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【摘要】 目的 探讨实施多元化综合护理干预对老年重度褥疮的影响及效果评价。方法 将重度褥疮患者随机分为干预组和对照组,入院后均积极处理原发病,输入抗生素抗感染,对症及支持治疗。干预组通过健康教育、基础护理方法、配合碘伏消毒;湿性敷料封闭;鸡蛋内膜贴敷;局部氧疗;磺胺嘧啶银外敷;紫外线灯照射,直至痊愈出院。并对两组患者创面愈合时间、换药次数、治疗费用进行比较。结果 干预组平均愈合时间、换药次数、有效率较对照组有显著性差异(P<0.05)。结论 多元化综合护理干预可明显缩短褥疮愈合时间,提高疗效,降低复发率,缩短病程,减轻了患者痛苦。
【关键词】护理干预;多元化;老年褥疮;重度;影响
Diversify the valuation synthesizing effect and effect that the nursing interferes with to in the dry tree serious bedsore
LI Zhong-mei,SUN Yu-xin,MA Hai-yun.Department of Allergen Testing Center,the Second People’s Hospital of Liaocheng,Liaocheng Shandong 252601,China
【Abstract】 Objective Purpose investigation and discussion is put into effect diversifying the valuation synthesizing effect and effect that the nursing interferes with to in the dry tree serious bedsore.
Methods The patient divides serious bedsore method randomly in order interfering with the group and the collation group,the morbidity,entering antibiotic handling a plain without exception actively after being hospitalized resist infection,good for the disease and hold out treat.Interfere with the degassing forming by healthy education,basis nursing method,coordinating the iodine volt;dressing closes wet;the film sticks the egg inner apply;oxygen cures part;silver external application of sulphadiazine;UV-lamp irradiates,leaves hospital until being recovered.And the surface of a wound time heals,change fresh dressing for a wound to two set of patients number of times,the comparison curing cost being in progress.Results Interfere with form the number of times sharing coalescence time,changing fresh dressing for a wound,have efficiency contrasting a group comparatively having notable difference(P<0.05).Conclusion Has diversified the coalescence time synthesizing a nursing to interfere with but shortening bedsore obviously,has improved the curative effect,lessening relapse rate,curtailing course of disease,has lightened patient agony.
【Key words】
Nursing intervention;Diversification; Old age bedsore; Serious; Affect
DOI:10.3760/cma.j.issn 1673-8799.2010.06.158
作者單位:252601山东省聊城市第二人民医院过敏原检测中心
褥疮是常见并发症之一,好发于老年患者抵抗力低下、骨折后、脑血管意外后、各种昏迷意识障碍、癌症晚期恶液质、长期卧床、营养不良等。好发部位为骶尾部、双脚踝部、足跟部、肩胛骨粗隆部及双胯皮肤薄嫩处。褥疮一旦发生,进展较快,常因继发感染而危及生命。其发病程度判断标准:①轻度:局部皮肤受压或受潮湿刺激后,出现红、肿、热、麻木或触痛;②中度:受压表面皮色转为紫红,皮肤因水肿变薄而出现水疱,此时极易破溃,显露出潮湿红润的创面;③重度:静脉血液回流受到严重障碍,组织缺血缺氧。轻者浅层组织感染,脓液流出,溃疡形成;重者坏死组织发黑,脓性分泌物增多,有臭味。感染向周围及深部扩展,可达骨骼,甚至引起败血症。为了能够使重度褥疮的早日痊愈进行了多元化综合护理干预,以观察对重度褥疮的影响,现将结果报告如下。
1 资料与方法
1.1 一般资料 2007年3月至2009年10月,我院收集由各种原因引起的皮肤损伤共32例,男18例,女14例;年龄65~83岁,包括脑梗死后遗症瘫痪6例,热水袋保暖烫伤2例,高渗性液体外渗引起组织坏死6例,各种癌症晚期患者12例,骨折卧床患者4例,肺心病2例。皮肤破损程度及面积:脑梗死后遗症瘫痪患者周边组织坏死面积2 cm×3 cm~15 cm×10 cm,热水袋烫伤面积3 cm×4 cm~12 cm×7 cm,高渗性液体外渗引起左下肢内踝焦痂面积4 cm~9 cm,肺癌晚期卧床压疮面积3 cm×2 cm~5 cm×3 cm,长期卧床压创面积2 cm×1 cm~3 cm×3 cm,均符合期褥疮标准。年龄、性别、褥疮严重程度均无显著性差异。
1.2 方法 两组患者均常规处理创面,无菌棉签蘸取生理盐水擦净疮面及周围皮肤,清除脓性分泌物和坏死组织,保持局部清洁干燥,有细菌感染者使用抗生素治疗。对照组:创面处用3%过氧化氢清洁伤口,剪去坏死组织,生理盐水加压冲洗方法清洁,待干后均匀涂上约1 cm厚的自制的磺胺嘧啶银膏。
干预组:①指导患者及家属皮肤护理方法;②在创面涂0.5%碘伏;③鸡蛋内膜外敷;④局部干燥吹氧(湿化瓶内不加蒸馏水);⑤将自制的磺胺嘧啶银加0.1%新洁尔灭2 ml,用棉签拌成糊状,均匀涂于患处约1 cm厚即可;⑥将患者置于合适的辐射保暖台并暴露患处进行紫外线烤灯照射。
【关键词】护理干预;多元化;老年褥疮;重度;影响
Diversify the valuation synthesizing effect and effect that the nursing interferes with to in the dry tree serious bedsore
LI Zhong-mei,SUN Yu-xin,MA Hai-yun.Department of Allergen Testing Center,the Second People’s Hospital of Liaocheng,Liaocheng Shandong 252601,China
【Abstract】 Objective Purpose investigation and discussion is put into effect diversifying the valuation synthesizing effect and effect that the nursing interferes with to in the dry tree serious bedsore.
Methods The patient divides serious bedsore method randomly in order interfering with the group and the collation group,the morbidity,entering antibiotic handling a plain without exception actively after being hospitalized resist infection,good for the disease and hold out treat.Interfere with the degassing forming by healthy education,basis nursing method,coordinating the iodine volt;dressing closes wet;the film sticks the egg inner apply;oxygen cures part;silver external application of sulphadiazine;UV-lamp irradiates,leaves hospital until being recovered.And the surface of a wound time heals,change fresh dressing for a wound to two set of patients number of times,the comparison curing cost being in progress.Results Interfere with form the number of times sharing coalescence time,changing fresh dressing for a wound,have efficiency contrasting a group comparatively having notable difference(P<0.05).Conclusion Has diversified the coalescence time synthesizing a nursing to interfere with but shortening bedsore obviously,has improved the curative effect,lessening relapse rate,curtailing course of disease,has lightened patient agony.
【Key words】
Nursing intervention;Diversification; Old age bedsore; Serious; Affect
DOI:10.3760/cma.j.issn 1673-8799.2010.06.158
作者單位:252601山东省聊城市第二人民医院过敏原检测中心
褥疮是常见并发症之一,好发于老年患者抵抗力低下、骨折后、脑血管意外后、各种昏迷意识障碍、癌症晚期恶液质、长期卧床、营养不良等。好发部位为骶尾部、双脚踝部、足跟部、肩胛骨粗隆部及双胯皮肤薄嫩处。褥疮一旦发生,进展较快,常因继发感染而危及生命。其发病程度判断标准:①轻度:局部皮肤受压或受潮湿刺激后,出现红、肿、热、麻木或触痛;②中度:受压表面皮色转为紫红,皮肤因水肿变薄而出现水疱,此时极易破溃,显露出潮湿红润的创面;③重度:静脉血液回流受到严重障碍,组织缺血缺氧。轻者浅层组织感染,脓液流出,溃疡形成;重者坏死组织发黑,脓性分泌物增多,有臭味。感染向周围及深部扩展,可达骨骼,甚至引起败血症。为了能够使重度褥疮的早日痊愈进行了多元化综合护理干预,以观察对重度褥疮的影响,现将结果报告如下。
1 资料与方法
1.1 一般资料 2007年3月至2009年10月,我院收集由各种原因引起的皮肤损伤共32例,男18例,女14例;年龄65~83岁,包括脑梗死后遗症瘫痪6例,热水袋保暖烫伤2例,高渗性液体外渗引起组织坏死6例,各种癌症晚期患者12例,骨折卧床患者4例,肺心病2例。皮肤破损程度及面积:脑梗死后遗症瘫痪患者周边组织坏死面积2 cm×3 cm~15 cm×10 cm,热水袋烫伤面积3 cm×4 cm~12 cm×7 cm,高渗性液体外渗引起左下肢内踝焦痂面积4 cm~9 cm,肺癌晚期卧床压疮面积3 cm×2 cm~5 cm×3 cm,长期卧床压创面积2 cm×1 cm~3 cm×3 cm,均符合期褥疮标准。年龄、性别、褥疮严重程度均无显著性差异。
1.2 方法 两组患者均常规处理创面,无菌棉签蘸取生理盐水擦净疮面及周围皮肤,清除脓性分泌物和坏死组织,保持局部清洁干燥,有细菌感染者使用抗生素治疗。对照组:创面处用3%过氧化氢清洁伤口,剪去坏死组织,生理盐水加压冲洗方法清洁,待干后均匀涂上约1 cm厚的自制的磺胺嘧啶银膏。
干预组:①指导患者及家属皮肤护理方法;②在创面涂0.5%碘伏;③鸡蛋内膜外敷;④局部干燥吹氧(湿化瓶内不加蒸馏水);⑤将自制的磺胺嘧啶银加0.1%新洁尔灭2 ml,用棉签拌成糊状,均匀涂于患处约1 cm厚即可;⑥将患者置于合适的辐射保暖台并暴露患处进行紫外线烤灯照射。