结构化护理方案在神经外科手术病人皮肤护理中的应用分析
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摘要
目的调查结构化护理方案在神经外科手术病人皮肤护理中的应用效果。方法以择期行神经外科手术、采取俯卧位的病人为研究对象,采用随机数字表法分为结构化护理组和常规护理组,根据诺顿评分细分为压疮高危(诺顿评分≤16)结构化护理组和常规护理组及压疮低危(诺顿评分>16)结构化护理组和常规护理组,比较手术当日、术后1d、2d和3d的诺顿评分及术后3d内压疮的发生率。结果结构化护理组和高危结构化护理组术后第2d和第3d的诺顿评分显著高于术前,常规护理组、高危常规护理组及低危结构化护理组和常规护理组术后1-3d的诺顿评分与术前无显著差异;结构化护理组和高危结构化护理组术后3d内压疮的发生率显著低于常规护理组和高危常规护理组,而低危结构化护理组与常规护理组的压疮发生率无显著差异。结论结构化皮肤护理方案能升高压疮高危病人的诺顿评分,并降低压疮发生率,但对压疮低危病人无显著效果。因此,在神经外科俯卧位手术患者围术期的皮肤护理中,应根据诺顿评分选择护理方案,对高危患者采取结构化皮肤护理方案,对低危患者采取常规护理,以降低压疮的发生率,同时降低临床护理负担。
Objective To investigate the effect of a structured nursing program applied in the skin care of neurosurgery patients.Methods Neurosurgery patients adopting the prone position were enrolled and randomLy allocated into the structured nursing group and routine nursing group. The structured nursing group was then subdivided into the high-risk structured nursing group and low-risk routine nursing group, and the routine nursing group into the high-risk routine nursing group and low-risk routine nursing group. Norton scale on the day of surgery, the 1 st day, 2 nd day and 3 rd day after surgery and the incidence of pressure sore within three days after surgery were compared. Results Norton scale was higher on 2 nd day and 3 rd day than on the day of surgery in the structured nursing group and high-risk structured nursing group, and Norton scale was not statistically different between 1 st-3 rd day after surgery and the day of surgery in the routine nursing group, high-risk routine nursing group, low-risk structured nursing group and low-risk routine nursing group; the incidence of pressure sore within three days after surgery was lower in the structured nursing group and high-risk structured nursing group than in the routine nursing group and high-risk routine nursing group, and the incidence was not statistically different between the low-risk structured nursing group and low-risk routine nursing group. Conclusions A structured nursing program could improve Norton scale and reduce the incidence of pressure sore for patients with the high risk of pressure sore, but had no influence for patients without the high risk of pressure sore. Therefore, a structured nursing program should be applied to neurosurgery patients with the high risk of pressure sore and a routine nursing program to neurosurgery patients without the high risk of pressure sore in order to reduce the incidence of pressure sore and clinical nursing burden.
Objective To investigate the effect of a structured nursing program applied in the skin care of neurosurgery patients.Methods Neurosurgery patients adopting the prone position were enrolled and randomLy allocated into the structured nursing group and routine nursing group. The structured nursing group was then subdivided into the high-risk structured nursing group and low-risk routine nursing group, and the routine nursing group into the high-risk routine nursing group and low-risk routine nursing group. Norton scale on the day of surgery, the 1 st day, 2 nd day and 3 rd day after surgery and the incidence of pressure sore within three days after surgery were compared. Results Norton scale was higher on 2 nd day and 3 rd day than on the day of surgery in the structured nursing group and high-risk structured nursing group, and Norton scale was not statistically different between 1 st-3 rd day after surgery and the day of surgery in the routine nursing group, high-risk routine nursing group, low-risk structured nursing group and low-risk routine nursing group; the incidence of pressure sore within three days after surgery was lower in the structured nursing group and high-risk structured nursing group than in the routine nursing group and high-risk routine nursing group, and the incidence was not statistically different between the low-risk structured nursing group and low-risk routine nursing group. Conclusions A structured nursing program could improve Norton scale and reduce the incidence of pressure sore for patients with the high risk of pressure sore, but had no influence for patients without the high risk of pressure sore. Therefore, a structured nursing program should be applied to neurosurgery patients with the high risk of pressure sore and a routine nursing program to neurosurgery patients without the high risk of pressure sore in order to reduce the incidence of pressure sore and clinical nursing burden.
引文
[1]Black JM,Gray M,Bliss DE,et al.MASD part 2:incontinence-associated dermatitis and intertriginous dermatitis:a consensus[J].J Wound Ostomy Continence Nurs,2011,38(4):359-70.
[2]Black J,Baharestani M,Cuddigan J,et al.National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system[J].Dermato Nurs,2007,19(4):343-9.
[3]汤秀云,蒋劲林,汤银惠.两种护理干预在神经外科手术中的应用与效果[J].中国实用医药,2012,7(5):196-7.
[4]张颖.神经外科手术护理安全隐患及防范对策[J].全科护理,2010,8(12A):3160.
[5]Pancorbo-Hidalgo PL,Garcia-Fernandez FP,Lopez-Medina IM,et al.Risk assessment scales for pressure ulcer prevention:a systematic review[J].J Adv Nurs,2006,54(1):94-110.
[6]Guy N,Lerman Y,Justo D.Admission Norton scale scores(ANSS)correlate with rehabilitation outcome and length in elderly patients with deconditioning[J].Arch Gerontol Geriatr,2012,54(2):381-4.
[7]贾静,徐晶晶,仇晓溪.结构化皮肤护理方案对降低患者失禁性皮炎患病率的应用效果[J].中华护理杂志,2016,51(5):590-3.
[8]付淑红.择期髋关节置换的老年患者低诺顿量表评分和术后并发症的关系[J].国际护理学杂志,2015,34(23):3200-2.
[9]王泠.2014版国际《压疮预防和治疗:临床实践指南》解读[J].中国护理管理,2016,16(5):577-80.
[10]李玲,周霞,赵毅,等.强化神经外科基础护理工作的实践与效果[J]护理管理杂志,2005,15(6):37-8.
[11]杨华,王小玲.三级管理路径在预防压疮中的应用[J].中国护理管理,2013,13(7):105-6.
[12]Beeckman D,Verhaeghe S,Defloor T,et al.A 3-in-1 perineal care washcloth impregnated with dimethicone 3%versus water and PH netural soap to prevent and treat IAD:a randomized controlled clinical trial[J].J Wound Ostomy Continence Nurs,2011,38(4):1-13.
[2]Black J,Baharestani M,Cuddigan J,et al.National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system[J].Dermato Nurs,2007,19(4):343-9.
[3]汤秀云,蒋劲林,汤银惠.两种护理干预在神经外科手术中的应用与效果[J].中国实用医药,2012,7(5):196-7.
[4]张颖.神经外科手术护理安全隐患及防范对策[J].全科护理,2010,8(12A):3160.
[5]Pancorbo-Hidalgo PL,Garcia-Fernandez FP,Lopez-Medina IM,et al.Risk assessment scales for pressure ulcer prevention:a systematic review[J].J Adv Nurs,2006,54(1):94-110.
[6]Guy N,Lerman Y,Justo D.Admission Norton scale scores(ANSS)correlate with rehabilitation outcome and length in elderly patients with deconditioning[J].Arch Gerontol Geriatr,2012,54(2):381-4.
[7]贾静,徐晶晶,仇晓溪.结构化皮肤护理方案对降低患者失禁性皮炎患病率的应用效果[J].中华护理杂志,2016,51(5):590-3.
[8]付淑红.择期髋关节置换的老年患者低诺顿量表评分和术后并发症的关系[J].国际护理学杂志,2015,34(23):3200-2.
[9]王泠.2014版国际《压疮预防和治疗:临床实践指南》解读[J].中国护理管理,2016,16(5):577-80.
[10]李玲,周霞,赵毅,等.强化神经外科基础护理工作的实践与效果[J]护理管理杂志,2005,15(6):37-8.
[11]杨华,王小玲.三级管理路径在预防压疮中的应用[J].中国护理管理,2013,13(7):105-6.
[12]Beeckman D,Verhaeghe S,Defloor T,et al.A 3-in-1 perineal care washcloth impregnated with dimethicone 3%versus water and PH netural soap to prevent and treat IAD:a randomized controlled clinical trial[J].J Wound Ostomy Continence Nurs,2011,38(4):1-13.