不同皮肤保护剂护理失禁患者的效果分析
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摘要
目的失禁相关性皮炎是临床常见的皮肤损伤,但何种皮肤保护剂能够有效预防和降低成本尚缺乏证据,文章旨在探讨两种皮肤保护剂护理失禁患者的临床效果和成本效益,为有效预防失禁相关性皮炎提供依据。方法便利抽样选取124例失禁患者,随机分为观察组与对照组,每组62例,在以管理失禁、清洁和保护为主的结构化皮肤护理方案基础上,观察组患者涂抹复合氧化锌软膏保护皮肤,对照组患者涂抹造口粉联合皮肤保护膜保护皮肤,连续干预7 d,主要观察指标为失禁相关性皮炎发生率和护理材料成本。结果观察组62例患者完成研究,对照组因死亡和出院脱落2例,60例患者完成研究。对照组和观察组IAD发生率方案数据分析集显示分别为20.00%和6.45%,意向性分析集显示分别为22.58%和6.45%,差异均有统计学意义(P<0.05)。观察组护理材料平均每例成本[(239.71±48. 55)元]低于对照组[(264. 35±61. 55)元],差异有统计学意义(P<0.05)。结论在结构化皮肤护理方案基础上采用复合氧化锌软膏能够提高失禁相关性皮炎的预防效果,同时降低材料成本。
Objective Incontinence-associated dermatitis( IAD) is a common skin disease,but there is still lack of evidence on which kind of skin proctectant can provide effective prevention and cost reduction. The article aimed to explore the clinical effect and cost-effectiveness of two skin protectants based on structured skin care regimens in the nursing care of incontinent patients and provide evidence for effective prevention of IAD. Methods A total of 124 patients with incontinence were randomly selected and divided into observation group( 62 cases) and control group( 62 cases). On the basis of the structured skin care program which focused on incontinence management,cleansing and protection,the patients in the observation group were treated with the composite zinc oxide ointment for 7 days,while patients in control group were treated with ostomy powder combined with skin barrier film for 7 days. The main observation indicators were the incidence of IAD and the cost of nursing materials. Results All 62 patients in the observation group completed the study,while in the control group 2 patients fell off because of death and discharge from hospital and 60 patients completed the study. The per-protocol analysis showed that the incidences of IAD in two groups were 6.45% and 20.00%,the intention-to-treat analysis showed 6.45% and 22.58%,and there was significant difference between groups( P<0.05). The nursing cost of the observation group( 239.71±48.55) was lower than that of control group( 264.35±61.55),and the difference was statistically significant( P< 0.05).Conclusion The use of the composite zinc oxide ointment based on a structured skin care regimen can improve the preventive effect of IAD and reducing costs.
Objective Incontinence-associated dermatitis( IAD) is a common skin disease,but there is still lack of evidence on which kind of skin proctectant can provide effective prevention and cost reduction. The article aimed to explore the clinical effect and cost-effectiveness of two skin protectants based on structured skin care regimens in the nursing care of incontinent patients and provide evidence for effective prevention of IAD. Methods A total of 124 patients with incontinence were randomly selected and divided into observation group( 62 cases) and control group( 62 cases). On the basis of the structured skin care program which focused on incontinence management,cleansing and protection,the patients in the observation group were treated with the composite zinc oxide ointment for 7 days,while patients in control group were treated with ostomy powder combined with skin barrier film for 7 days. The main observation indicators were the incidence of IAD and the cost of nursing materials. Results All 62 patients in the observation group completed the study,while in the control group 2 patients fell off because of death and discharge from hospital and 60 patients completed the study. The per-protocol analysis showed that the incidences of IAD in two groups were 6.45% and 20.00%,the intention-to-treat analysis showed 6.45% and 22.58%,and there was significant difference between groups( P<0.05). The nursing cost of the observation group( 239.71±48.55) was lower than that of control group( 264.35±61.55),and the difference was statistically significant( P< 0.05).Conclusion The use of the composite zinc oxide ointment based on a structured skin care regimen can improve the preventive effect of IAD and reducing costs.
引文
[1]朱文,蒋琪霞,郭艳侠,等.失禁相关性皮炎患病现况及预防现状的多中心研究[J].医学研究生学报,2016,29(6):633-638.
[2]Beeckman D.Proceedings of The Global IAD Expert Panel.Incontinence-Associated Dermatitis:Moving Prevention Forward.Wounds International 2015.http://www.wounds international.com.
[3]蒋琪霞.压疮护理学[M].北京:人民卫生出版社,2015:71-72.
[4]Gray M,Giuliano KK.Incontinence-Associated Dermatitis,Characteristics and Relationship to Pressure Injury:A Multisite Epidemiologic Analysis[J].J Wound Ostomy Continence Nurs,2018,45(1):63-67.
[5]蒋琪霞,刘燕平,彭青,等.应用指南建议的方法护理失禁相关性皮炎8例研究报告[J].中华现代护理杂志,2016,22(1):20-23.
[6]Guest JF,Greener MJ,Vowden K,et al.Clinical and economic evidence supporting a transparent barrier film dressing in incontinence-associated dermatitis and pier-wound skin protection[J].JWound Care,2011,20(2):76-84.
[7]Matar H,Larner J,Viegas V,et al.Evaluation of a new topical skin protectant(RD1433)for the prevention and treatment of incontinence-associated dermatitis[J].Cutan Ocul Toxicol,2017,36(3):211-219.
[8]徐慧敏,洪洋,吴娟.造口袋防治大便失禁患者失禁性皮炎效果的Meta分析[J].重庆医学,2017,46(33):4690-4694.
[9]Beeckman D,Verhaeghe S,Defloor T,et al.A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3%Versus Water and p H Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis:A Randomized,Controlled Clinical Trial[J].JWound Ostomy Continence Nurs,2011,38(6):627-634.
[10]Bliss DZ,Savik K,Thorson MA,et al.Incontinence-Associated Dermatitis in Critically Ill Adults:Time to Development,Severity,and Risk Factors[J].J Wound Ostomy Continence Nurs,2011,38(4):433-445.
[11]徐慧敏,吴娟,卢丽华,等.两种失禁性皮炎风险评估工具在失禁患者中信效度的比较[J].中国实用护理杂志,2017,33(19):1446-1449.
[12]蒋琪霞,俞惠,彭青.分级护理方案治愈皮肤撕裂伤26例护理报告[J].医学研究生学报,2018,31(2):185-189.
[13]Draelos ZD.Active agents in common skin care products[J].Plast Reconstr Surg,2010,125(2):719-724.
[14]Kon Y,Ichikawashigeta Y,Iuchi T,et al.Effects of a Skin Barrier Cream on Management of Incontinence-Associated Dermatitis in Older Women:A Cluster Randomized Controlled Trial[J].JWound Ostomy Continence Nurs,2017,44(5):481-486.
[15]宋娟,蒋琪霞,王雪妹.不同护理措施预防重症患者失禁相关性皮炎的对比研究[J].中华护理杂志,2016,51(1):62-65.
[16]项荣,丁栋博,范亮亮,等.氧化锌的抗菌机制及其安全性研究进展[J].中国组织工程研究,2014,18(3):470-475.
[17]于志芳,朱胜春,居蓓华.新鲜芦荟外敷结合生理盐水脉冲式冲管预防可达龙注射液所致静脉炎的效果观察[J].护理学报,2014,21(12):52-54.
[2]Beeckman D.Proceedings of The Global IAD Expert Panel.Incontinence-Associated Dermatitis:Moving Prevention Forward.Wounds International 2015.http://www.wounds international.com.
[3]蒋琪霞.压疮护理学[M].北京:人民卫生出版社,2015:71-72.
[4]Gray M,Giuliano KK.Incontinence-Associated Dermatitis,Characteristics and Relationship to Pressure Injury:A Multisite Epidemiologic Analysis[J].J Wound Ostomy Continence Nurs,2018,45(1):63-67.
[5]蒋琪霞,刘燕平,彭青,等.应用指南建议的方法护理失禁相关性皮炎8例研究报告[J].中华现代护理杂志,2016,22(1):20-23.
[6]Guest JF,Greener MJ,Vowden K,et al.Clinical and economic evidence supporting a transparent barrier film dressing in incontinence-associated dermatitis and pier-wound skin protection[J].JWound Care,2011,20(2):76-84.
[7]Matar H,Larner J,Viegas V,et al.Evaluation of a new topical skin protectant(RD1433)for the prevention and treatment of incontinence-associated dermatitis[J].Cutan Ocul Toxicol,2017,36(3):211-219.
[8]徐慧敏,洪洋,吴娟.造口袋防治大便失禁患者失禁性皮炎效果的Meta分析[J].重庆医学,2017,46(33):4690-4694.
[9]Beeckman D,Verhaeghe S,Defloor T,et al.A 3-in-1 Perineal Care Washcloth Impregnated With Dimethicone 3%Versus Water and p H Neutral Soap to Prevent and Treat Incontinence-Associated Dermatitis:A Randomized,Controlled Clinical Trial[J].JWound Ostomy Continence Nurs,2011,38(6):627-634.
[10]Bliss DZ,Savik K,Thorson MA,et al.Incontinence-Associated Dermatitis in Critically Ill Adults:Time to Development,Severity,and Risk Factors[J].J Wound Ostomy Continence Nurs,2011,38(4):433-445.
[11]徐慧敏,吴娟,卢丽华,等.两种失禁性皮炎风险评估工具在失禁患者中信效度的比较[J].中国实用护理杂志,2017,33(19):1446-1449.
[12]蒋琪霞,俞惠,彭青.分级护理方案治愈皮肤撕裂伤26例护理报告[J].医学研究生学报,2018,31(2):185-189.
[13]Draelos ZD.Active agents in common skin care products[J].Plast Reconstr Surg,2010,125(2):719-724.
[14]Kon Y,Ichikawashigeta Y,Iuchi T,et al.Effects of a Skin Barrier Cream on Management of Incontinence-Associated Dermatitis in Older Women:A Cluster Randomized Controlled Trial[J].JWound Ostomy Continence Nurs,2017,44(5):481-486.
[15]宋娟,蒋琪霞,王雪妹.不同护理措施预防重症患者失禁相关性皮炎的对比研究[J].中华护理杂志,2016,51(1):62-65.
[16]项荣,丁栋博,范亮亮,等.氧化锌的抗菌机制及其安全性研究进展[J].中国组织工程研究,2014,18(3):470-475.
[17]于志芳,朱胜春,居蓓华.新鲜芦荟外敷结合生理盐水脉冲式冲管预防可达龙注射液所致静脉炎的效果观察[J].护理学报,2014,21(12):52-54.