外科重症患者压疮发生高危因素分析

The risk factors of pressure ulcer in surgical critically ill patients

目的:探讨外科重症患者压疮发生相关危险因素,为制定预防压疮的有效措施提供依据。方法:采用自设外科重症患者压疮危险因素调查表收集某三级甲等医院47例外科重症患者资料,将其中发生院内压疮的14例患者设为压疮组,未发生压疮的33例患者设为对照组,两组间对20项指标进行单因素分析及多因素Logistic回归分析,找出压疮发生的危险因素。结果 :单因素分析显示,压疮组在ICU住院期间去甲肾上腺素使用总计小时数、动脉血乳酸最高值、机械通气总天数、血液净化治疗天数、排便失禁天数5项指标值高于对照组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,去甲肾上腺素使用总计小时数、动脉血乳酸最高值是压疮发生的高危因素(P<0.05)。结论:应针对压疮高危人群和危险因素采取有针对性的措施,积极控制原发病,在抢救的同时采取积极的减压措施,以提高危重患者压疮防控的护理质量。

Objective：To investigate the risk factors related to the development of pressure ulcer in surgical critically ill patients and to provide the basis for the formulation of effective precautions. Methods：The questionnaire of the risk factors of pressure ulcer in surgical critically ill patients was used to collect data in a level-three class-A hospital by using case control study. In total of 47 patients enrolled into the study, 14 patients who developed nosocomial pressure ulcer were allocated to the case group and the remaining 33 patients who met the inclusion criteria without pressure ulcer were allocated to the control group. Univariate and multivariate logistic regression analysis were used to compare the difference of 20 indicators between the two groups to ifnd out the risk factors causing pressure ulcer. Results：According to the univariate analysis, the total hours of using noradrenaline, the maximum value of lactic acid in arterial blood, the total days of using mechanical ventilation, the total days of receiving blood puriifcation, and the days of bowel incontinence in the case group were statistically higher than the control group （P〈0.05） . The multivariate logistic regression analysis showed that the total hours of using noradrenaline and the level of lactic acid in arterial blood were the high risk factors of pressure ulcer （P〈0.05） . Conclusion：The best way to prevent and control pressure ulcer in surgical critically ill patients is to attach great emphasis on the duration of critical status and to pay special attention to patients with continuous state of shock. The targeted measures for high-risk populations, actively controlling primary diseases, and decompression while in the rescue can help improve the prevention and control of pressure ulcers in critically ill patients.