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护理学报 ›› 2022, Vol. 29 ›› Issue (8): 35-39.doi: 10.16460/j.issn1008-9969.2022.08.035

• 文献研究 • 上一篇    下一篇

ICU患者不同部位黏膜压力性损伤的特征及护理研究进展

刘天贶1, 龙玉娟2, 刘欢1, 刘逸文1   

  1. 1.四川大学华西医院重症医学科/四川大学华西护理学院,四川 成都 610041;
    2.成都市第七人民医院 重症医学科,四川 成都 610044
  • 收稿日期:2021-12-21 出版日期:2022-04-25 发布日期:2022-05-11
  • 通讯作者: 刘逸文（1981-）,女,四川广安人,硕士,副主任护师。E-mail：liuyiwen3@163.com
  • 作者简介:刘天贶（1991-）,女,重庆人,硕士,护师。
  • 基金资助:
    四川省科技厅重点研发项目（2019YFS0290）

  • Received:2021-12-21 Online:2022-04-25 Published:2022-05-11

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摘要： 目的 综述ICU患者不同部位黏膜压力性损伤的临床现状、分期、影响因素及预防措施,以供临床实践及进一步研究参考。方法 检索国内外相关文献,分析归纳ICU患者黏膜压力性损伤在不同部位的发生现状、特征与护理。结果 黏膜压力性损伤在ICU发生率较高,目前临床多关注于口腔和鼻部,对消化道、气道及尿道关注有限。黏膜压力性损伤在不同的ICU人群和部位表现出不同的特征,预防护理措施也不尽相同。结论 ICU患者黏膜压力性损伤的发生率不容忽视,而对其的临床关注和相关研究仍十分有限,亟需进一步研究来完善各部位黏膜压力性损伤的监测方案,开发科学的分级系统,构建风险预测模型和集束化的预防策略等,从而降低黏膜压力性损伤的发生率。

关键词: 黏膜压力性损伤, ICU, 部位, 护理, 综述

中图分类号: 

  • R472
[1] Schank JE.The NPUAP Meeting-This was No Consensus Conference[J]. J Am Coll Clin Wound Spec, 2016, 7(1-3):19-24. DOI:10.1016/j.jccw.2016.07.001.
[2] Barakat-Johnson M, Barnett C, Wand T, et al.Medical Device-related Pressure Injuries: An Exploratory Descriptive Study in an Acute Tertiary Hospital in Australia[J]. J Tissue Viability, 2017, 26(4):246-253. DOI:10.1016/j.jtv.2017.09.008.
[3] 秦鸿利,赵震,王艳芳,等.ICU患者压力性损伤预防的最佳证据总结[J].护理学报,2021,28(10):45-51.DOI:10.16460/j.issn1008-9969.2021.10.045.
[4] Coyer F, Miles S, Gosley S, et al.Pressure Injury Prevalence in Intensive Care Versus Non-intensive Care Patients: A State-wide Comparison[J]. Aust Crit Care, 2017, 30(5):244-250. DOI: 10.1016/j.aucc.2016.12.003.
[5] Zaratkiewicz S, Teegardin C, Whitney JD.Retrospective Review of the Reduction of Oral Pressure Ulcers in Mechanically Ventilated Patients: A Change in Practice[J]. Crit Care Nurs Q, 2012,35(3):247-254.DOI:10.1097/CNQ.0b013e3182542de3.
[6] Hanonu S, Karadag A.A Prospective, Descriptive Study to Determine the Rate and Characteristics of and Risk Factors for the Development of Medical Device-related Pressure Ulcers in Intensive Care Units[J]. Ostomy Wound Manage, 2016, 62(2):12-22.
[7] Kim CH, Kim MS, Kang MJ, et al.Oral Mucosa Pressure Ulcers in Intensive Care Unit Patients: A Preliminary Observational Study of Incidence and Risk Factors[J]. J Tissue Viability, 2019, 28(1):27-34. DOI:10.1016/j.jtv.2018.11.002.
[8] Choi BK, Kim MS, Kim SH.Risk Prediction Models for the Development of Oral-mucosal Pressure Injuries in Intubated Patients in Intensive Care Units: A Prospective Observational Study[J]. J Tissue Viability, 2020, 29(4):252-257. DOI:10.1016/j.jtv.2020.06.002.
[9] Reaper S, Green C, Gupta S, et al.Inter-rater Reliability of the Reaper Oral Mucosa Pressure Injury Scale (ROMPIS): A Novel Scale for the Assessment of the Severity of Pressure Injuries to the Mouth and Oral Mucosa[J]. Aust Crit Care, 2017, 30(3):167-171. DOI:10.1016/j.aucc.2016.06.003.
[10] Hampson J, Green C, Stewart J, et al.Impact of the Introduction of an Endotracheal Tube Attachment Device on the Incidence and Severity of Oral Pressure Injuries in the Intensive Care Unit: A Retrospective Observational Study[J]. BMC Nurs,2018,17:4. DOI:10.1186/s12912-018-0274-2.
[11] Kim SH, Nah HS, Kim JB, et al.Relationships Between Oral-Mucosal Pressure Ulcers, Mechanical Conditions, and Individual Susceptibility in Intubated Patients Under Intensive Care: A PCR-Based Observational Study[J]. Biol Res Nurs,2021,23(4):557-567.DOI:10.1177/1099800421998071.
[12] European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.)[M]. EPUAP/NPIAP/PPPIA,2019.
[13] 杨小辉,赵媛媛,钮美娥. ICU医疗器械相关压力性损伤的研究现状[J]. 护理学报,2017, 24(13):49-53. DOI:10.16460/j.issn1008-9969.2017.13.049.
[14] Jang CS, Shin YS.Effects of Combination Oral Care on Oral Health, Dry Mouth and Salivary pH of Intubated Patients: A Randomized Controlled Trial[J]. Int J Nurs Pract,2016, 22(5):503-511. DOI:10.1111/ijn.12460.
[15] Sands KM, Wilson MJ, Lewis MAO, et al.Respiratory Pathogen Colonization of Dental Plaque, the Lower Airways, and Endotracheal Tube Biofilms During Mechanical Ventilation[J]. J Crit Care, 2017, 37:30-37. DOI:10.1016/j.jcrc.2016.07.019.
[16] Amrani G, Gefen A.Which Endotracheal Tube Location Minimises the Device-Related Pressure Ulcer Risk: The Centre or a Corner of the Mouth[J]. Int Wound J, 2020, 17(2):268-276. DOI:10.1111/iwj.13267.
[17] Saghaleini SH, Dehghan K, Shadvar K, et al.Pressure Ulcer and Nutrition[J]. Indian J Crit Care Med, 2018, 22(4):283-289. DOI:10.4103/ijccm.IJCCM_277_17.
[18] 张艺,张建凤.PDCA在预防经口气管插管致口唇黏膜压力性损伤中的应用[J].护士进修杂志,2017,32(20):1906-1908.DOI:10.16821/j.cnki.hsjx.2017.20.027.
[19] Black J, Alves P, Brindle CT, et al.Use of Wound Dressings to Enhance Prevention of Pressure Ulcers Caused by Medical Devices[J]. Int Wound J, 2015, 12(3):322-327. DOI:10.1111/iwj.12111.
[20] Kulik LA, Connor JA, Graham DA, et al.Pressure Injury Prevention for Paediatric Cardiac Surgical Patients Using a Nurse-Driven Standardized Clinical Assessment and Management Plan[J]. Cardiol Young, 2018, 28(9):1151-1162. DOI:10.1017/S1047951118000975.
[21] Barakat-Johnson M, Lai M, Wand T, et al.The Incidence and Prevalence of Medical Device-Related Pressure Ulcers in Intensive Care: A Systematic Review[J]. J Wound Care, 2019, 28(8):512-521. DOI:10.12968/jowc.2019.28.8.512.
[22] Coyer FM, Stotts NA, Blackman VS.A Prospective Window into Medical Device-related Pressure Ulcers in Intensive Care[J]. Int Wound J, 2014, 11(6):656-664. DOI:10.1111/iwj.12026.
[23] 南锐伶. ICU患者鼻黏膜压力性损伤的影响因素研究[D].兰州:兰州大学,2021.DOI:10.27204/d.cnki.glzhu.2021.001957.
[24] Shapira-Galitz Y, Karp G, Cohen O, et al.Evaluation and Predictors for Nasogastric Tube Associated Pressure Ulcers in Critically Ill Patients[J]. Isr Med Assoc J, 2018, 20(12):731-736.
[25] Bonfim Sde F, de Vasconcelos MG, de Sousa NF, et al. Nasal Septum Injury in Preterm Infants Using Nasal Prongs[J].Rev Lat Am Enfermagem, 2014, 22(5):826-833. DOI:10.1590/0104-1169.3451.2486.
[26] 晏蓉,李素云,詹昱新,等. 经鼻肠内营养并发鼻黏膜压力性损伤风险预警分级标准及干预方案的构建[J].中华临床营养杂志,2020,28(6):346-350.DOI:10.3760/cma.j.cn115822-20201128-00252.
[27] Sayan HE,Girgin NK,Asan A.Prevalence of Pressure Ulcers in Hospitalized Adult Patients in Bursa, Turkey: A Multicentre, Point Prevalence Study[J]. J Eval Clin Pract, 2020, 26(6):1669-1676. DOI:10.1111/jep.13354.
[28] Slowikowski GC, Funk M.Factors Associated with Pressure Ulcers in Patients in a Surgical Intensive Care Unit[J]. J Wound Ostomy Continence Nurs,2010,37(6):619-626. DOI: 10.1097/WON.0b013e3181f90a34.
[29] Stellar JJ, Hasbani NR, Kulik LA, et al.Medical Device-Related Pressure Injuries in Infants and Children[J]. J Wound Ostomy Continence Nurs,2020,47(5):459-469. DOI:10.1097/WON.0000000000000683.
[30] 刘艳,王丽娟,昂慧,等. ICU患者压疮危险因素的Meta分析[J]. 护理学杂志,2018,33(4):84-87. DOI:10.3870/j.issn.1001-4152.2018.04.084.
[31] Imbulana DI, Manley BJ, Dawson JA, et al.Nasal Injury in Preterm Infants Receiving Non-invasive Respiratory Support: A Systematic Review[J].Arch Dis Child Fetal Neonatal Ed, 2018, 103(1):F29-F35. DOI:10.1136/archdischild-2017-313418.
[32] Cherng CH,Chen YW.Using a Modified Nasotracheal Tube to Prevent Nasal Ala Pressure Sore during Prolonged Nasotracheal Intubation[J]. J Anesth, 2010, 24(6):959-961. DOI:10.1007/s00540-010-1009-z.
[33] Huang TT, Tseng CE, Lee TM, et al.Preventing Pressure Sores of the Nasal Ala after Nasotracheal Tube Intubation: from Animal Model to Clinical Application[J]. J Oral Maxillofac Surg, 2009,67(3):543-551.DOI:10.1016/j.joms.2008.06.100.
[34] Ambutas S, Staffileno BA, Fogg L.Reducing Nasal Pressure Ulcers with an Alternative Taping Device[J]. Medsurg Nurs, 2014, 23(2):96-100.
[35] Anand R, Turner M, Sharma S, et al.Use of a Polyvinyl Acetyl Sponge (Merocel) Nasal Pack to Prevent Alar Necrosis during Prolonged Nasal Intubation[J]. Br J Oral Maxillofac Surg, 2007, 45(7):601. DOI:10.1016/j.bjoms.2007.01.012.
[36] Graham A, Sutton D.Prevention of Intraoperative Pressure Injuries Caused by Nasogastric Tubes[J]. Br J Oral Maxillofac Surg, 2015, 53(6):564-565. DOI:10.1016/j.bjoms.2015.03.001.
[37] Yang G, Gao C, Cai J.Prevention of Nasal Ala Pressure Injuries With Use of Hydroactive Dressings in Patients with Nasotracheal Intubation of Orthognathic Surgery: A Randomized Controlled Trial[J]. J Wound Ostomy Continence Nurs, 2020, 47(5):484-488. DOI:10.1097/WON.0000000000000675.
[38] Schroeder J, Sitzer V.Nursing Care Guidelines for Reducing Hospital-Acquired Nasogastric Tube-related Pressure Injuries[J]. Crit Care Nurse, 2019, 39(6):54-63. DOI:10.4037/ccn2019872.
[39] Barinagarrementeria R, Blancas Valencia JM, Teramoto Matsubara O,et al.Effect of Nasogastric Tube on Esophageal Mucosa[J]. GEN,1991,45(2):98-100.
[40] 李建萍,王筱慧,庄海花,等. 留置胃管患者鼻腔、食管黏膜损伤的防护研究[J]. 解放军护理杂志,2005,22(12):21-22. DOI:10.3969/j.issn.1008-9993.2005.12.009.
[41] Roscoe A, Kanellakos GW, McRae K, et al. Pressures Exerted by Endobronchial Devices[J]. Anesth Analg, 2007, 104(3):655-658. DOI:10.1213/01.ane.0000255171.94527.c7.
[42] Ferreira TH, Allen M, De Gasperi D, et al.Impact of Endotracheal Tube Size and Cuff Pressure on Tracheal and Laryngeal Mucosa of Adult Horses[J]. Vet Anaesth Analg, 2021, 48(6):891-899. DOI:10.1016/j.vaa.2021.08.046.
[43] Chadha NK, Gordin A, Luginbuehl I, et al.Automated Cuff Pressure Modulation: A Novel Device to Reduce Endotracheal Tube Injury[J]. Arch Otolaryngol Head Neck Surg, 2011, 137(1):30-34. DOI:10.1001/archoto.2010.228.
[44] 张艳,刘童心,张宇,等.导尿管不同固定部位对预防脑卒中患者黏膜压力性损伤的影响[J].实用医药杂志,2018,35(6):541-543. DOI:10.14172/j.issn1671-4008.2018.06.021.
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