| 陈小恩,文 雯,陈小芬,沈芬芬,苏 驳,林白浪.海南省三级甲等医院医疗器械压力性损伤现状及干预对策[J].,2019,19(6):1108-1114 |
| 海南省三级甲等医院医疗器械压力性损伤现状及干预对策 |
| Current Status and Intervention Measures of Medical Device-Related Pressure Injuries in Class Ⅲ Grade A hospitals in Hainan Province |
| 投稿时间：2018-10-23 修订日期：2018-11-18 |
| DOI：10.13241/j.cnki.pmb.2019.06.023 |
| 中文关键词: 医疗器械 压力性损伤 调查 对策 |
| 英文关键词: Medical device Pressure injury Investigation Measure |
| 基金项目:海南省重点研发计划社会发展方向项目（ZDYF2017107） |
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| 中文摘要: |
| 摘要 目的：分析海南省7家三级甲等医院医疗器械压力损伤现况及原因并提出相应的干预对策。方法：采用欧洲和美国的调研工具，由培训合格的调查员对7家三级甲等医院的住院患者实施横断面调查，用SPSS17.0软件对数据进行统计分析。结果：7248例住院患者中，医疗器械所致的压力性损伤30例，患病率为0.41 %。其中，医疗器械相关性压力性损伤18例，患病率为0.25 %；黏膜压力性损伤12例，患病率为0.17 %。83.33 %的医疗器械压力性损伤是医院获得，而82.22 %的骨隆突处压力性损伤由入院时带入。重症医学科、肠内营养的患者更容易获得医疗器械压力性损伤(P< 0.05)。对于骨隆突处的压力性损伤的患者，护士会更有意识地去使用减压敷料(P< 0.05)。医疗器械压力性损伤最常所致的医疗设备是鼻胃管(51.60%)，其次是双鼻导管吸氧管(19.35 %)，黏膜压力性损伤无法按照系统分期，占比38.71 %，医疗器械相关性压力性损伤主要集中在1期和2期，占比51.61 %。医疗器械相关性压力性损伤常见部位是耳(22.58 %)，黏膜压力性损伤最常见的部位是鼻黏膜(35.47 %)。结论：海南省三级甲等综合医院管理者及临床工作者开始对此类压力性损伤的认知及积极预防，但仍需要进一步加强培训与控制，并定期调研、连续监控，构建延续化护理模式；针对医疗器械压力性损伤的高风险的科室、人群及特定部位予以早期预防、鉴别及保护，正确使用医疗器械，预防性减少医疗器械压力性损伤；同时关注医疗器械压力损伤产生主要原因、部位、分期及进展情况，综合干预措施，建立压力性损伤预警管理组织架构，形成集束化管理。 |
| 英文摘要: |
| ABSTRACT Objective: To explore and analyze the current status and causes of medical device-related pressure injuries(MDR PIs) in 7 Class Ⅲ Grade A hospitals in Hainan Province, and put forward corresponding intervention measures. Methods: Using the survey tools in Europe and the United States, a cross-sectional survey of inpatients in 7 Class Ⅲ Grade A hospitals was conducted by trained qualified investigators, and the data was statistically analyzed using SPSS 17.0 software. Results: Among the 7248 hospitalized patients, there were 30 cases of pressure injuries caused by medical devices, and the prevalence rate was 0.41 %, including 18 cases of medical device-related pressure injuries, the prevalence rate was 0.25 %, and 12 cases of mucosal membrane pressure injuries, which prevalence rate was 0.17 %. 83.33 % of the medical device-related pressure injuries were acquired by the hospital, and 82.22 % of the pressure injuries at the bone eminence were present on admission; Patients with intensive care and enteral nutrition are more likely to get pressure injuries from medical devices(P< 0.05). Nurses will be more conscious about using decompression dressings for patients with pressure injuries at the bone eminence (P< 0.05); Nasogastric tube (51.60 %) was the most common cause of medical device-related pressure injuries, followed by oxygen inhalation tube (19.35 %). Mucosal membrane pressure injury could not be staged according to the system, accounting for 38.71 %. Medical device-related pressure injuries mainly concentrated in stage 1 and stage 2, accounting for 51.61 %. The ear (22.58 %) was the most common site of medical device-related pressure injuries, while the nasal mucosa (35.47 %) was the most common site of mucosal membrane pressure injuries. Conclusion: Managers and clinical nurses of Class Ⅲ Grade A hospitals in Hainan Province have already recognized and actively prevented such pressure injuries, but they still need to further strengthen training and regulation, organize regular investigation and continuous monitoring, and build a Continuous care model; for departments, people and specific parts of the relatively high risk of medical device-related pressure injuries, early prevention, identification and protection should be provided. Medical devices should be used correctly, preventive medical device-related pressure injuries should be reduced proactively; At the same time, we actively pay attention to the main causes, sites, stages and progress of medical device-related pressure injuries, and adopt comprehensive intervention measures to establish an organizational structure for pressure injuries early warning management to form a cluster management. |
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