重症患者医疗器械相关压力性损伤影响因素的Meta分析
延边大学, 护理学院, 吉林延吉 133002
| 摘 要： | 目的：通过Meta分析确定重症患者医疗器械相关压力性损伤发生的危险因素。方法：系统检索Cochrane Library、Embase、PubMed、Web of Science、中国知网、万方数据库、维普数据库、CBM数据库中公开发表的关于重症患者医疗器械相关压力性损伤危险因素的相关研究，检索时限为建库至2023年3月30日。由2名研究员根据纳入和排除标准独立进行文献筛选、数据提取，进行质量评价后使用Stata17.0软件进行Meta分析。结果：最终纳入14篇文献。Meta分析结果显示，年龄[OR=1.05, 95%CI (1.03, 1.08), p<0.001]、手术[OR=3.71, 95%CI (1.88, 7.32), p<0.001]、APACHEⅡ评分[OR=1.32, 95%CI (1.15, 1.51), p<0.001]、ICU住院时长[OR=5.60, 95%CI (1.53, 20.52), p<0.001]、合并糖尿病[OR=4.63, 95%CI (2.51, 8.55), p<0.001]、发热[OR=4.21, 95%CI (2.32, 7.65), p<0.001]、水肿[OR=3.62, 95%CI (2.31, 5.67), p<0.001]为重症患者发生医疗器械相关压力性损伤的危险因素，血红蛋白[OR=0.96, 95%CI (0.94, 0.99), p<0.001]、血清白蛋白[OR=0.81, 95%CI (0.74, 0.88), p<0.001]为重症患者发生医疗器械相关压力性损伤的保护因素。结论：高龄、手术、APACHEⅡ评分高、低血红蛋白、ICU住院时间长、血清白蛋白含量低、合并糖尿病、发热、水肿的重症患者更容易发生医疗器械相关压力性损伤，护理人员可结合危险因素，针对性地制订预防和护理措施，降低重症患者医疗器械相关压力性损伤的发生率。 |
| 关 键 词： | 医疗器械; 压力性损伤; 重症患者; Meta分析; 循证护理 |
| DOI： | 10.57237/j.nhres.2023.03.001 |
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收稿日期: 2023-07-10
接受日期: 2023-08-31
在线出版日期: 2023-09-08
Meta-Analysis of Factors Influencing Medical Device-Related Pressure Injury in Critically Ill Patients
School of Nursing, Yanbian University, Yanji 133002, China
| Abstract: | Objective: To determine the risk factors for medical device related pressure injury in critically ill patients through meta-analysis. Method: A systematic search was conducted on publicly published research on the risk factors of pressure injury related to medical devices in critically ill patients from Cochrane Library, Embase, PubMed, Web of Science, CNKI, Wanfang Database, VIP Database, and CBM Database. The search was conducted until March 30, 2023. Two researchers independently conducted literature screening and data extraction based on inclusion and exclusion criteria, conducted quality evaluation, and conducted meta-analysis using Stata17.0 software. Result: 14 articles were ultimately included. Meta analysis showed that age [OR=1.05, 95% CI (1.03, 1.08), p<0.001], surgery [OR=3.71, 95% CI (1.88, 7.32), p<0.001], APACHE II score [OR=1.32, 95% CI (1.15, 1.51), p<0.001], length of stay in ICU [OR=5.60, 95% CI (1.53, 20.52), p<0.001], combined diabetes [OR=4.63, 95% CI (2.51, 8.55), p<0.001], fever [OR=4.21, 95% CI (2.32, 7.65), P<0.001], edema [OR=3.62, 95% CI (2.31, 5.67), p<0.001] are risk factors for medical device related pressure injury in critically ill patients, while hemoglobin [OR=0.96, 95% CI (0.94, 0.99), p<0.001], serum albumin [OR=0.81, 95% CI (0.74, 0.88), p<0.001] are protective factors for medical device related pressure injury in critically ill patients. Conclusion: Severe patients with advanced age, surgery, high APACHE II score, low hemoglobin, long stay in ICU, low serum albumin content, diabetes, fever and edema are more prone to medical device related pressure injury. Nursing staff can combine risk factors to formulate targeted prevention and nursing measures to reduce the incidence of medical device related pressure injury in severe patients. |
| Keywords: | Medical Devices; Pressure Injury; Critically Ill Patients; Meta-Analysis; Evidence-Based Nursing |
基金
| 1. | 延边大学科技基金项目 (YDBQ202038) |
参考文献
| [1] | Black J M, Cuddigan J E, Walko M A, et al. Medical device related pressure ulcers in hospitalized patients [J]. Int Wound J, 2010, 7 (5): 358-365. |
| [2] | Apold J, Rydrych D. Preventing device-related pressure ulcers: using data to guide statewide change [J]. J Nurs Care Qual, 2012, 27 (1): 28-34. |
| [3] | 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. |
| [4] | 杨龙飞, 宋冰, 倪翠萍, 等. 2019版 «压力性损伤的预防和治疗: 临床实践指南» 更新解读 [J].中国护理管理, 2020, 20 (12): 1849-1854. |
| [5] | Delmore B A, Ayello E A. CE: Pressure Injuries Caused by Medical Devices and Other Objects: A Clinical Update [J]. Am J Nurs, 2017, 117 (12): 36-45. |
| [6] | Black J, Alves P, Brindle C T, 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. |
| [7] | Black J, Kalowes P. Medical device-related pressure ulcers [J]. Chronic Wound Care Management and Research, 2016, 3: 91-99. |
| [8] | 曹子璇, 魏亚倩, 章晋,等. 成人住院患者医疗器械相关性压力性损伤流行特征的Meta分析 [J].中国护理管理, 2020, 20 (05): 707-716. |
| [9] | Maruccia M, Ruggieri M, Onesti M G. Facial skin breakdown in patients with non-invasive ventilation devices: report of two cases and indications for treatment and prevention [J]. Int Wound J, 2015, 12 (4): 451-455. |
| [10] | 邓妍, 周建仪, 刘秀珍, 等. 无创正压通气患者发生鼻面部压疮危险因素的回顾性分析 [J]. 临床与病理杂志, 2017, 37 (01): 137-142. |
| [11] | 董正惠, 祁进芳, 李振刚, 等. ICU患者医疗器械相关性压力性损伤发生特征及影响因素分析 [J]. 中国医药导报, 2023, 20 (02): 109-113. |
| [12] | 祁进芳, 胡宁宁, 李振刚, 等. ICU患者医疗器械相关性压力性损伤风险预测模型的构建 [J]. 新疆医科大学学报, 2022, 45 (09): 1051-1057. |
| [13] | 祁进芳, 董正惠, 李阳, 等. ICU患者头面部器械相关性压力性损伤风险预测模型的构建 [J]. 护理学报, 2022, 29 (19): 11-15. |
| [14] | 申微军, 陈琨, 丁美祝. 慢性阻塞性肺疾病无创正压通气患者面部压疮发生的危险因素分析与风险预测模型的构建及检验[J].护士进修杂志, 2019, 34 (24): 2224-2228. |
| [15] | 吴丹, 金瑛, 吕翔燕, 等. ICU患者氧疗器械相关性压力性损伤现状及影响因素分析 [J]. 浙江医学, 2020, 42 (19): 2120-2122+2126. |
| [16] | 王娟, 张岚, 马晶淼, 等. 两所医院ICU医疗设备相关压疮的调 [J]. 天津护理, 2015, 23 (04): 290-292. |
| [17] | 杜爱平, 黄兵. 无创正压通气致鼻面部压疮相关因素分析 [J]. 护理学杂志, 2016, 31 (09): 65-67. |
| [18] | 刘迪. EICU经口气管插管患者发生相关性口腔黏膜压力性损伤的现状及影响因素分析 [D]. 北京协和医学院, 2022. |
| [19] | 南锐伶. ICU患者鼻黏膜压力性损伤的影响因素研究 [D]. 兰州大学, 2021. |
| [20] | Koo M, Sim Y, Kang I. Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units [J]. J Korean Acad Nurs, 2019, 49 (1): 36-45. |
| [21] | Weber P, Weaver L, Miller C. Risk factors for the development of medical device related pressure injuries in the adult intensive care patient; A case-control study [J]. J Tissue Viability, 2022, 31 (4): 601-605. |
| [22] | Wu P L, Li Y J, Pai H C, et al. Factors associated with facial pressure injury in patients receiving non-invasive positive pressure ventilation mask: A retrospective case-control study [J]. J Clin Nurs, 20222022 Nov 15. doi: 10.1111/jocn.16585. Epub ahead of print. PMID: 36380461. |
| [23] | Dang W, Liu Y, Zhou Q, et al. Risk factors of medical device-related pressure injury in intensive care units [J]. J Clin Nurs, 2022, 31 (9-10): 1174-1183. |
| [24] | Nan R, Su Y, Pei J, et al. Characteristics and risk factors of nasal mucosal pressure injury in intensive care units [J]. J Clin Nurs, 2023, 32 (1-2): 346-356. |
| [25] | Cox J, Schallom M. Pressure Injuries in Critical Care Patients: A Conceptual Schema [J]. Adv Skin Wound Care, 2021, 34 (3): 124-131. |
| [26] | Edsberg L E, Black J M, Goldberg M, et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System [J]. J Wound Ostomy Continence Nurs, 2016, 43 (6): 585-597. |
| [27] | Ko E, Choi S. Factors Associated with Pressure Injury Among Critically Ill Patients in a Coronary Care Unit [J]. Adv Skin Wound Care, 2022, 35 (10): 1-10. |
| [28] | Dhandapani M, Dhandapani S, Agarwal M, et al. Pressure ulcer in patients with severe traumatic brain injury: significant factors and association with neurological outcome [J]. J Clin Nurs, 2014, 23 (7-8): 1114-1119. |
| [29] | Jung Y K, Hahn H M, Park D H. Factors influencing the severity of medical device-related pressure injuries: Pressure injury staging comparison [J]. Int Wound J, 2023. |
| [30] | 付佳, 田甜. 糖尿病患者术中皮肤压力性损伤风险列线图预测模型的构建 [J]. 中国医科大学学报, 2021, 50 (11): 1014-1019+1025. |
| [31] | 乔彩虹, 杨辉, 曹慧丽. ICU医疗器械相关性压力性损伤的风险评估及护理干预研究进展 [J] 护理研究, 2021, 35 (18): 3308-3311. |
| [32] | 吴佳倩, 李敏, 甘秀妮. «器械相关压力性损伤: SECURE安全预防» 国际专家共识解读 [J], 护理研究 [J], 2022, 36 (18): 3197-3201. |
