出院压力性损伤风险患者现况及危险因素分析

Status and risk factors of discharged patients at risk of pressure injury

目的:调查存在压力性损伤风险出院患者的现况,并分析压力性损伤的危险因素。方法:采用便利抽样法,选取重庆市涪陵中心医院的54家医联体单位进行横断面调查,将2019年8月—2020年6月出院时存在压力性损伤风险的患者及其照顾者作为研究对象。采用一般人口学资料表、临床检验资料表、Braden压疮风险评估量表、Barthel指数、照顾者照顾能力量表(FCTI)进行调查。本研究共发放问卷409份,回收有效问卷409份,有效回收率为100%。结果:压力性损伤轻度危险患者224例(54.8%),中度危险患者74例(18.1%),高度危险患者89例(21.8%),极度危险患者22例(5.4%)。409例患者的一般人口学资料、临床检验资料、自理能力等级比较,差异均有统计学意义(P<0.05);不同风险等级患者照顾者的FCTI得分比较,差异有统计学意义(P<0.05)。有序Logistic回归分析结果显示,白细胞计数(OR=1.103,95%CI:1.006~1.209,P=0.035)、照顾者照顾能力(OR=1.060,95%CI:1.017~1.104,P=0.005)、大便失禁(OR=14.112,95%CI:2.505~79.497,P=0.003)、留置导尿管(OR=3.111,95%CI:1.332~7.269,P=0.009)、重度依赖(OR=15.705,95%CI:2.655~92.918,P=0.002)是出院患者压力性损伤风险的危险因素。结论:Braden评分≤18分的出院患者中,压力性损伤中度危险及以上者占45.2%(185/409)。应重点关注白细胞水平高、照顾者照顾能力弱、留置导尿管和自理能力等级为重度依赖的出院患者,以预防压力性损伤发生。

Objective To investigate the current status of discharged patients at risk of pressure injury and analyze risk factors of pressure injury.Methods Using the convenient sampling method,54 medical alliance units of Chongqing Fuling Central Hospital were selected for a cross-sectional survey.Patients at risk of pressure injury when discharged from the hospital and their caregivers were selected as the research objects from August 2019 to June 2020.The general demographic data sheet,clinical test data sheet,Braden Pressure Ulcer Risk Assessment Scale,Barthel index,and Family Caregiver Task Inventory(FCTI)were used for investigation.In this study,a total of 409 questionnaires were issued and 409 were effectively received,with an effective recovery of 100%.Results There were 224 patients(54.8%)at light risk of pressure injury,74 patients(18.1%)at moderate risk,89 patients(21.8%)at high risk and 22(5.4%)patients at extreme risk.The differences in general demographic data,clinical test data and self-care ability grade of 409 patients were statistically significant(P<0.05).The FCTI scores of caregivers for patients with different risk levels were compared,and the difference was statistically significant(P<0.05).The results of ordered logistic regression analysis showed that white blood cell count(OR=1.103,95%CI:1.006-1.209,P=0.035),care ability of caregivers(OR=1.060,95%CI:1.017-1.104,P=0.005),fecal incontinence(OR=14.112,95%CI:2.505-79.497,P=0.003),indwelling catheter(OR=3.111,95%CI:1.332-7.269,P=0.009),severe dependence(OR=15.705,95%CI:2.655-92.918,P=0.002)were risk factors for the risk of pressure injury in discharged patients.Conclusions Among discharged patients with Braden score less than or equal to 18 points,there are 45.2%(185/409)patients with moderate risk of pressure injury and above.It is necessary to focus on discharged patients with high levels of white blood cells,weak care ability of caregivers,indwelling catheters and self-care ability of heavy dependence grade to prevent pressure injuries.