压疮愈合计分对评价压疮清创效果的可行性及有效性分析

Pressure ulcer scale for healing:Feasibility and validity in evaluating the effect of debridement on pressure ulcers

目的清创是压疮治疗的首要环节,以往对清创效果的评价无客观量化指标。美国压疮专家组于1998年制订了压疮愈合计分(PUSH),用于客观评价压疮治疗的效果。文中探讨压疮愈合计分对评价压疮清创效果的可行性和有效性。方法 2006年8月至2008年7月就诊处理的Ⅱ～Ⅳ期有清创指征的压疮患者48例计74处,由造口治疗师给予分次逐步清创,直至坏死组织完全清除,伤口床转为红色肉芽为止。由造口治疗师和统一受训的护士分别于每处压疮清创后7、14、21、28d进行观察和评价,按照PUSH计分表内容动态计分,并记录每次评分所需的时间,用SPSS 11.0软件进行统计学分析。结果Ⅱ～Ⅳ期压疮4周内各次PUSH计分结果组间和组内差异均有统计学意义(P均为0.000)。Ⅳ期压疮清创前和清创期PUSH计分值明显大于Ⅲ期和Ⅱ期压疮(P值分别为0.001,0.000)。造口治疗师和受训护士对同一压疮的计分结果和计分时间基本一致(P>0.05)。结论用PUSH计分综合评价伤口面积、渗液量和组织类型变化,可量化地客观评价各期压疮的清创效果,方法简便可行,结果可信有效。

Objective The pressure ulcer scale for healing（PUSH）,established in 1998 by the American Pressure Ulcers Advisory Panel（APUAP）,is applied to the objective evaluation of the effects of pressure ulcer care.Debridement is a crucial step in the treatment of pressure ulcers,but there had been no objective indications for its evaluation before the establishment of PUSH.The authors investigated the feasibility and validity of PUSH in evaluating the effect of debridement on pressure ulcers.Methods We retrospectively analyzed 74 sites of stage Ⅱ-Ⅳ pressure ulcers in 48 patients,who were treated by step-by-step debridement till the appearance of granulation.The wounds were observed and evaluated by enterostomal therapists and trained nurses at 7,14,21 and 28 days after debridement,and the results of and the time used in PUSH scoring were recorded and subjected to statistical analysis with the SPSS11.0 software.Results The PUSH scores for stage Ⅱ-Ⅳ pressure ulcers at 4 weeks showed significant differences between different groups（P = 0.000）,and the scores before and during the debridement of stage Ⅳ were significantly higher than those of stages Ⅲ（P = 0.001） and Ⅱ（P = 0.000）.The results of and the time used in PUSH scoring for a specific wound showed no significant differences between the enterostomal therapists and trained nurses（P 0.05）.Conclusion The pressure ulcer scale for healing,easy to be used and reliable for its results,can give a quantitative objective evaluation of the effect of debridement on pressure ulcers of different stages.