基层医院重症患者失禁性皮炎预防和治疗中皮肤保护措施对比探讨(1)
【摘 要】 目的：探讨基层医院重症患者失禁性皮炎(IAD)预防和治疗中不同皮肤保护措施的效果对比。方法：选取本院60例符合纳入标准的重症患者。通过随机数字法将患者分为对照组和观察组，各30例，两组均接受一般护理基础上分别采用造口粉和思密达联合皮肤保护膜进行皮肤护理。对比两组患者IAD发生率及严重程度、治疗情况、费用和满意度。结果：两组患者IAD发生率及严重程度、平均治疗天数、护理质量得分、服务满意度比较无明显差异，无统计学意义(P>0.05)。两组患者日均皮肤护理专项费用比较有明显差异，实验组明显低于对照组，差异有统计学意义(P<0.05)。结论：采用思密达联合皮肤保护膜进行皮肤护理，同样能达到减少重症患者失禁性皮炎发生率、提高治疗有效率和护理服务质量、减轻患者身心痛苦的目的，对比造口粉更适于基层医院医疗服务对象。
【关键词】 重症患者；失禁性相关性皮炎；思密达；皮肤保护膜
[Abstract] Objective：To compare the effects of different skin protection measures in the prevention and treatment of critically ill patients with incontinent dermatitis (IAD) in primary hospitals. Methods：Sixty ICU patients who met the inclusion criteria were selected in our hospital. Patients were divided into control group and experimental group by random number method. Each group received oral care powder and Smecta combined with skin protection film for skin care. The incidence and severity of IAD， treatment status， costs， and satisfaction were compared between the two groups. Results：There was no significant difference in the incidence and severity of IAD， average number of days of treatment， quality of care score， and service satisfaction between the two groups， with no statistical significance (P>0.05). There was a significant difference in the average daily skin care cost between the two groups. The experimental group was significantly lower than the control group， and the difference was statistically significant (P<0.05).Conclusion：The use of Smecta combined with skin protection film for skin care can also reduce the incidence of incontinent dermatitis in critical patients， improve the efficiency of treatment and the quality of care services， and reduce the patient's physical and mental pain. The comparison of stoma powder is more suitable for primary hospitals service object.
[Key words]Severe patient； Incontinence related dermatitis； Smecta； Skin protective film
失禁性皮炎(incontinence-associated dermatitis，IAD)指皮膚长期暴现以局部皮肤发红、水肿及澄清渗出物[1]。ICU收治的危重患者通常采用机械通气、氧气吸入、使用镇静剂、亚低温等抢救和治疗措施，大多存在不同程度的营养不良、低白蛋白水平导致吸收障碍和腹泻发生，还常合并慢性病，因长期使用广谱抗生素，使肠道菌群失调，大便失禁伴腹泻的发生率很高，以及高压疮风险(Braden)评分等，均为IAD
*张霞为本文通讯作者
发生的相关高发危险因素[2]。目前国内外关于IAD的预防方法很多，但未形成统一的规范，缺乏统一的护理流程和标准。皮肤保护膜可有效维持皮肤的正常功能进而有效地预防IAD的发生，而造口粉和皮肤保护膜联合使用更能有效预防失禁性皮炎的发生，但针对经济承受能力相对薄弱的基层医院医疗服务人群，作者在临床护理工作中致力于探讨效果相当而价格低廉的同类皮肤保护剂，经过临床应用对比研究，效果满意，现总结如下。
1 资料与方法
1.1 临床资料
选取连云港市赣榆区中医院2016年1月至2018年3月收治的符合纳入标准的60例患者。通过随机数字法将患者分为对照组和实验组各30例。纳入标准：1)年龄≥18岁；入院≥24h；2)出现尿失禁和(或)大便失禁/腹泻的患者；3)IAD风险评估≥7分；4)入院时臀部、会阴部等观察部位皮肤完整、无红斑及皮疹，无炎症反应；5)经患者或家属知情同意。排除标准：1)患者入住ICU时带入的IAD、好发部位皮肤损伤、骶尾部发生压疮；2)有影响IAD观察的皮肤病；3)接触性皮炎、药疹。两组患者基线资料比较无明显差异，具有可比性(P>0.05)。, 百拇医药(李小娟 李颖 张霞)
【关键词】 重症患者；失禁性相关性皮炎；思密达；皮肤保护膜
[Abstract] Objective：To compare the effects of different skin protection measures in the prevention and treatment of critically ill patients with incontinent dermatitis (IAD) in primary hospitals. Methods：Sixty ICU patients who met the inclusion criteria were selected in our hospital. Patients were divided into control group and experimental group by random number method. Each group received oral care powder and Smecta combined with skin protection film for skin care. The incidence and severity of IAD， treatment status， costs， and satisfaction were compared between the two groups. Results：There was no significant difference in the incidence and severity of IAD， average number of days of treatment， quality of care score， and service satisfaction between the two groups， with no statistical significance (P>0.05). There was a significant difference in the average daily skin care cost between the two groups. The experimental group was significantly lower than the control group， and the difference was statistically significant (P<0.05).Conclusion：The use of Smecta combined with skin protection film for skin care can also reduce the incidence of incontinent dermatitis in critical patients， improve the efficiency of treatment and the quality of care services， and reduce the patient's physical and mental pain. The comparison of stoma powder is more suitable for primary hospitals service object.
[Key words]Severe patient； Incontinence related dermatitis； Smecta； Skin protective film
失禁性皮炎(incontinence-associated dermatitis，IAD)指皮膚长期暴现以局部皮肤发红、水肿及澄清渗出物[1]。ICU收治的危重患者通常采用机械通气、氧气吸入、使用镇静剂、亚低温等抢救和治疗措施，大多存在不同程度的营养不良、低白蛋白水平导致吸收障碍和腹泻发生，还常合并慢性病，因长期使用广谱抗生素，使肠道菌群失调，大便失禁伴腹泻的发生率很高，以及高压疮风险(Braden)评分等，均为IAD
*张霞为本文通讯作者
发生的相关高发危险因素[2]。目前国内外关于IAD的预防方法很多，但未形成统一的规范，缺乏统一的护理流程和标准。皮肤保护膜可有效维持皮肤的正常功能进而有效地预防IAD的发生，而造口粉和皮肤保护膜联合使用更能有效预防失禁性皮炎的发生，但针对经济承受能力相对薄弱的基层医院医疗服务人群，作者在临床护理工作中致力于探讨效果相当而价格低廉的同类皮肤保护剂，经过临床应用对比研究，效果满意，现总结如下。
1 资料与方法
1.1 临床资料
选取连云港市赣榆区中医院2016年1月至2018年3月收治的符合纳入标准的60例患者。通过随机数字法将患者分为对照组和实验组各30例。纳入标准：1)年龄≥18岁；入院≥24h；2)出现尿失禁和(或)大便失禁/腹泻的患者；3)IAD风险评估≥7分；4)入院时臀部、会阴部等观察部位皮肤完整、无红斑及皮疹，无炎症反应；5)经患者或家属知情同意。排除标准：1)患者入住ICU时带入的IAD、好发部位皮肤损伤、骶尾部发生压疮；2)有影响IAD观察的皮肤病；3)接触性皮炎、药疹。两组患者基线资料比较无明显差异，具有可比性(P>0.05)。, 百拇医药(李小娟 李颖 张霞)
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