以质量求发展,以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (6): 42-46.doi: 10.16460/j.issn1008-9969.2023.06.042

• 循证护理 • 上一篇    下一篇

新生儿尿布皮炎预防及管理的最佳证据总结

罗黎, 何娇, 张娟, 张岚, 杨雪娇   

  1. 华中科技大学同济医学院附属协和医院 新生儿科,湖北 武汉 430000
  • 收稿日期:2022-11-27 出版日期:2023-03-25 发布日期:2023-04-12
  • 通讯作者: 何娇(1979-),女,湖北武汉人,硕士,副主任护师,护士长。E-mail:476216334@qq.com
  • 作者简介:罗黎(1992-),女,湖北荆州人,本科学历,护师。
  • 基金资助:
    湖北省卫生健康委2021-2022年度面上项目(WJ2021M225)

Best evidence summary for prevention and management of diaper dermatitis

LUO Li, HE Jiao, ZHANG Juan, ZHANG Lan, Yang Xue-jiao   

  1. Dept. of Neonatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
  • Received:2022-11-27 Online:2023-03-25 Published:2023-04-12

摘要: 目的 总结新生儿尿布皮炎预防及管理的最佳证据,为医务人员的临床实践提供借鉴。方法 检索BMJ、UpToDate、GIN、NICE、NGC、JBI、Cochrane Library、PubMed、CBM、医脉通、中国知网、万方、维普,课题研究小组的2名成员对文献的质量进行评价后,再对文献里的证据进行提取与汇总。结果 共纳入文献9篇,2篇证据总结,2篇临床决策,1篇指南,2篇系统评价,2篇专家共识。从新生儿尿布皮炎的评估、影响因素、用物选择、预防及干预措施、药物治疗及培训6个方面,共提取20条证据。结论 建议医务人员遵循新生儿尿布皮炎预防及管理的最佳证据,评估新生儿尿布皮炎的风险因素并对尿布皮炎的严重程度进行分级,合理选择用物,根据分级采取对应的预防和护理措施,提高医护人员对尿布皮炎的管理水平,规范护理新生儿尿布皮炎,降低新生儿尿布皮炎的发生率。

关键词: 新生儿, 尿布皮炎, 循证护理, 证据总结

Abstract: Objective To retrieve, evaluate and summarize the best evidence for the prevention and management of diaper dermatitis. Methods We searched databases of BMJ, UpToDate, GIN, NICE, NGC, JBI, Cochrane Library, PubMed, CBM, Yimaitong, CNKI,Wangfang,and VIP for eligible literature. Two researchers evaluated the literature independently and extract and summarize the evidence. Results Totally 9 articles, 2 evidence summaries, 2 clinical decision-making, 1 guideline, 2 systematic reviews, and 2 expert consensuses were collected. Twenty pieces of evidence were extracted from 6 aspects including evaluation, influencing factors, choice of materials, prevention and intervention measures, drug treatment and training. Conclusion It is recommended to follow the best evidence of the prevention and management of diaper dermatitis. Assessing the risk factors, grading the severity of diaper dermatitis, selecting appropriate materials, and taking corresponding preventive and nursing measures according to the severity of diaper dermatitis are conducive to improving the management and reducing the incidence of diaper dermatitis.

Key words: neonates, diaper dermatitis, evidence-based nursing, evidence summary

中图分类号: 

  • R473.72
[1] Klunk C, Domingues E, Wiss K.An update on diaper dermatitis[J].Clin Dermatol, 2014,32(4):477-487.DOI:10.1016/j.clindermatol.2014.02.003.
[2] Pogaar MI, Maver U,Varda NM,et al.Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the Diaper Area[J]. Int J Dermatol,2018,57(3):265-275. DOI: 10.1111/ijd.13748.
[3] Thaman LA, Eichenfield LF.Diapering habits: a global perspective[J].Pediatr Dermatol, 2014, 31(1):15-18.DOI:10.1111/pde.12468.
[4] Scheinfeld N.Diaper dermatitis: a review and brief survey of eruptions of the Diaper Area[J]. Am J Clin Dermatol,2005,6(5):273-281.DOI:10.2165/00128071-200506050-00001.
[5] Sukhneewat C, Chaiyarit J, Techasatian L.Diaper dermatitis: a survey of risk factors in thai children aged under 24 months[J]. BMC Dermatology, 2019,19(1):7.DOI:10.1186/s12895-019-0089-1.
[6] Li C,Zhu Z,Dai Y.Diaper dermatitis: a survey of risk factors for children aged 1 -24 months in China[J].J Int Med Res,2012, 40(5):1752-1760.DOI:10.1177/030006051204000

[7] Blume-Peytavi U,Kanti V.Prevention and treatment of diaper dermatitis[J]. Pediatr Dermatol,2018, 35(1):s19-s23.DOI:10.1111/pde.13495.
[8] 乐琼,张岚,吴丽芬,等.新生儿尿布皮炎结构化管理流程的制订及应用[J].护理学报, 2019,374(19):27-31.DOI:10.16460/j.issn1008-9969.2019.19.022.
[9] 胡雁,郝玉芳.循证护理学[M].2版.北京:人民卫生出版社,2018.
[10] Alper BS, Haynes RB.EBHC pyramid 5.0 for accessing preappraised evidence and guidance[J]. Evid Based Med, 2016,21(4):123-125.DOI:10.1136/ebmed-2016-110447.
[11] Brouwers MC, Kho ME, Browman GP,et al.AGREE II:advancing guideline development,reporting,and evaluation in health care[J].Prev Med,2010,51(5):421-424.DOI:10.1016/j.ypmed.2010.08.005.
[12] 张方圆,沈傲梅,曾宪涛,等.系统评价方法学质量评价工具AMSTAR2解读[J].中国循证心血管医学杂志, 2018(1):14-18.DOI:10.3969/j.issn.1674-4055.2018.01.03.
[13] The Joanna Briggs Institute. Joanna briggs institute reviewers’ manual: 2016 edition[M]. Australia:The Joanna Briggs Institute,2016.
[14] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[15] Saira M.Diaper dermatitis(ifants and preschool):management[EB/OL].(2021-06-15)[2022-04-10].https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=BOIHFPCAMBEBEEOBIPNJJFPFDLEIAA00&Complete+Reference=S.sh.14%7c1%7c1&Counter5=SS_view_found_complete%7cJBI1296%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI1296%7cjbi%7cjbidb%7cjbi.
[16] Lind SN,Deepak Kamat.Nappy rash[EB/OL]. (2021-02-04)[2022-04-10].http://bestpractice-bmj-com-443.webvpn.bjmu.keyan123.cn/topics/en-gb/676.
[17] Horii KA.Diaper dermatitis[EB/OL]. (2018-11-08)[2022-04-10].http://www-uptodate-com-443.webvpn.bjmu.keyan123.cn/contents/diaper-dermatitis?search=Diaper%20 Dermatitis&source=search_result&selectedTitle=1~107&usage_type=default&display_rank=1.
[18] Horii KA. Patient education: diaper rash in infants and children (beyond the basics) [EB/OL].(2019-09-10)[2022-04-10]. http://www-uptodate-com-443.webvpn.bjmu.keyan123.cn/contents/diaper-rash-in-infants-and-children-beyond-the-basics?search=Patient%20Education:%20Diaper%20Rash%20in%20Infants%20and%20Children%20&source=search_result&selectedTitle=1~107&usage_type=default&display_rank=1 .
[19] 万兴丽,李霞,胡艳玲,等.重症监护病房新生儿皮肤管理指南(2021)[J].中国当代儿科杂志,2021, 23(7):659-670.DOI:10.7499/j.issn.1008-8830.2106004.
[20] Blume-Peytavi U, Hauser M,Lünnemann L,et al.Prevention of diaper dermatitis in infants—a literature review[J]. Pediatr Dermatol, 2014, 31(4):413-429. DOI:10.1111/pde.12348.
[21] Behr JH,Wardell D,Rozmus CL,et al.Prevention strategiesfor neonatal skin injury in the NICU[J]. Neonatal Netw,2020,39(6):321-329.DOI:10.1891/0730-0832/11-T-623.
[22] 张琳琪,李杨,宋楠,等.婴幼儿尿布性皮炎护理实践专家共识[J].中华护理杂志, 2020,55(8):1-6.
[23] 杨童玲,王丽,张崇凡,等.新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识[J].中国循证儿科杂志,2020,15(3):161-165.DOI:10.3969/j.issn.1673-5501.2020.03.001.
[24] Merrill L.Prevention, Treatment and parent education for diaper dermatitis[J]. Nurs Womens Health, 2015, 19(4):324-337. DOI:10.1111/1751-486X.12218.
[25] Šikić Pogačar M,Maver U,Mar un Varda N,et al.Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the Diaper Area[J]. Int J Dermatol,2018,57(3):265-275.DOI:10.1111/ijd.13748.
[26] Nield LS, Kamat D.Prevention,diagnosis,and management of diaper dermatitis[J]. Clin Pediatr (Phila), 2007,46(6):480-486.DOI:10.1177/0009922806292409.
[27] Lavender T, Furber C, Campbell M, et al.Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies:assessor-blinded randomised controlled equivalence trial[J]. BMC Pediatr,2012,12:59.DOI:10.1186/1471-2431-12-59.
[28] Baer EL,Davies MW,Easterbrook KJ.Disposable nappies for preventing napkin dermatitis in infants[J].Cochrane Database Syst Rev, 2006, 3(3):CD004262.DOI:10.1002/14651858.CD004262.pub2.
[29] Coughlin CC, Eichenfield LF,Frieden IJ.Diaper dermatitis: clinical characteristics and differential diagnosis[J].Pediatr Dermatol,2014,31(1):19-24.DOI:10.1111/pde.12500.
[30] Buckley BS, Mantaring JB,Dofitas RB,et al.A new scale for assessing the severity of uncomplicated diaper dermatitis in infants: development and validation[J]. Pediatr Dermatol,2016,33(6):632-639. DOI:10.1111/pde.12988.
[31] 陈羽双,杨斯钰,黄玉婷,等.新生儿尿布皮炎的影响因素及预防进展[J].中国儿童保健杂志,2021, 29(3):277-280.DOI:10.11852/zgetbjzz2020-0964.
[32] Atherton DJ.Understanding irritant napkin dermatitis[J].Int J Dermatol,2016, 55(S1):7-9.DOI:10.1111/ijd.13334.
[33] 周英凤,黄娜,王凯蓉,等.ARCC循证实践模式的步骤及在护理实践中的应用[J].护理研究,2020,34(16):138-140.DOI:10.12102/j.issn.1009-6493.2020.16.027.
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