以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (10): 45-51.doi: 10.16460/j.issn1008-9969.2021.10.045

• 循证护理 • 上一篇    下一篇

ICU患者压力性损伤预防的最佳证据总结

秦鸿利1a, 赵震1b, 王艳芳2, 卢颖1a, 王志霞1c, 李黎明1a   

  1. 1.河南省人民医院 a.护理部; b.急危重症医学科; c.胃肠外科,河南 郑州 450003;
    2.南方医科大学南方医院 药物临床试验中心,广东 广州 510515
  • 收稿日期:2020-07-07 出版日期:2021-05-25 发布日期:2021-06-09
  • 通讯作者: 李黎明（1967-）,女,河南郑州人,硕士,主任护师。E-mail: syliliming868199@126.com
  • 作者简介:秦鸿利（1991-）,女,河南郑州人,硕士,主管护师。
  • 基金资助:
    河南省科技攻关基金资助项目（182102310147）

Best Evidence Summary for Prevention of Pressure Ulcer in ICU Patients

QIN Hong-li1a, ZHAO Zhen1b, WANG Yan-fang2, LU Ying1a, WANG Zhi-xia1c, LI li-ming1a   

  1. 1a. Dept. of Nursing Administration; 1b. Dept. of Emergency and Critical Care Medicine; 1c. Dept. of Gastrointestinal Surgery,Henan Provincial People's Hospital, Zhengzhou 450003,China;
    2. Drug Clinical Trials Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2020-07-07 Online:2021-05-25 Published:2021-06-09

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摘要： 目的 检索、评价和总结ICU患者压力性损伤预防的最佳证据,为临床实践提供循证依据。方法 检索JBI、Up To Date、BMJ Best Practice、国际指南图书馆、美国指南网、英国国家临床医学研究所指南库、Cochrane Library、医脉通、PubMed、CINAHL、EMbase、万方数据库、中国知网、中国生物医学文献数据库并补充检索了相关官方网站。结果 共筛选证据14篇,包括指南7篇、证据总结1篇、系统评价2篇、随机对照试验3篇和专家共识1篇,最终总结了40条最佳证据。结论 临床护理人员需结合专业判断、患者的需求和偏好以及应用证据的场景,有针对性的选择最佳证据,降低ICU患者压力性损伤的发生率,提高护理质量。

关键词: 重症监护病房, 压力性损伤, 预防, 循证护理

Abstract: Objective To retrieve, evaluate and summarize the best evidence for prevention of pressure ulcer in ICU patients and provide reference for clinical practice. Methods We searched literature from Joanna Briggs Institute(JBI), Up To Date, BMJ Best Practice, Guidelines International Network(GIN), National Guideline Clearinghouse(NGC), National Institute for Health and Care Excellence(NICE), Cochrane Library, Yi Maitong, PubMed, CINAHL, Embase, Wanfang Data, CNKI and CBM, and relevant official websites. Results Fourteen pieces of evidence were selected, including 7 guidelines, 1 evidence summary, 2 systematic reviews, 3 randomized controlled trials and 1 expert consensus. Forty pieces of best evidence were summarized. Conclusion It is suggested that clinical nursing staff should take clinical expertise, patient preference and clinical context into consideration to select the best evidence, thus to reduce the incidence of pressure ulcer in ICU patients and improve nursing quality.

Key words: intensive care unit, pressure ulcer, prevention, evidence-based nursing

中图分类号: 

  • R473
[1] National Pressure Ulcer Advisory Panel. National Pressure Ulcer Advisory Panel (NPUAP) Announces a Change in Terminology from Pressure Ulcer to Pressure Injury and Updates the Stages of Pressure Injury[EB/OL].(2014-04-13)[2020-02-01]. http://www.npuap.org/nationalpressure -ulcer -advisory -panel -npuap -announces -a-change-in-terminology-from-pressure-ulcer-topressure-injury-and-updates-the-stages-of-pressure-injury/.
[2] 刘艳,王丽娟,昂慧,等. ICU患者压疮危险因素的Meta分析[J]. 护理学杂志, 2018,33(4):84-87.DOI:10.3870/j.issn.1001-4152.2018.04.084.
[3] Keller PB, Wille J, van Ramshorst B, et al. Pressure Ulcers in Intensive Care Patients: A Review of Risks and Prevention[J]. Intensive Care Med, 2002, 28(10):1379-1388.DOI:10.1007/s00134-002-1487-z.
[4] 蒋琪霞,刘云,管晓萍,等.住院患者压疮现患率的多中心研究[J].医学研究生学报,2013,26(12):1298-1303. DOI:10.16571/j.cnki.1008-8199.2013.12.004.
[5] National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline[M]. Perth: Cambridge Media, 2019:22-30.
[6] Gould L, Stuntz M, Giovannelli M, et al.Wound Healing Society 2015 Update on Guidelines for Pressure Ulcers[J]. Wound Repair Regen, 2016, 24(1):145-162. DOI:10.1111/wrr.12396.
[7] Stansby G, Avital L, Jones K, et al.Prevention and Management of Pressure Ulcers in Primary and Secondary Care: Summary of NICE Guidance[J]. BMJ, 2014, 348(23):g2592.DOI:10.1136/bmj.g2592.
[8] Wound,Ostomy and Continence Nurses Society-Wound Guidelines Task Force.WOCN 2016 Guideline for Prevention and Management of Pressure Injuries(Ulcers)[J].JWound, Ostomy and Continence Nurs,2017,44(3):241-246.DOI:10.1097/WON.0000000000000321.
[9] Doris G. Risk Assessment and Prevention of Pressure Ulcers (Revised)[EB/OL].(2011-03-11)[2020-02-01].https://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers.
[10] Doris G. Assessment and Management of Pressure Injuries for the Interprofessional Team,Third Edition[EB/OL].(2016-08-16)[2020-02-01].https://rnao.ca/bpg/guidelines/pressure-injuries.
[11] Qaseem A, Mir TP, Starkey M, et al.Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians[J].Ann Intern Med, 2015, 162(5):359-369.DOI:10.7326/M14-1567.
[12] Editor T.Pressure Ulcers in Adults: Prediction and Prevention. Agency for Health Care Policy and Research[J]. Am Fam Physician, 1992, 46(3):787-794.
[13] 朱政,胡雁,邢唯杰,等. 不同类型循证问题的构成[J]. 护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[14] Dicenso A, Bayley L, Haynes RB.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[15] Brouwers MC, Kho ME, Browman GP, et al.AGREE II:Advancing Guideline Development, Reporting and Evaluation in Healthcare[J].J Clin Epidemiol, 2010,63(12):1308-1311.DOI:10.1016/j.ypmed.2010.08.005.
[16] 栾贝贝,汤玉霞,宇丽,等.儿童外周静脉穿刺疼痛管理相关实践指南的质量评价和分析[J].护理学杂志,2019,34(14):93-96.DOI:10.3870/j.issn.1001-4152.2019.14.093.
[17] The Joanna Briggs Institute. Checklist for Systematic Reviews and Research Syntheses[EB/OL].(2019-06-27)[2020-02-01].https://joannabriggs.org/research/critical-appraisal-tools.html.
[18] The Joanna Briggs Institute.Checklist for Randomized Controlled Trials[EB/OL].(2019-06-27)[2020-02-01].https://joannabriggs.org/research/critical-appraisal tools.html.
[19] 胡雁,郝玉芳.循证护理学[M].2 版.北京:人民卫生出版社,2018.
[20] The Joanna Briggs Institute(JBI). Critical Appraisal Tools [EB/OL].(2017-07-15)[2020-02-01].http://joannabriggs.org/research/critical-appraisal tools.html.
[21] 刘晁含,付沫,丁娟,等.危重患者院内转运的最佳证据总结[J].护理学报,2020,27(15):33-38.DOI:10.16460/j.issn1008-9969.2020.15.033
[22] 王青春,胡雁. JBI 证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[23] Eric Fong MBBS MPHTM. Evidence Summary. Pressure Ulcers(Prevention):Intensive Care Unit(ICU).[EB/OL].(2019-02-20)[2020-02-01].https://journals.lww.com/jbisrir/Pages/default.aspx.
[24] Fulbrook P, Mbuzi V, Miles S.Effectiveness of Prophylactic Sacral Protective Dressings to Prevent Pressure Injury: A Systematic Review and Meta-analysis[J]. IntJNurs Stud, 2019(100):103400. DOI:10.1016/j.ijnurstu.2019.103400.
[25] Walia GS, Wong AL, Lo AY, et al.Efficacy of Monitoring Devices in Support of Prevention of Pressure Injuries: Systematic Review and Meta-analysis[J]. Adv Skin Wound Care,2016,29(12):567-574. DOI:10.1097/01.ASW.0000504579.83707.f6.
[26] Manzano F,Colmenero M,Pérez-Pérez AM,et al.Comparison of Two Repositioning Schedules for the Prevention of Pressure Ulcers in Patients on Mechanical Ventilation with Alternating Pressure Air Mattresses[J].Intensive Care Med, 2014, 40(11):1679-1687.DOI:10.1007/s00134-014-3424-3.
[27] 蒋琪霞,李国宏,刘海英,等.减压床垫结合不同翻身频率用于重症患者预防压疮的多中心对照研究[J].医学研究生学报,2017, 30(1):77-82.DOI:10.16571/j.cnki.1008-8199.2017.01.016.
[28] 王晓慧,江娇,魏媛媛,等. 两种减压床垫预防心外 ICU 术后患者压疮的效果比较[J]. 护理学杂志, 2016, 31(4): 12-14.DOI:10.3870/j.issn.1001-4152.2016.04.012.
[29] Schmitt S, Andries MK,Ashmore PM, et al.WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers(injuries)[J].J Wound Ostomy Continence Nurs,2017,44(5):458-468.DOI:10.1097/WON.0000000000000361.
[30] 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.
[31] 廖园园,周毅峰,秦月兰,等.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.DOI:10.16460/j.issn1008-9969.2020.15.039.
[32] Bergstrom N.The Braden Scale for Predicting Pressure Sore Risk[J]. Nurs Res,1987,36(2):205-210. DOI:10.1097/01.ASW.0000411403.11392.10.
[33] Norton D.Calculating the Risk: Reflections on the Norton Scale[J].Decubitus,1989,2(3):24-31.
[34] Waterlow J.Pressure Sores:A Risk Assessment Card[J]. Nurs Times,1985,81(48):49-55.
[35] 汤玉琴. Braden 量表在预防老年长期卧床住院患者压疮中的应用[J].中西医结合护理(中英文),2015,1(4):123-125.DOI:10.11997 /nitcwm.201504049.
[36] 童琍琍,赵梅.国内压疮评估量表的应用进展[J].护理管理杂志,2019, 19(4):275-279.DOI:10.3969/j.issn.1671-315x.2019.04.012.
[37] 张丽红,周园,宁曼曼,等.Waterlow 量表在评价住院患者压疮危险程度中的应用[J]. 武警后勤学院学报(医学版),2011, 20(6):477-478.DOI:10.3969 /j.issn.1008-5041.2011.06.016.
[38] Swigart V, Liang Z.Digital Resources for Nursing Education: Open Courseware and massive Open Online Courses[J]. International Journal of Nursing Sciences,2016, 3(3):307-313.DOI:10.1016/j.ijnss.2016.07.003.
[39] Liu X, Cheng J, Huang S.Mobile Phone Training Platform for the Nursing Staff in the Emergency Department[J]. Telemedicine e-Health, 2018, 25(1):66-70.DOI:10.1089/tmj.2017.0317.
[40] 蒋琪霞,瞿小龙,王建东,等.减压装置用于重症患者压疮预防效果的系统评价[J].中国护理管理,2015,15(6):695-699.DOI:10.3969/j.issn.1672-1756.2015.06.018.
[41] 李飞,邓波,朱世琴,等.压疮危险人群翻身间隔时间最佳证据总结[J].护理学报,2018,25(11):21-25.DOI:10.16460/j.issn1008-9969.2018.11.021.
[42] Gillespie BM, Chaboyer WP, Mcinnes E, et al. Repositioning for Pressure Ulcer Prevention in Adults[J]. Cochrane Database Syst Rev, 2014,4(4):CD009958.DOI:10.1002/14651858.CD009958.pub2.
[43] 刘云访,喻姣花,李素云,等.ICU成人患者气管插管非计划性拔管预防及管理的证据总结[J].护理学报,2020,27(3):43-48.DOI:10.16460/j.issn1008-9969.2020.03.043.
[44] 黄玉美,丁易云.液体及营养管理在ICU难免压疮患者中的临床观察[J].哈尔滨医药,2017,37(5):498-499.
[45] 唐德琼. 护理干预对 ICU 患者难免压疮的影响[J].世界最新医学信息文摘,2014,16(9):278-279.DOI:10.3969/j.issn.1671-3141.2014.09.228.
[46] 泮伊丽. 结构化皮肤护理管理模式应用于重症监护室大便失禁患者对预防失禁性皮炎、压疮的影响[J].当代护士(上旬刊), 2017(6):152-154.DOI:10.3969/j.issn.1006-6411.2017.06.077.
[47] 蒋庆丽. 结构化皮肤护理管理模式应用于重症监护室大便失禁患者对预防失禁性皮炎、压疮的影响[J].全科口腔医学电子杂志,2019, 6(32):73.DOI:10.16269/j.cnki.cn11-9337/r.2019.32.054.
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