重症监护室患儿压力性损伤发生特征及影响因素分析

Characteristics and risk factors of pressure injuries in patients admitted to the PICU

目的了解儿童重症监护室(pediatric intensive care unit,PICU)患儿压力性损伤发生特征并分析其影响因素,为临床PICU患儿压力性损伤防治提供依据。方法 2016年12月—2017年4月横断面调查上海、广东、浙江5所三级甲等医院儿童重症医学科的302例患儿,收集相关人口学资料、病情、压力性损伤评估及发生特征等,并对相关因素进行分析。结果PICU患儿压力性损伤发生率为16.23%,其中40.82%为医疗设备相关,损伤程度以1期为主(81.63%);头面部(64.40%)为压力性损伤的高发部位,其次是骶尾部(10.17%)、足跟部(8.47%)、足踝部(8.47%)。不同病种间压力性损伤发生率不同,压力性损伤患儿多有病情严重、意识障碍、机械通气、接受手术治疗、医疗设备使用数量多、低Braden Q评分等特征。结论PICU患儿是发生压力性损伤的高危人群,损伤部位多集中于头面部,医疗设备相关压力性损伤发生率较高,临床护理过程应早期识别压力性损伤的危险因素,及时干预,预防PICU患儿发生压力性损伤。

Objective To investigate the characteristics and risk factors of pressure injuries in patients admitted to the pediatric intensive care unit（PICU）. Methods Totally 302 PICU patients were recruited from five tertiary general hospitals from December 2016 to April 2017. Data about the characteristics of the patients（demographic and clinical data）,the assessment and characteristics of pressure injuries were collected and analyzed. Results The prevalence of pressure injuries in pediatric patients was 16.23%,in which 40.82% were related to medical devices, and 81.63% of the patients had grade 1 injury. The most commonly affected site was head and face（64.g0%）,fol- lowed by sacrococcygeal region（10.17%）,heels（8.47%） and ankles（8.g7%）. The prevalence of pressure injuries was different among different diseases. Patients with pressure injuries were usually accompanied by serious condition, disturbance of consciousness,mechanical ventilation,surgical procedure,frequent use of medical devices and with low Braden Q scores. Conclusion Patients in PICU are high risk group,the key to prevent pressure injuries is early identification of risk factors and timely intervention. Clinical nurses should identify its characteristics timely and take corresponding protective measures.