大便失禁的ICU患者压疮形成的危险因素研究

Study on risk factors of pressure ulcers in ICU patients with fecal incontinence

目的探讨大便失禁患者失禁相关性皮炎(IAD)发生情况和压疮形成的危险因素。方法纳入2019年2月—2019年10月首都医科大学附属北京世纪坛医院重症医学科收治的120例Bristol粪便性状评估表(BSFS)评分5分及以上的患者。每天检查皮肤的情况并进行失禁相关性皮炎严重程度量表(IADS)、Bates-Jensen伤口评估工具(BWAT)的评估,共14 d。14 d内记录的最高量表分值用于数据分析。单因素分析考察患者发生压疮的可疑危险因素,有统计学意义的变量采用渐进法逐步进入多因素Logistic回归模型分析压疮(PU)发生的独立危险因素。结果所有大便失禁的患者都发生不同程度的IAD,平均IADS评分为(9.30±7.42)分。1/3的患者(n=40)发生了PU,BWAT平均评分为(23.30±3.84)分。多元Logistic回归分析显示,IADS评分每增加1分,发生PU的可能性增加1.18倍(OR:1.18,95%CI:1.07-1.42);Braden量表评分≤12分的患者发生压疮的概率是>12分患者的2.39倍(OR:2.39,95%CI:2.14-1.56);血清白蛋白与压疮的发生呈负相关(OR:0.22,95%CI:0.08-0.34)。总淋巴细胞数<0.8×10^9/L也是患者发生压疮的独立危险因素(OR:1.25,95%CI:1.10-1.44)。大便BSFS分型6~7型[OR:95%CI:1.36(1.25-1.58)]和每日大便失禁6次以上[OR:95%CI:1.87(1.65-2.23)]也是患者发生PU的独立危险因素。结论大便严重失禁患者IAD的发生率较高。大便失禁的严重程度、IAD严重程度和患者的营养状态是大便失禁的ICU患者PU形成的独立危险因素。建议将IAD患者归类为PU发生的高危人群,及早进行评估和干预,以防止PU的发生。

Objective To investigate the risk factors of incontinence-associated dermatitis(IAD)and pressure ulcers(PU)in patients with fecal incontinence.Methods A total of120 patients with BSFS score of 5 or above admitted to the Department of Critical Care Medicine,Beijing Shijitan Hospital affiliated to Capital Medical University from February to October 2019 were included.Skin condition was checked daily and assessed by IADseverity scale(IADS)and batesjensen wound assessment tool(BWAT)for 14 days.The highest scale score recorded within 14 days was used for data analysis.Demographic and disease data of the patients were recorded.Univariate analysis was carried out to investigate the suspected risk factors for the occurrence of pressure ulcers in the patients.The variables with statistical significance were gradually introduced into the multivariate Logistic regression model to analyze the independent risk factors for PU.Results All patients with fecal incontinence developed perineal dermatitis to varying degrees,with an average IADS score of 9.30±7.42.One-third of the patients(n=40)developed PU,and the average BWAT score was 23.30±3.84.Multiple Logistic regression analysis showed that for every 1 point increase in IADS score,the probability of PU increased by 1.18 times(OR:1.18,95%CI:1.07-1.42).The probability of PU in thepatients with Braden scale score≤12 was 2.39 times higher than that in the patients with>score 12(OR:2.39,95%CI:2.14-1.56).Serum albumin was negatively correlated with the occurrence of the pressure sores(OR:0.22,95%CI:0.08-0.34).Total lymphocyte number<0.8×10^9/L was also an independent risk factor for PU(OR:1.25,95%CI:1.10-1.44).Stool BSFS type 6~7[OR:95%CI:1.36(1.25-1.58)]and fecal incontinence more than 6 times a day[OR:95%CI:1.87(1.65-2.23)]were also the independent risk factors for PU.Conclusion The severity of fecal incontinence,the severity of IAD and the nutritional status of the patient are independent risk factors for PU formation in ICU patients with IAD.It is recommended that IAD patients be classified as the high-risk population of PU,and early assessment and intervention should be conducted to prevent the occurrence of PU.