临床决策支持工具用于多发伤危重患者失禁相关性皮炎管理

Implementation of the TIME clinical decision support tool in management of incontinence-associated dermatitis in critically ill patients with multiple injuries

目的探讨基于TIME原则的临床决策支持工具(TIME-CDST)在多发伤危重患者失禁相关性皮炎分级管理中的应用效果。方法将2019年入住创伤外科重症监护病房的300例危重症患者作为对照组,2020年收治的210例危重患者作为观察组。对照组采取常规皮肤护理措施,观察组应用TIME-CDST,通过评估、协作、控制、决策、评价5个方面进行系统化分级管理。比较两组失禁相关性皮炎及真菌性皮疹发生率,失禁相关性皮炎严重程度、皮肤受累区域范围及愈合时间。结果与对照组相比,观察组失禁相关性皮炎、真菌性皮疹发生率显著降低,失禁相关性皮炎皮肤受累区域缩小,严重程度降低,愈合时间缩短(P<0.05,P<0.01)。结论TIME-CDST有助于对多发伤危重患者失禁相关性皮炎进行分级管理,有效降低失禁相关性皮炎发生率及真菌性皮疹发生率,促进皮炎早期愈合。

Objective To investigate the effect of the TIME clinical decision support tool(CDST)applied in management of incontinence-associated dermatitis(IAD)in critically ill patients with multiple injuries.Methods Three hundred critically ill patients hospitalized in the trauma intensive care unit in 2019 were assigned into a control group,receiving routine skin care,while 210 patients admitted in 2020 were treated as an intervention group and were given systematic,graded wound management based on the TIME-CDST involving 5 key elements:assess,bring,control,decide,and evaluate.Incidence of IAD and fungal rash,severity of IAD,area of skin involved and healing time were compared between the two groups.Results Compared with the control group,the intervention group had significantly lower incidence of IAD and fungal rash,smaller area of skin involved,milder IAD severity and shorter healing length(P<0.05,P<0.01).Conclusion TIME-CDST is useful for graded management of IAD in critically ill patients with multiple injuries,which can effectively reduce IAD and fungal rash,and shorten healing time.