10例造口底盘医疗器械相关性压疮的原因分析及对策

Cause analysis and interventions of 10 cases in Medical Device Related Pressure Ulcer of colostomy stoma

目的：分析发生在造口底盘下压疮的原因,并采用针对性护理措施。方法：对2014年4月至2015年12月造口护理门诊就诊的10例造口底盘下压疮患者进行原因分析,并制定护理对策,观察创面恢复情况。结果：10例均使用腰带和二件式底盘;6例底盘下缘卷边;4例凸面底盘突出部造成压力;4例造口位置欠佳（3例位置过低、1例位于右上腹肋缘下）;4例合并其他并发症;2例合并糖尿病。10例患者经护理后创面愈合,愈合时间5~67d,平均时间24.8d。结论：造口底盘下压疮与佩戴腰带有关,要加强评估底盘佩戴的时间、腰带的松紧度;加强底盘下缘固定,防止卷边;调整底盘型号避免皮肤受压;位置欠佳者偏心圆裁剪底盘。同时根据压疮的分期和面积,选择合适的敷料处理创面,促进创面愈合。

Objective： To evaluate the causes of medical device related pressure ulcer under the Colostomy Stoma and implement interventions accordingly. Methods： Investigate the possible reasons of 10 patients with medical device related pressure ulcer between April 2014 and December 2015, and making nursing plans accordingly, then observe the effects. Results： The reasons for the 10 patients with pressure ulcer were as follows： all of them using belt and two-piece chassis; six patients using convex chassis for stoma retraction; and for another four patients whose stomas were in poor position, one patient＇s stoma was under the right upper quadrant costal margin, while the other three＇s were too low; four patients had comorbidities; and two patients had diabetes. After the intervention according to the pressure ulcer guidelines, all pressure ulcers were healed, with healing time of 5-67 d, and the average time was 24.8 d. Conclusions： Pressure ulcer under stoma chassis was related to belt. We should assess chassis conditions and belt wearing time as well as tightness. And we can stablize the chassis to prevent the curling of the edge. When the patient＇s stoma was not in the optimum position, the enterostomal therapist could use eccentric circle tailor the chassis. At the same time, choosing appropriate dressing to debridement according to the stage and area of the pressure ulcer to enhance healing.