截肢病人殘肢傷口感染的臨床表徵及相關因素之探討

Clinical Characteristics and Related Factors of Stump Wound Infection in Amputation Patients

蔣季華(C. H. Chiang) ； 高紀惠(C. H. Kao)

《長庚護理》 7卷2期 (1996/06) Pp. 40-57

摘要

本研究目的在於確認殘肢傷口感染的臨床表徵及相關因素，並探討影響臨床表徵明顯程度的主要因素及找出可預測殘肢傷口感染的危險因子。以立意取樣方式，針對某醫學中心接受截肢手術的病人，採會談、觀察、身體檢查、查閱病歷等方法，用經過專家效度處理後之評量表收集資料，共取得102人次樣本。
研究結果顯示，52人次確認感染並呈現17項較明顯的臨床表微，及12項較常出現的相關因素；與臨床表微明顯度有顯著相關的7項因素，經多因子逐步迴歸分析，顯現較高位截肢、營養不良、住院科別爲外傷科、ASA術前評分爲3-5分、術前住院日數少於7天等5項因素存在時，殘肢傷口感染的臨床表徽較明顯，解釋變異量爲53.28%；與殘肢傷口感染有顯著相關的16項因素，經逐步對數式迴歸分析截取出過多分泌物蓄積、心理壓力存在、術後傷口分類屬於污染的或骯髒污染的傷口、工作人員未切實遵守無菌換藥原則等4項危險因子，其預測傷口感染的一致率達92.7%。故建議護理人員可針對能掌握的因素作處置，以預防傷口感染之發生或惡化，並可應用評量表作爲傷口評估之依據。

關鍵字

殘肢傷口 ； 傷口感染 ； 相關因素 ； 臨床表徵

並列摘要

The purposes of this study were: (1) to identify the clinical characteristics of stump wound infection, (2) to identify the related factors of stump wound infection, (3) to explore the factors related to the acuity of clinical characteristics, (4) to analyze the predicted risk-factors of stump wound infection. A 3 point rating scale construct the 28 clinical, characteristics and 26 related factors of stump wound infection based on comprehensive literature review Forteen nursing and medical experts appraised the applicability of each item The saw ple was composed of 52 wound infection patients and 50 non-infection patients Data was collected by observations physical examinations structured interviews and patient's charts review in the surgical wards at a medical center.
The major findings were (1) The 17 frequent clinical characteristics were identified according to the percentage (2) The 12 frequent related factors were identified according to the percentage (3) The results of step wise multiple regression analysis indicate that the significant predictors of clinical characteristics were height of amputation, emergent surgery, malnutrition, trauma patient. ASA physical status classification, and duration of preoperative stay. Also, the predictors for clinical characteristics were also explored. (4) Stepwise logistic regression analysis revealed four risk-factors that were independent of each other and highly predictive for subsequent wound infection, These were the excess exudata accumulation, psychogenic stress, worse surgical wound classification, and disobey asepsic policy to dressing change. Addition of the variables to our model did not increase the predicted probability of infection.
The findings of this study may be used by nursing staff and nursing educators to take precautions against wound infection and improve the quality of nursing care.

並列關鍵字

stump wound ； wound infections ； clinical characteristics ； related factors