神经内科ICU老年患者失禁相关性皮炎的危险因素分析

Risk Factors of Incontinence-associated Dermatitis in Elderly Patients in Neuro-ICU

目的探讨神经内科ICU老年患者发生失禁相关性皮炎的危险因素。方法将2017年1月至2019年6月河南省人民医院神经内科ICU住院的119例老年患者作为研究对象,收集患者性别、年龄、是否合并糖尿病等一般资料,以及疾病情况、失禁情况、入住ICU时Braden评分(包括感知能力、潮湿程度、活动力、移动力、营养状态及摩擦力/剪切力)等数据,根据ICU入住期间失禁相关性皮炎的发生情况将患者分为失禁相关性皮炎组和非失禁相关性皮炎组,并采用单因素、logistic回归分析失禁相关性皮炎发生的影响因素。结果119例患者中有33例出现失禁相关性皮炎,发生率为27.73%。单因素分析显示:失禁相关性皮炎组和非失禁相关性皮炎组在是否合并糖尿病、失禁类型、失禁频次、腹泻、低蛋白血症、抗菌药物种类、大便性状、感知能力、潮湿程度及摩擦力/剪切力方面评分比较,差异有统计学意义(P<0.05)。logistic回归分析结果显示:大小便失禁、失禁频次>6次/d、低蛋白血症、水样便、感知能力低及潮湿程度高是神经内科ICU老年患者发生失禁相关性皮炎的独立危险因素(P<0.05)。结论神经内科ICU老年患者发生失禁相关性皮炎与失禁状态、低蛋白血症、排便状态及Braden评分密切相关,临床可针对患者自身特点采取相应的预防措施,以降低失禁相关性皮炎的发生风险。

Objective To investigate the risk factors of incontinence-associated dermatitis in elderly patients in the neuro-ICU.Methods A total of 119 elderly patients hospitalized in the neuro-ICU of He'nan Provincial People's Hospital from January 2017 to June 2019 were selected.Their general information such as gender,age,presence or absence of diabetes,as well as the disease condition,incontinence,Braden score at ICU admission(including sensory perception,moisture,activity,mobility,nutrition and friction/shear)were collected.Then,the patients were divided into the incontinence-associated dermatitis group and the nonincontinence-associated dermatitis group according to the occurrence of incontinence-associated dermatitis during ICU admission.Univariate and logistic regression analyses were used to analyze the influencing factors of incontinence-associated dermatitis.Results Incontinence-related dermatitis occurred in 33 of 119 patients(27.73%).Univariate analysis showed that there were significant differences in the scores of presence or absence of diabetes,type of incontinence,frequency of incontinence,diarrhea,hypoproteinemia,type of antibacterial drugs,stool form,sensory perception,moisture and friction/shear between the incontinenceassociated dermatitis group and the non-incontinence-associated dermatitis group(P<0.05).Logistic regression analysis showed that incontinence,frequency of incontinence more than 6 times/d,hypoproteinemia,watery stool,low sensory perception and high moisture were independent risk factors for incontinenceassociated dermatitis in elderly patients in the neuro-ICU(P<0.05).Conclusion Incontinence-associate dermatitis in elderly patients in the neuro-ICU is closely related to incontinence,hypoproteinemia,defecation and Braden score.In clinical practice,appropriate preventive measures can be taken according to the patients'own characteristics to reduce the risk of incontinence-associate dermatitis.