广州市某中心先天性心脏病儿童医用黏胶相关性皮肤损伤现状与危险因素分析

Current situation and risk factors of medical adhesive-related skin injury in children with congenital heart disease in the center in Guangzhou

目的探讨广州市某中心先天性心脏病儿童医用黏胶相关性皮肤损伤(MARSI)现状与危险因素。方法回顾性分析2020年2—9月于广州市妇女儿童医疗中心心脏重症监护室治疗的639例患儿,其中140例先天性心脏病患儿的临床资料。统计MARSI发生情况,采用单因素及多因素Logistic回归分析先天性心脏病儿童MARSI的影响因素。结果2020年2—9月心脏重症监护室治疗的患儿639例,先天性心脏病患儿140例,发生MARSI患儿70例。MARSI发生率为10.95%,MARSI主要发生类型为表皮剥脱、张力性损伤、接触性皮炎;MARSI多发于婴儿;MARSI主要发生部位在中心静脉导管(CVC)附近、脸颊及前额;易发生MARSI的黏胶类型为3M透明敷料。单因素分析结果显示,出生体质量、皮肤问题、皮肤潮湿度、白蛋白(ALB)、激素种类、肝功能、pH、乳酸(Lac)均为先天性心脏病儿童MARSI的影响因素,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,有皮肤问题、pH异常、Lac异常、肝功能异常、使用1种以上激素均为先天性心脏病儿童MARSI的危险因素(OR>1,P<0.05)。结论有皮肤问题、pH异常、Lac异常、肝功能异常、使用1种以上激素均为先天性心脏病儿童MARSI的危险因素,应根据上述因素进行针对性预防MARSI的发生。

Objective To investigate the current situation and risk factors of medical adhesive-related skin injury(MARSI)in children with congenital heart disease in the center of Guangzhou.Methods The clinical data of 639 children who were treated in the cardiac intensive care unit of Guangzhou Women and Children's Medical Center from February to September 2020 were retrospectively analyzed,including 140 children with congenital heart disease.The incidence of MARSI was statistically analyzed,and the influencing factors of MARSI in children with congenital heart disease were analyzed by univariate and multivariate Logistic regression analysis.Results There were 639 children from February to September 2020 treated in the cardiac intensive care unit,140 children with congenital heart disease,and 70 children with MARSI.The incidence of MARSI was 10.95%,and the main types of MARSI were epidermal exfoliation,tension injury,and contact dermatitis;MARSI occurs mostly in infants.MARSI mainly occurs near the central venous catheter(CVC),cheek and forehead.The type of adhesive prone to MARSI was 3M transparent dressing.Univariate analysis showed that birth weight,skin problems,skin moisture,albumin(ALB),hormone types,liver function,pH,and lactic acid(Lac)were the influencing factors of MARSI in children with congenital heart disease,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that skin problems,abnormal pH,abnormal Lac level,abnormal liver function,and the use of more than one hormone were risk factors forMARSI in children with congenital heart disease(OR>1,P<0.05).Conclusion Skin problems,abnormal pH,abnormal Lac level,abnormal liver function,and the use of more than one hormone are risk factors for MARSI in children with congenital heart disease,and targeted prevention of MARSI should be carried out according to the above factors.