分级护理方案治愈皮肤撕裂伤26例的护理报告
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摘要
目的皮肤撕裂伤因增加患者住院时间和费用,成为住院患者的皮肤不良事件之一。如何有效干预是全球研究重点之一。文章分析26例皮肤撕裂伤的损伤特征及分级,实施分级处理方案,探讨分级处理方案处理皮肤撕裂伤的效果。方法采用分组评价效果,根据ST严重度分级分为2a、2b和3级,根据发生部位分为头颈、上肢和下肢,根据持续时间分为≤21 d和>21 d。从初诊开始,评估其损伤部位、原因和严重度分级及持续时间,采用分级护理方案实施伤口护理和整体干预,每周测量1次面积缩小率评价效果,动态调整干预措施直至愈合。结果 26例皮肤撕裂伤以3级为主,占76.92%(20/26),部位以四肢为多,占84.62%(22/26)。初诊面积(9.41±11.21)cm~2,在60 d内全部治愈,平均愈合时间(22.38±13.56)d,中位愈合时间20 d。不同严重度分级、不同持续时间和不同部位的撕裂伤干预3周内的面积缩小率和愈合时间差异无统计学意义(P均>0.05)。结论分级护理方案能有效治疗不同严重度、不同持续时间和不同部位的皮肤撕裂伤。
Objective Skin tears are one of the skin adverse events in hospitalized patients which increased the length of stay and cost. How to intervene effectively is one of the global research priorities.The article aimed to study effective treatment for skin laceration by analyzing the characteristic and classification and applying grading nursing care for skin laceration. Methods From the first visit of 26 patients,the wound care center assessed the site,cause,severity classification and duration of skin laceration and managed wounds with individualized grading nursing care and overall intervention. Measurement was done on the area reduction once a week with dynamic adjusting interventions until healing. Results 26 patients with skin laceration were mainly grade 3,accounting for 76.92%( 20/26). Extremities were the main injured sites,accounting for 84.62%( 22/26). All wounds healed within 60 days and the average healing time was( 22.38±13.56) days. Median healing time was 20 days. No significance was found in the reduction rate of wounding site in 3 weeks and healing time for different severity grades,different durations and different sites of skin laceration( P > 0. 05).Conclusion Individualized grading nursing care can efficiently treat skin tears with different severity,durations and sites.
Objective Skin tears are one of the skin adverse events in hospitalized patients which increased the length of stay and cost. How to intervene effectively is one of the global research priorities.The article aimed to study effective treatment for skin laceration by analyzing the characteristic and classification and applying grading nursing care for skin laceration. Methods From the first visit of 26 patients,the wound care center assessed the site,cause,severity classification and duration of skin laceration and managed wounds with individualized grading nursing care and overall intervention. Measurement was done on the area reduction once a week with dynamic adjusting interventions until healing. Results 26 patients with skin laceration were mainly grade 3,accounting for 76.92%( 20/26). Extremities were the main injured sites,accounting for 84.62%( 22/26). All wounds healed within 60 days and the average healing time was( 22.38±13.56) days. Median healing time was 20 days. No significance was found in the reduction rate of wounding site in 3 weeks and healing time for different severity grades,different durations and different sites of skin laceration( P > 0. 05).Conclusion Individualized grading nursing care can efficiently treat skin tears with different severity,durations and sites.
引文
[1]Le Blanc K,Baranoski S,Christensen D,et al.International Skin Tear Advisory Panel:A Tool Kit to Aid in the Prevention,Assessment,and Treatment of Skin Tears Using a Simplified Classification System[J].Adv Skin Wound Care,2013,26(10):459-476.
[2]Koyano Y,Nakagami G,Iizaka S,et al.Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan[J].Int Wound J,2014(1):1-9.
[3]Strazzieri-Pulido KC,Peres GRP,Campanili TCGF,et al.Skin tear prevalence and associated factors:a systematic review[J].Rev Esc Enferm USP,2015,49(4):668-674.
[4]Vandervord JG,Tolerton SK,Campbell PA,et al.Acute management of skin tears:a change in practice pilot study[J].Int Wound J,2014,11(1):1-6.
[5]Moradian S,Klapper AM.A novel way to treat skin tears[J].Int Wound J,2015,12(1):1-4.
[6]Manning JA,Chrisakis H.The journey towards healing:recalcitrant skin tear injuries[J].Wound Prac Res,2011,19(1):32-36.
[7]Strazzieri-Pulido KC,Gouveia Santos VC,Carville K.Cultural adaptation,content validity and inter-rater reliability of the“STAR Skin Tear Classification System”[J].Rev Latino-Am Enfermagem,2015,23(1):155-161.
[8]郑美春,蒋琪霞.伤口评估.见蒋琪霞主译.伤口护理实践原则[M].北京:人民卫生出版社,2017:114-117.
[9]蒋琪霞,王桂玲,翁志强.压疮愈合计分量表评价不同类型伤口的治疗效果[J].医学研究生学报,2017,3(4):436-439.
[10]蒋琪霞,王建东,彭青,等.压疮愈合计分量表的汉化及其信效度研究[J].医学研究生学报,2015,28(7):750-754.
[11]蒋琪霞,李晓华,彭青,等.红光和红外线辅助治疗对创伤性伤口愈合效果的对比研究[J].护理学杂志,2012,27(22):19-22.
[12]蒋琪霞,朱礼霞,张媛,等.负压伤口治疗联合湿性疗法同于交通挤压伤的研究[J].医学研究生学报,2014,27(9):955-958.
[13]蒋琪霞,刘玉秀,李晓华,等.177例慢性伤口应用纳米银敷料的效果研究[J].中华护理杂志,2015,50(8):932-936.
[14]舒勤,蒋琪霞.伤口清创.见蒋琪霞主译.伤口护理实践原则[M].北京:人民卫生出版社,2017:176-194.
[15]Holmes RF,Davidson MW,Thompson BJ,et al.Skin Tears Care and Management of the Older Adult at Home[J].Home Healthcare Nurse,2013,31(2):90-102.
[16]Leblanc K,Baranoski S.Skin tears:State of the science:consensus statements for the prevention,prediction,assessment,and treatment of skin tears[J].Adv Skin Wound Care,2011,24(9):2-15.
[17]蒋琪霞.皮肤撕裂伤流行病学特征及预防研究进展[J].中华现代护理杂志,2016,22(24):3405-3409.
[18]蒋琪霞,郭艳侠,李晓华.皮肤撕裂伤发生原因和相关因素及评估研究进展[J].中华现代护理杂志,2016,22(24):3429-3431.
[19]郭艳侠,蒋琪霞,张玉红,等.住院患者皮肤撕裂伤的现况分析及其护理措施[J].中华护理杂志,2016,51(2):167-171.
[20]Le Blanc K,Baranoski S.International Skin Tear Advisory Panel(ISTAP).Skin Tears:The forgotten wound[J].Nurs Manag,2014,12(1):36-46.
[21]Xu XT,Lau K,Taira BR,et al.The current management of skin tears[J].Ameri J Emergency Med,2009,27(1),729-733.
[22]蒋琪霞,郭艳侠,江智霞,等.三级医院中皮肤撕裂伤预防现况的多中心研究[J].中华现代护理杂志,2016,22(24):3410-3414.
[23]蒋琪霞,江智霞,郑美春,等.医院内皮肤撕裂伤现患率及流行特征的多中心横断面调查[J].中国护理管理,2017,17(5):631-635.
[24]Solway DR,Consalter M,Levinson DJ.Microbial Cellulose Wound Dressing in the Treatment of Skin Tears in the Frail Elderly[J].Wounds,2010,22(1):17-19.
[25]徐元玲,王建东,蒋琪霞.慢性伤口细菌生物膜的临床识别及影响因素的研究进展[J].医学研究生学报,2014,27(12):1337-1339.
[26]Akers KS,Mende K,Cheatle KA,et al.Biofilms and persistent wound infections in United States military trauma patients:a case-control analysis[J].BMC Infect Dis,2014,14(1):190.
[2]Koyano Y,Nakagami G,Iizaka S,et al.Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan[J].Int Wound J,2014(1):1-9.
[3]Strazzieri-Pulido KC,Peres GRP,Campanili TCGF,et al.Skin tear prevalence and associated factors:a systematic review[J].Rev Esc Enferm USP,2015,49(4):668-674.
[4]Vandervord JG,Tolerton SK,Campbell PA,et al.Acute management of skin tears:a change in practice pilot study[J].Int Wound J,2014,11(1):1-6.
[5]Moradian S,Klapper AM.A novel way to treat skin tears[J].Int Wound J,2015,12(1):1-4.
[6]Manning JA,Chrisakis H.The journey towards healing:recalcitrant skin tear injuries[J].Wound Prac Res,2011,19(1):32-36.
[7]Strazzieri-Pulido KC,Gouveia Santos VC,Carville K.Cultural adaptation,content validity and inter-rater reliability of the“STAR Skin Tear Classification System”[J].Rev Latino-Am Enfermagem,2015,23(1):155-161.
[8]郑美春,蒋琪霞.伤口评估.见蒋琪霞主译.伤口护理实践原则[M].北京:人民卫生出版社,2017:114-117.
[9]蒋琪霞,王桂玲,翁志强.压疮愈合计分量表评价不同类型伤口的治疗效果[J].医学研究生学报,2017,3(4):436-439.
[10]蒋琪霞,王建东,彭青,等.压疮愈合计分量表的汉化及其信效度研究[J].医学研究生学报,2015,28(7):750-754.
[11]蒋琪霞,李晓华,彭青,等.红光和红外线辅助治疗对创伤性伤口愈合效果的对比研究[J].护理学杂志,2012,27(22):19-22.
[12]蒋琪霞,朱礼霞,张媛,等.负压伤口治疗联合湿性疗法同于交通挤压伤的研究[J].医学研究生学报,2014,27(9):955-958.
[13]蒋琪霞,刘玉秀,李晓华,等.177例慢性伤口应用纳米银敷料的效果研究[J].中华护理杂志,2015,50(8):932-936.
[14]舒勤,蒋琪霞.伤口清创.见蒋琪霞主译.伤口护理实践原则[M].北京:人民卫生出版社,2017:176-194.
[15]Holmes RF,Davidson MW,Thompson BJ,et al.Skin Tears Care and Management of the Older Adult at Home[J].Home Healthcare Nurse,2013,31(2):90-102.
[16]Leblanc K,Baranoski S.Skin tears:State of the science:consensus statements for the prevention,prediction,assessment,and treatment of skin tears[J].Adv Skin Wound Care,2011,24(9):2-15.
[17]蒋琪霞.皮肤撕裂伤流行病学特征及预防研究进展[J].中华现代护理杂志,2016,22(24):3405-3409.
[18]蒋琪霞,郭艳侠,李晓华.皮肤撕裂伤发生原因和相关因素及评估研究进展[J].中华现代护理杂志,2016,22(24):3429-3431.
[19]郭艳侠,蒋琪霞,张玉红,等.住院患者皮肤撕裂伤的现况分析及其护理措施[J].中华护理杂志,2016,51(2):167-171.
[20]Le Blanc K,Baranoski S.International Skin Tear Advisory Panel(ISTAP).Skin Tears:The forgotten wound[J].Nurs Manag,2014,12(1):36-46.
[21]Xu XT,Lau K,Taira BR,et al.The current management of skin tears[J].Ameri J Emergency Med,2009,27(1),729-733.
[22]蒋琪霞,郭艳侠,江智霞,等.三级医院中皮肤撕裂伤预防现况的多中心研究[J].中华现代护理杂志,2016,22(24):3410-3414.
[23]蒋琪霞,江智霞,郑美春,等.医院内皮肤撕裂伤现患率及流行特征的多中心横断面调查[J].中国护理管理,2017,17(5):631-635.
[24]Solway DR,Consalter M,Levinson DJ.Microbial Cellulose Wound Dressing in the Treatment of Skin Tears in the Frail Elderly[J].Wounds,2010,22(1):17-19.
[25]徐元玲,王建东,蒋琪霞.慢性伤口细菌生物膜的临床识别及影响因素的研究进展[J].医学研究生学报,2014,27(12):1337-1339.
[26]Akers KS,Mende K,Cheatle KA,et al.Biofilms and persistent wound infections in United States military trauma patients:a case-control analysis[J].BMC Infect Dis,2014,14(1):190.