一效散外敷联合个体化分级分期护理ICU危重患者压疮

The Nursing Experience of the Bedsore Prevention and Control of Combining Yixiao Powder External Application and Iodophor Disinfection and Debridement

[目的]观察一效散外敷联合个体化分级分期护理ICU危重患者压疮效果。[方法]使用前瞻性设计方法,对30例住院ICU危重患者1基础护理,易受压骨突起部位放置棉垫,局部架空,加强翻身(避免拖、拉、推等动作);及时按摩受压处皮肤,患者大便后及时用温水清洗会阴,严格交接班和记录制度;鼓励患者增加营养;意识清楚患者,心理护理,讲解褥疮治疗的必要性,加强认识性。2一效散局部外敷,压疮部位碘伏消毒、清创,外敷一效散。3分级分期个体化护理,根据压疮分级分期,制订个体化护理措施;I度:加强压疮预防措施,尽力治疗压疮,使面积不再继续发展,消除致病原因,增加翻身次数,避免摩擦、潮湿和排泄物刺激,改善局部血液循环,加强营养摄人,增强机体抵抗力;Ⅱ度:注意保护皮肤,避免感染;若有水泡未破要减少摩擦,防止破裂感染;大水泡可在无菌操作下用注射器抽出泡内液体,不必剪去表皮,涂以碘伏注射液,无菌敷料包扎;Ⅲ度:保持局部清洁与干燥,联合一效散局部涂抹,直到疮面愈合;Ⅳ度:消毒清洁疮面,清除坏死组织,促进肉芽生长,联合一效散局部涂抹;由于疮口深,可先用2%利多卡因喷于疮面,清洗时动作轻柔,减轻患者痛苦。换药后用无菌纱布覆盖疮面,促进愈合,可用红外线照射增加局部血液回流。连续治疗护理7d为1疗程。观测临床症状、溃疡状况、家属满意度、不良反应。连续治疗护理2个疗程,判定疗效。[结果]显效15例,有效13例,无效2例,总有效率:93.30%,家属满意29例,满意度96.70%。[结论]一效散外敷联合个体化分级分期护理ICU危重患者压疮效果显著,值得推广。

[ Objective ] Observe the effects of the bedsore nursing in ICU patients by combining Yixiao powder external application and iodophor disinfection. [ Methods ] Select 30 critical patients with bedsore as research objects, all the patients were regular treated with iodophor disinfection, debridement and combining Yixiao powder external application in two weeks. Based on the classification of the bedsore, making the individual nursing plans to treat the bedsore. I degree bedsore, Strengthen the nursing measures to treat and prevent the bedsores, make the area stoping extension, eliminating pathogenic reason, turning the patient over frequentlyo II degree, pay attention to protect the skin, avoid and prevent rupture infection;Blisters in the sterile operation, pull bubble in liquid with a syringe, disinfect with idophor and sterile dressing bandage. Ⅲ degrees ： keep the area clean and dry, combing the Yixiao powder external application until wound healing Ⅳdegrees ： disinfection clean wound, remove the necrotic tissue and promote the growth of granulation, and combine the Yixiao powder external application, use first 2% lidocaine hydrochloride injection in the wound, relieve patients＇ pain. 7 straight days nursing as a course, observe the satisfaction of family members clinical symptoms, adverse reactions. [ Results ] The study indicates： 15 cases significantly effective, 13 cases effective, 2 cases valid.The total effective rate is 93.30%. 29 cases shows high degree of satisfaction to the nursing and the degree of satisfaction is 96.70%. [ Conclusion ] The bedsore＇ s prevention and control of combining traditional Chinese and western medicine in ICU patients with good clinical effects, improve the degree of satisfaction from the patients＇ family member, and worth to popularize in clinical application.