#每日一读SCI：在重症监护病房中减少潮湿相关皮肤损伤的综合策略的有效性：一项准实验研究

推荐理由

1. 皮肤表面的液体并不总会造成皮肤损伤，但当皮肤长期暴露于过度潮湿的环境中，特别是当潮湿环境中含有刺激物时，皮肤损伤就会发生。称为：潮湿相关皮肤损伤。（失禁性相关皮炎（IAD）就是其中一种。）

2. 推荐几篇文献：

• [1]朱守林,蒋琪霞,李来娟,彭青,黄秀玲.负压伤口治疗患者发生潮湿相关性皮肤损伤的研究[J].中华护理杂志,2020,55(11):1642-1647.

• [2]侯银萌,李硕,王泠.潮湿相关性皮炎病理特征及护理研究进展[J].护理学杂志,2020,35(19):105-109.

• [3]马燕君.潮湿相关皮肤损伤的护理研究进展[J].全科护理,2014,12(18):1637-1641.

Del Cotillo-Fuente M, Valls-Matarín J, Sandalinas-Mulero I. Efficacy of a comprehensive strategy to reduce moisture-associated skin damage in an intensive care unit: A quasi-experimental study[J]. Intensive and Critical Care Nursing, 2021,63:102964.

在重症监护病房中减少潮湿相关皮肤损伤的综合策略的有效性：一项准实验研究

摘 要

Objectives Assess the impact of a bundle of interventions to reduce the incidence of moisture-associated skin damage in an intensive care unit.

研究目的：评估一系列综合干预措施在重症监护病房中降低潮湿相关皮肤损伤发生率的有效性。

Methods Quasi-experimental study with pre-post comparison carried out in a general intensive care unit. The intervention consisted of an online training on skin lesions and implementation of a skin care program. In the pre-post intervention period, the skin of the pelvic area was assessed daily until the appearance of a moisture-related lesion or intensive care unit discharge. Demographic and clinical variables, type of moisture lesion and severity were collected. To assess the impact of the intervention the odds ratio (OR) adjusted for the confounding variables was used.

研究方法：①一项前后准实验研究设计；②干预包括在线皮肤损伤培训和结构化护理干预；③4名资深护士，有20年皮肤科工作经验，接受过专门的皮损培训，每天检查骨盆区皮肤(肛周、会阴、生殖器、腹股沟区、臀部和臀襞)，直到出现潮湿相关皮肤损伤、患者出院、死亡或最多14天住院期间。④收集人口统计学和疾病资料、潮湿相关皮肤损伤的类型和严重程度。⑤干预内容见下图：

Results Trained nurses accounted for 87.7%. In each phase 145 patients were studied. The incidence of moisture-associated skin damage in the pre-phase was of 29% and 14.5% in the post phase. The OR adjusted for the confounding variables (ICU length of stay, obesity, faecal incontinence and non-communicative patients) was 0.44 (95%CI:0.23–0.82). The reduction of incontinence-associated dermatitis presented an OR of 0.81 (95%CI:0.30–2.16) and intertriginous dermatitis of 0.39 (95%CI:0.17–0.85).

研究结果：①受过培训的护士占87.7%；②共纳入145例患者；③干预前，潮湿相关皮肤损伤的发生率为29%，干预后为14.5%。 ④在干预前，对未暴露组发生MASD的危险因素进行研究，分析两组的可比性，并识别可能的混杂变量。发生潮湿相关皮肤损伤的危险因素包括在ICU待的时间长、肥胖、尿失禁，特别是大便失禁。⑤经混杂变量(ICU住院时间、肥胖、粪便失禁和非沟通患者)调整后的OR为0.44 (95%CI:0.23 -0.82)。⑥失禁相关皮炎的减少OR为0.81 (95%CI:0.30-2.16)，间擦疹的减少OR为0.39 (95%CI:0.17-0.85)。

Conclusions Online training for nurses and the introduction of structured skin care reduced by half the moisture-associated skin damage, especially intertriginous dermatitis.

研究结论：对护士进行在线培训和结构化皮肤护理的介入，减少了一半的潮湿相关皮肤损伤发生，特别是间擦疹的发生率。

小班长微信

●主题图源：pexels