以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (7): 15-20.doi: 10.16460/j.issn1008-9969.2021.07.015

• 护理管理 • 上一篇    下一篇

心脏术后压力性损伤规范化实践方案的构建与应用

管艳, 卢山, 叶家欣, 王哲芸   

  1. 南京大学医学院附属鼓楼医院 心胸外科重症监护,江苏 南京 210008
  • 收稿日期:2020-11-20 出版日期:2021-04-10 发布日期:2021-05-12
  • 通讯作者: 王哲芸（1981-）,女,山东莱州人,本科学历,主管护师,护士长。E-mail：13914704734@163.com
  • 作者简介:管艳（1989-）,女,江苏宿迁人,本科学历,护师。
  • 基金资助:
    中国博士后科学基金（2019M651804）

Construction and Application of Standardized Practice Scheme for Pressure Injury after Cardiac Surgery

GUAN Yan, LU Shan, YE Jia-xin, WANG Zhe-yun   

  1. Cardiac Surgery Intensive Care Unit, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-11-20 Online:2021-04-10 Published:2021-05-12

PDF (PC)

101

赞

摘要： 目的 构建心脏术后压力性损伤规范化实践方案并探讨其应用效果。方法 以减少压力性损伤为目标,从压力性损伤的预防、风险评估、分期、干预与处理措施等方面构建压力性损伤规范化实践方案。对该方案运行效果进行对比研究。结果 应用压力性损伤规范化实践方案后,规范化组与对照组相比,患者压力性损伤发生率下降,损伤皮肤愈合时间缩短,皮肤护理费用减少,护士对患者压力性损伤风险评估的及时性、准确性以及护理措施落实率提高,50名ICU护士理论知识、操作技能考核分数提高,2组之间差异均有统计学意义（P<0.05）。结论 构建心脏术后压力性损伤规范化实践方案,可降低ICU成人压力性损伤发生率,提高ICU护士对压力性损伤的认知和管理的能力,从而提高护理质量。

关键词: 压力性损伤, 压疮, 心脏外科手术, 风险管理, 规范化实践方案

Abstract: Objective To establish a standardized practice scheme for pressure injury after cardiac surgery and to explore its application effect. Methods A standardized practice plan of pressure injury was constructed in terms of prevention, risk assessment, staging, intervention and treatment measures of pressure injury. The effect of the scheme was compared before and after its implementation. Results After the implementation of the standardized practice scheme for pressure injury, the incidence of pressure injury in the experiment group decreased when compared with that in the control group and there were shortened healing time of the injured skin and less cost of skin care. The timeliness and accuracy of nurses’ risk assessment of pressure injury and the implementation rate of nursing measures were improved and the scores of theoretical knowledge and operation skills of 50 ICU nurses were improved. The differences between the two groups were statistically significant (P<0.05). Conclusion Standardized practice scheme for pressure injury after cardiac surgery is effective for reducing the incidence of stress injury among ICU adults, improving the ability of ICU nurses to recognize and manage pressure injury, thus to improve nursing quality.

Key words: pressure injury, pressure sore, cardiac surgery, risk management, standardized practice scheme

中图分类号: 

  • R473.6
[1] National Pressure Ulcer Advisory Panel.NPUAP Pressure Injury Stages[EB/OL].(2016-04-08)[2019-06-24].https://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/.
[2] Cakmak SK, Gul U, Ozer S, et al.Risk Factors for Pressure Ulcers[J]. Adv Skin Wound Care.2009,22(9):412-415. DOI: 10.1097/01.ASW.0000360256.99980.84.
[3] 廖冬花,吴艳平,杨泽,等.围手术期压力性损伤风险评估研究进展[J].临床护理杂志,2018,17(6):61-64. DOI:10.3969/j.issn.1671-8933.2018.06.024.
[4] 史桂蓉,王晓慧,冯晓岚,等.基于共词聚类法国外手术患者压力性损伤研究热点分析[J].解放军护理杂志, 2020,37(7):41-45. DOI:10.3969/j.issn.1008-9993.2020.07.010.
[5] 张敏,张允,陈建芬.ICU住院病人压力性损伤发生特征及原因分析[J].全科护理,2020,18(25):3387-3390. DOI:10.12104/j.issn.1674-4748.2020.25.038.
[6] 杨小辉,赵媛媛,钮美娥. ICU医疗器械相关压力性损伤的研究现状[J].护理学报, 2017,24(13):49-53. DOI:10.16460/j.issn1008-9969.2017.13.049.
[7] 霍婉君,刘荣敏,冯素云,等. 2007-2016年我国压疮发生危险因素研究的文献计量分析[J].护理学报,2017,24(20):14-16. DOI:10.16460/j.issn1008-9969.2017.20.014.
[8] 魏丽丽,韩斌如.以护士为主导的早期活动方案在机械通气患者中的应用研究[J].中华护理志, 2019,54(12):1765-1770. DOI:10.3761/j.issn.0254-1769.2019.12.001.
[9] Wound, Ostomy and Continence Nurses Society-Wound Guidelines Task Force.WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers):An Executive Summary[J]. J Wound Ostomy Continence Nurs,2017,44(3):241-246. DOI:10.1097/WON.0000000000000321.
[10] Gray M, Black JM, Baharestani MM, et al.Moisture-associated Skin Damage:Overview and Pathophysiology[J]. J Wound Ostomy Continence Nurs,2011,38(3):233-241.DOI:10.1097/WON.0b013e318215f798.
[11] Black JM, Gray M, Bliss DZ, et al.MASD Part 2:Incontinence-associated Dermatitis and Iintertriginous Dermatitis:A Consensus[J].J Wound Ostomy Continence Nurs, 2011, 38(4):359-370. DOI:10.1097/WON.0b013e31822272d9.
[12] Colwell JC, Ratliff CR, Goldberg M, et al.MASD part 3:Peristomal Moisture-associated Dermatitis and Periwound Moisture-associated Dermatitis: A Consensus[J]. J Wound Ostomy Continence Nurs, 2011, 38(5):541-553. DOI:10.1097/WON.0b013e31822acd95.
[13] McNichol L, Lund C, Rosen T, et al.Medical Adhesives and Patient Safety:State of the Science:Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-related Skin Injuries[J].J Wound Ostomy Continence Nurs, 2013,40(5):365-380.DOI:10.1097/NOR.0b013e3182a39caf.
[14] Tayyib N, Coyer F.Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units:A Systematic Review[J].Worldviews Evid Based Nurs, 2016, 13(6):432-444. DOI:10.1111/wvn.12177.
[15] Coyer F, Gardner A, Doubrovsky A, et al.Reducing Pressure Injuries in Critically Ill Patients by Using A Patient Skin Integrity Care Bundle(InSPiRE)[J].Am J Crit Care, 2015, 24(3):199-209. DOI:10.4037/ajcc2015930.
[16] 黄海燕,米元元,喻姣花,等.危重症住院患者失禁相关性皮炎预防及护理的最佳证据总结[J].护理学杂志, 2017, 32(21):50-53. DOI:10.3870/j.issn.1001-4152.2017.21.050.
[17] The NPSA.Seven Steps to Patient Safety.The Full Reference Guide[EB/OL].[2012-06-12].http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety.
[18] 蒋琪霞,彭青,周昕,等.伤口护理风险预案的制订及应用效果评价[J].中华护理杂志,2012,47(11):968-971. DOI:10.3761/j.issn.0254-1769.2012.11.002.
[19] 卢山,孙小玲,夏萍.70岁以上高龄心脏瓣膜手术患者术后发生便秘的影响因素分析及对策[J].中西医结合护理(中英文),2020,6(1):10-15. DOI:10.11997/nitcwm.202001003.
[20] Baernholdt M, Yan G, Hinton ID,et al.Effect of Preventive Care Interventions on Pressure Ulcer Rates in a National Sample of Rural and Urban Nursing Units:Longitudinal Associations Over 4 Years[J]. Int J Nurs Stud, 2020(105):103455.DOI:10.1016/j.ijnurstu.2019.103455.
[21] 王亚婷,彭晓红,董正惠. ICU心脏外科术后成人患者压力性损伤影响因素分析[J].护理学报,2019,26(3):1-4. DOI:10.16460/j.issn1008-9969.2019.03.001.
[22] 胡青晔,吴晓蓉,秦彦雯,等.基于链式流程的手术患者压力性损伤信息平台构建[J].中华现代护理杂志,2018,24(25):3016-3021.DOI:10.3760/cma.j.issn.1674-2907.2018.25.009.
[23] 王亚婷,陈桂花,董正惠. Norton量表对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值及护理策略[J]. 实用心脑肺血管病杂志,2019,27(3):99-103. DOI:10.3969/j.issn.1008-5971.2019.03.020.
[24] 宋思敏,闫雅凤,赵凯丽,等.赛肤润预防医务人员头面部压力性损伤的早期干预效果[J].解放军医学院学报,2020,41(5):498-501.DOI:10.3969/j.issn.2095-5227.2020.05.015.
[25] European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel,Pan Pacific Pressure Injury Alliance.Prevention and Treatment of Pressure Ulcers/Injuries:Clinical Practice Guideline[S].Epuap/npiap/pppia:2019. DOI:10.1016/j.jtv.2019.01.001.
[26] 周青,江智霞,郑喜兰,等.三甲医院住院患者皮肤损伤的调查分析[J].护士进修杂志,2018,33(1):87-89.DOI:10.16821/j.cnki.hsjx.2018.01.030.
[27] 俞超,高春华,王辉,等.ICU危重患者皮肤管理流程的设计与实践[J].护理学杂志,2019,34(12):58-60. DOI:10.3870/j.issn.1001-4152.2019.12.058.
[28] Megan WM, Rebecca TE, Gary LF.Reduction of Hospital-acquired Pressure Injuries Using a Multidisciplinary Team Approach:A Descriptive Study[J]. Wounds, 2019, 31(4):108-113.
[29] 卢明,俞燕娟,李中东,等.基于家庭医护平台延续性护理模式的构建及应用[J].中华护理杂志, 2019,54(12):1851-1855. DOI:10.3761/j.issn.0254-1769.2019.12.017.
[30] 陆秋芳,应燕萍,赵翠松,等.神经内科患者树状图失禁护理流程的设计与实践[J].护理学杂志,2018,33(16):1-4. DOI:10.3870/j.issn.1001-4152.2018.16.001.
[31] 闫燕. 基于5E理念的综合康复护理在风湿性心脏病瓣膜置换术后患者中的应用价值[J]. 现代中西医结合杂志,2017, 26(12):1355-1359. DOI:10.3969/j.issn.1008-8849.2017.12.037.
[32] 陈明慧,陈秋莲,宋丹丹,张海平.集束化护理在降低难免压疮患者压疮发生率中的应用[J].护理学报, 2014,21(10):43-44. DOI:10.16460/j.issn1008-9969.2014.10.013.
[33] 许志秀,孙风丽.专科医院护理人员对岗位管理的认知调查[J].护理学杂志, 2020,35(21):69-71. DOI:10.3870/j.issn.1001-4152.2020.21.069.
[1] 高兴莲, 余文静, 肖瑶, 胡娟娟, 赵诗雨, 杨英. 手术患者围术期压力性损伤预防及管理最佳证据总结[J]. 护理学报, 2021, 28(6): 22-26.
[2] 吴磊, 周济宏, 蒋琪霞. 2例4期压力性损伤继发鳞状细胞癌患者护理难点与临床特征分析及干预[J]. 护理学报, 2020, 27(6): 65-68.
[3] 周燕茹, 王丽娜, 葛晨希, 王凤, 赵霞. 多功能翻身枕的设计及其在Ⅰ期压力性损伤患者中的应用[J]. 护理学报, 2020, 27(6): 74-77.
[4] 蔡忠香, 方婷, 范婧慧, 杨欣, 王雪芬, 鲜于云艳, 刘春英, 张美芳. 新型冠状病毒肺炎疫情期间护理管理应急问题及对策[J]. 护理学报, 2020, 27(5): 76-78.
[5] 王凡凡, 彭易, 苏怡芳, 林萍, 庄敏. 压力性损伤知识评估工具的汉化与心理测量学分析[J]. 护理学报, 2020, 27(23): 68-70.
[6] 李昭慧, 詹昱新, 谭珊, 向玉洁. 改良氧气面罩在ICU护理中的应用[J]. 护理学报, 2020, 27(21): 77-78.
[7] 廖园园, 周毅峰, 秦月兰, 陶美伊, 李珍. 预防术中俯卧位患者面部压力性损伤的最佳证据总结[J]. 护理学报, 2020, 27(15): 39-43.
[8] 陆彤, 刘佳, 芮琳. 改良体位预防患者在达芬奇机器人手术中医疗器械相关压力性损伤的效果观察[J]. 护理学报, 2020, 27(1): 70-72.
[9] 郭思明, 杨鑫, 王敏, 赵连童. 35例无痛消化内镜手术患者术中穿孔镜下闭合的护理[J]. 护理学报, 2019, 26(8): 61-64.
[10] 卞伶玲, 杨金娜, 赵益, 杨雨佳. 双腔Power PICC置管部位医用粘胶剂相关性皮肤损伤的风险预防管理[J]. 护理学报, 2019, 26(6): 64-66.
[11] 王亚婷, 彭晓红, 董正惠. ICU心脏外科术后成人患者压力性损伤影响因素分析[J]. 护理学报, 2019, 26(3): 1-4.
[12] 冯尘尘, 王蒙蒙, 唐秀美, 周煜, 赵淑珍. 早期压力性损伤识别方法研究进展[J]. 护理学报, 2019, 26(3): 20-23.
[13] 林名云, 肖映珠, 廖燕娜, 郑海虹, 郭海强. 专科护士主导的压疮质量控制项目管理应用研究[J]. 护理学报, 2019, 26(22): 16-18.
[14] 于丰, 胡德英, 孙丽, 代艺, 刘敏, 张佳. 小组式护理论坛在肿瘤科患者自杀防治培训中的应用与启示[J]. 护理学报, 2019, 26(17): 14-17.
[15] 姚丽娟, 李红梅, 钱卫琴, 白佳燕, 达玉娟. 新型手术侧卧位固定垫的设计与临床应用[J]. 护理学报, 2019, 26(17): 77-78.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 杜金磊, 陈志美, 秦兰芳, 廉洁, 孙文静, 王翔, 徐巍, 邹晓月. 基于昼夜节律机制对ICU老年患者肠内营养延续性护理的对照研究[J]. 护理学报, 2021, 28(7): 1 -5 .
[2] 谭天, 庞永慧, 左红群, 邓玉燕. 隔姜灸对结直肠癌行腹腔镜根治术后凝血功能的影响[J]. 护理学报, 2021, 28(7): 6 -10 .
[3] 田丽, 李梦媛, 肖抒情, 阎玲. 晚期癌症患者预期性悲伤的现状及影响因素分析[J]. 护理学报, 2021, 28(7): 11 -14 .
[4] 任黎, 赵秀芳. 基于洋葱模型的妇幼专科医院新护士岗位胜任力模型及指标体系构建[J]. 护理学报, 2021, 28(7): 21 -25 .
[5] 肖萍, 宋洁, 吴淑琳, 姜倩倩, 陈海雯, 刘霖. 护生接受痴呆教育干预的研究进展[J]. 护理学报, 2021, 28(7): 26 -29 .
[6] 刘雨安, 杨小文, 李乐之. 机器学习在疾病预测的应用研究进展[J]. 护理学报, 2021, 28(7): 30 -34 .
[7] 刘萍, 尤奥林, 刘姝, 李亚楠, 栾晓嵘. 我国护理硕士专业学位研究生就读期间培养体验质性研究的Meta整合[J]. 护理学报, 2021, 28(7): 35 -42 .
[8] 李换则, 陈鸿芳, 黄丽群, 安芳芳, 徐鹏, 庄苗青, 张露语, 王嘉懿. 急诊科护士临终照护体验质性研究的Meta整合[J]. 护理学报, 2021, 28(7): 43 -48 .
[9] 谢晓星, 赵敏慧. 229例产科监护室高危妊娠产妇泌乳启动延迟现状及影响因素分析[J]. 护理学报, 2021, 28(7): 49 -52 .
[10] 刘鑫, 江锦芳, 覃彦珠, 周帅, 施洁, 刘彦君. 215例结直肠癌造口患者家庭主要照顾者照顾能力现状及影响因素分析[J]. 护理学报, 2021, 28(7): 53 -58 .