我国14所三级甲等综合医院住院患者皮肤撕裂伤的现状调查

Status of Skin Tears of Hospitalized Patients in 14 Class Ⅲ Grade Ⅰ Hospitals

目的了解我国皮肤撕裂伤的现患率、发生现状及预防护理措施落实现状,为临床采取合理的护理措施提供参考依据。方法采用便利抽样法,抽取全国9个省、11个城市的14所三级甲等综合医院的19 010例住院患者实施横断面调查,使用前期通过Delphi法研制并经过预调研验证具有良好效度和可行性的调查工具。结果 19 010份问卷中获得有效问卷18 806份,18 806例患者中有199例计238处皮肤撕裂伤患者,现患率为1.058%,均发生于住院期间。238处皮肤撕裂伤患者中,1a级48处(20.2%),1b级34处(14.3%),2a级26处(10.9%),2b级14处(5.9%),3级116处(48.7%)。最常见的发生部位是双上肢,发生皮肤撕裂伤的前3位原因依次为跌倒(29.0%)、钝力损伤(23.1%)、医用敷料(19.7%)。199例皮肤撕裂伤患者中有164例患者有皮肤撕裂伤发生史,占82.4%,不同时间皮肤撕裂伤发生史的患者,其皮肤撕裂伤现患率比较,差异有统计学意义(χ~2=88.836,P<0.001)。199例皮肤撕裂伤患者中,9项预防措施仅有2项护理措施落实率>50%。结论14所三级甲等综合医院住院患者的皮肤撕裂伤现患率为1.058%,最常见的皮肤撕裂伤发生部位为双上肢,最常见的皮肤撕裂伤分级为3级,最常见的3个原因是跌倒、钝力损伤和移除医用粘性敷料。我国住院患者皮肤撕裂伤护理措施的实施情况较差,9项护理措施中仅有2项落实率>50%。临床医护人员需要加强对好发人群及部位的关注,加强对皮肤撕裂伤相关知识的学习,采用有针对的预防措施以减少皮肤撕裂伤的发生。

Objective To understand the prevalence and occurrence and preventive measures of skin tears in China, so as to provide references for clinical nursing. Methods A total of 19,010 inpatients in 14 Class Ⅲ GradeⅠ hospitals of 11 cities from 9 provinces were selected by convenient sampling method. Cross-sectional survey was carried out by using investigative tool developed by Delphi method and verified by pilot investigation. Results A total of 19,010 questionnaires were issued and 18,806 valid questionnaires were obtained. The results showed that there were 199 patients with 238 cases of skin tears, all of which occurred during hospitalization, with a prevalence of 1.058%. Of the 238 cases with skin tears, 48 were in stage 1 a（20.2%）, 34 were in stage 1 b（14.3%）,26 were in stage 2 a（10.9%）, 14 were in stage 2 b（5.9%）, 116 were in stage 3（48.7%）.The most common site of skin tear was upper limbs; the main reason was fall（29.0%）, blunt force injury（23.1%） and viscous dressings（19.7%）. Among the 199 patients with skin tears, 164 patients had history of skin tears, accounting for 82.4%. The incidence of skin tears in patients with history of skin tears at different time was significantly different（χ~2=88.836,P0.001）. Among the 199 patinets of skin tears, only two of nine preventive measures were implemented and the implementation rate over 50%. Conclusion The prevalence rate of skin tears in 14 Class ⅢGradeⅠgeneral hospitals is 1.058%. Level 3 and upper limbs are the most common classification and occurrence site of skin tears.The main reasons of skin tears are fall, blunt force injury and viscous dressings. The implementation rate of prevention measures of skin tears is low, and clinical staff need to strengthen learning related knowledge to reduce the incidence of skin tears.