成年患者压力性损伤愈合率及其影响因素的系统评价

Rate and influencing factors of pressure injury healing in adult patients:a systematic review

目的 系统评价成年患者压力性损伤(pressure injury,PI)愈合率及其影响因素,为临床制定合理的治疗护理措施提供理论依据。方法 计算机检索Web of Science、PubMed、CINAHL、Cochrane、CNKI、WanFang、VIP、CBM数据库自建库至2021年4月关于成年患者PI愈合率及其影响因素的观察性研究。由2名研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险后,采用Stata 15.0软件进行系统评价。结果 纳入12篇文献,共6 733例患者,纳入文献均为高质量。系统评价结果显示,成年患者PI愈合率为44.2%[95%CI(0.331~0.553)],亚组分析显示,男性患者愈合率[48.2%,95%CI(0.322~0.642)]略高于女性[47.0%,95%CI(0.338~0.601)];2期PI愈合率最高[43.1%,95%CI(0.192~0.670)]、其次为1期[37.9%,95%CI(0.284~0.474)]、3期[32.0%,95%CI(0.155~0.485)]、4期[19.1%,95%CI (0.056~0.325)];国内患者愈合率[50.0%,95%CI (0.222~0.778)]高于国外[41.5%,95%CI (0.321~0.509)];随访时长≥140d愈合率[48.1%,95%CI (0.331~0.553)]高于随访时长<140d [40.4%,95%CI(0.242~0.566)]。PI的愈合受患者年龄、营养、组织灌注、移动能力、用药、合并症、干预措施等因素影响(均P<0.05)。结论 成年患者PI愈合率较低,PI的愈合受多种因素的影响,护士应对影响愈合的因素予以关注并采取针对性的护理措施,以防止PI恶化,促进早期愈合,提高愈合率。

Objective To systematically evaluate the rate and influencing factors of pressure injury(PI) healing in adult patients,so as to provide a theoretical basis for clinically formulating reasonable treatment and nursing measures. Methods Web of Science,PubMed, CINAHL, Cochrane, CNKI, WanFang, VIP, CBM database were searched for observational studies which studied the rate and influencing factors of PI healing in adult patients, and the search time limit is to build the database until April 2021. After 2 investigators independently screened the literature, extracted data and evaluated the risk of bias in the included studies, Stata 15.0 software was used to conduct a systematic review. Results 12 articles were included, including 6 733 patients, all of which were of high quality. The results of the systematic review showed that the healing rate of PI in adult patients was 44.2% [95%CI(0.331~0.553) ], and the subgroup analysis showed that the healing rate of PI in male patients [48.2%, 95%CI(0.322~0.642)]was slightly higher than that of female [47.0%, 95%CI(0.338~0.601)];the healing rate of stage 2 PI was the highest [43.1%,95%CI(0.192~0.670)], followed by stage 1 [37.9%, 95%CI(0.284~0.474)], stage 3 [32.0%, 95%CI(0.155~0.485)] and stage 4 [19.1%, 95%CI(0.056~0.325)];the healing rate of PI patients in China [50.0%,95%CI (0.222~0.778)]was higher than that in foreign countries[41.5%,95%CI(0.321~0.509)];the healing rate of follow-up time≥140d[48.1%,95%CI (0.331~0.553)]was higher than the follow-up time<140d[40.4%,95%CI (0.242~0.566)].The healing of PI is affected by the patient’s age,nutritional,tissue perfusion,mobility,medication,complication,intervention measures and other factors (all P<0.05).Conclusions The rate of healing in adult patients with PI is low.PI healing is affected by a variety of factors,nurses should pay attention to the factors affecting the healing and take targeted nursing measures to prevent PI deterioration,improve the healing rate and promote early healing.