压疮危险人群翻身间隔时间最佳证据总结

Evidence Summary on Repositioning Interval among Patients with Risk of Pressure Ulcer

目的评价总结压疮危险人群翻身间隔时间的最佳证据,为护理人员实施翻身计划提供参考。方法计算机检索压疮管理中有关翻身间隔时间的相关证据,并从中筛选符合纳入标准的文献。2名经过循证培训的研究人员分别对纳入文献进行质量评价和资料提取,对符合质量标准的文献进行证据的归纳总结。结果共纳入文献10篇,其中8篇指南,1篇系统评价,1篇最佳实践证据信息册。最佳证据总结如下:(1)所有压疮危险人群,都应该定时翻身(B级推荐);(2)减压支撑面可作为翻身的辅助手段(A级推荐),使用减压支撑面后其翻身间隔时间可适当延长(B级推荐);(3)决定翻身频次要考虑患者本身所处的体位(B级推荐)及其个体差异(A级推荐);(4)翻身间隔时间是一个动态的过程,应根据评估结果进行调整(B级推荐);(5)为压疮危险人群建立翻身时间卡,记录翻身时间及体位(A级推荐);(6)教会患者在规律翻身的间隙自我减压(A级推荐)。结论翻身是压疮的常规预防性措施,所有压疮危险人群都应该定时翻身,目前尚无确切的翻身频次推荐。翻身间隔时间的确定要结合患者实际及具体的临床情境,护理人员应基于循证落实翻身计划。

Objective To assess and summarize the available evidences on the repositioning interval among patients with the risk of pressure ulcer,thus to provide guidance for nursing staff.Methods We electronically retrieved the research on the repositioning strategies of pressure ulcer management.Two reviewers independently assessed the quality and extracted the data in the included studies.Evidence was summarized from eligible studies.Results Ten studies were included,with 8 guidelines,1 systematic review and 1 best practice information sheet.Evidences were summarized in the following:(1)Regular repositioning was in need for all patients with risk of pressure ulcer(strength of recommendation=B).(2)Pressure reduction support surface served as an aid for repositioning(strength of recommendation=A);with support surface,repositioning intervals could be extended(strength of recommendation=B).(3)Repositioning frequency should take body position(strength of recommendation=B),and individual condition(strength of recommendation=A)into account.(4)Assessment-based dynamic repositioning schedule is in need(strength of recommendation=B).(5)Repositioning schedules should be developed recording the frequency and body position of the patients(strength of recommendation=A).(6)Self pressure reduction of patients during the intervals of repositioning was recommended(Strength of recommendation=A).Conclusion Repositioning is a routine preventive measure for pressure ulcer.All patients at the risk for pressure ulcer should be repositioned regularly.No established repositioning frequency is recommended now,thus the individualized condition of the patients and the complex clinical status should be taken into consideration when making clinical decisions.