一例预防压力性溃疡最佳翻身策略的循证实践

Evidence-Based Nursing Practice of Best Turning Over Strategy for a Patient with the Risk of Pressure Ulcer

目的结合1例临床病例,采用循证医学方法,筛选预防压力性溃疡(压疮)的最佳翻身策略。方法依据PICO原则和患者情况,提出个性化的临床问题后,计算机检索NGC、DARE、CDSR、CCTR、MEDLINE、PubMed和CBM,收集预防压力性溃疡(压疮)翻身方法的高质量临床证据。结果最终共纳入1篇临床实践指南、1篇系统评价和3个随机对照试验。根据最终检索结果、患者病情和患者及家属意愿,采用卧于黏弹性泡沫减压床并每4小时翻身1次,使用仰卧位与仰卧位向左向右倾斜30°交替的翻身方法。患者住院期间,骶尾部4×6 cm2一度压疮部位清洁干燥,未有破溃,其他色素沉着部位也未有压疮发生。结论运用循证医学方法可为患者提供既科学又考虑患者个体化要求的护理。

Objective To formulate an evidence-based nursing strategy of turning over for a patient with the risk of pressure ulcer. Methods The personalized clinical questions were put forward based on the PICO and patient＇s con- dition, and the following databases such as NGC, The Cochrane Library of DARE, CDSR, CCTR, MEDLINE, PubMed and CBM were searched to collect the best clinical evidences of turning over for preventing pressure ulcer. Results One clinical guideline, one systematic review and three randomized controlled trials were included finally. According to the retrieval outcomes, patient＇s clinical condition, and patients and their family members＇ willingness, a reasonable nursing plan of turning over was formulated： lie on the visco-elastic foam decompression bed, turn over every 4 hours, and com- bine supine position with alternation of left-oblique 30° position and right-oblique 30° position. During hospitalization, the grade-I pressure ulcer in size of 4×6 cm2 on patient＇s sacrococcygeal region was clear, dry and not broken, and the other part of body with pigmentation had no occurrence of pressure ulcer. Conclusion Evidence-based approaches are helpful to provide patient with a nursing plan that meets the needs of both scientificalness and individualization.