造口门诊医疗器械相关性压力性损伤的现状调查及对策

Investigation and countermeasure of medical device-related pressure ulcer in the stoma care clinic

目的:调查造口门诊发生医疗器械相关性压力性损伤现状,并进行原因分析及对策探讨。方法:选取于造口护理门诊首次随访的949例肠造口病人,对其中发生医疗器械相关性压力性损伤的病人临床资料进行回顾性分析,调查现状,寻求原因并给予针对性的措施。结果:发生不同分期医疗器械相关性压力性损伤共76例,发生率为8.01%。其中,腰带相关性38例,发生率为8.54%;支撑棒相关性20例,发生率为75.92%;底盘相关性12例,发生率为1.28%;尾夹相关性4例,发生率为0.47%。其他原因2例,发生率为0.21%。不同分期医疗器械相关性压力性损伤的成因差异分析无统计学意义。76例1~3期压力性损伤创面经护理后创面愈合,愈合时间3~17 d。护理人员对医疗器械相关性压力性损伤的防治意识不强,健康教育不充分,病人和照护者知识缺乏,医疗器械材质和局部微环境改变是主要原因。结论:医疗器械相关性压力性损伤重在预防,需加强护理人员相关知识的培训,早期干预,制定个性化的造口居家护理健康教育。对已发生的压力性损伤,根据TIME原则选择合适的敷料及措施处理,促进创面愈合。

Objective:To investigate the current situation of medical device-related pressure ulcer in the stoma care clinic,and to analyze the causes and discuss the countermeasures.Methods:A total of 949 cases of enterostomy patients who were followed up for the first time in the stoma care clinic were selected.The clinical data of patients with medical device-related pressure ulcer were retrospectively analyzed to investigate the current situation,look for the causes and provide targeted measures.Results:There were 76 cases of medical device-related pressure ulcer in different stages,the incidence was 8.01%.Among them,there were 38 cases of ostomy belt correlation,the incidence was 8.54%;20 cases of rubber support correlation,the incidence was 75.92%;12 cases of ostomy barrier correlation,the incidence was 1.28%;4 cases of tail clip correlation,the incidence was 0.47%.There were 2 cases with other causes,and the incidence was 0.21%.There was no significant difference in the causes of medical device-related pressure ulcer in different stages.A total of 76 cases with 1-3 stage of wounds were healed,with healing time of 3-17 d.The main reasons were that the nurses′awareness of medical device-related pressure ulcer was not strong,the patients and caregivers did not have adequate health education and knowledge,and medical device material and local microenvironment changed.Conclusions:The prevention of medical device-related pressure ulcer is the most important.It is necessary to strengthen the training of the related knowledge for the nurses.The early intervention and making personal health education are also essential.Appropriate dressings and measures should be selected to treat the wounds in order to promote the wound healing according to the principle of TIME.