure rate of patients with pressure ulcers from outside of the hospital, pressure ulcer knowledge level of clinical nurse supervisors were comparatively analyzed between group A and B, and between group A and C, respectively. ResultsAfter the establishment of PUG, the incidence of inevitable pressure ulcer of hospitalized patients in group A, B, and C was 76.20%, 17.02%, and 14.61%, respectively. The cure rate of patients from outside of the hospital was 54.84%, 86.84%, and 87.97%, respectively. Differences between group A and B, and between group A and C both were significant (P<0.01). The pressure ulcer knowledge level of all nurse supervisors improved significantly (P<0.001). ConclusionThe establishment of PUG makes the clinical pressure ulcer management more scientific and objective. Furthermore, it can effectively reduce the incidence of pressure ulcers, and also improve the quality of medical care and ensure the safety of patients.
目的:探讨纯中药制剂化腐生肌散治疗中重度压疮的治疗效果。方法:对2005年2月至2009年1月北戴河医院和内蒙古民族大学附属医院经治的住院和门诊压疮患者106例,经中药方剂化腐生肌散外敷治疗的临床资料进行回顾性分析。结果:中重度压疮患者106例,经外敷治疗,愈合90例(84％),显效16例(16％),总有效率为100％。结论:化腐生肌散有明显的活血化瘀、去腐生肌、抗感染、迅速长皮之功能。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。
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。