重症病人壓瘡問題的預防與照護

Prevention and Management of Pressure Ulcers in Critical Patients

羅淑芬(Shu-Fen Lo) ； 張麗蓉(Li-Jung Chang) ； 曹文昱(Wen-Yu Cao)

《護理雜誌》 59卷4期 (2012/08) Pp. 24-29

https://doi.org/10.6224/JN.59.4.24

摘要

壓瘡已於2011年被台灣醫院評鑑暨醫療品質策進會列入臨床照護的品質指標，顯見壓瘡已是重要的健康照護議題，特別是在加護病房。壓瘡不僅象徵病人處於不良負向事件中，在生理層面易有疼痛、增加感染及敗血症機率、非預期性外科處置手術、功能及獨立性喪失，在心理層面病人易因壓瘡而出現憂鬱、壓力、焦慮、緊張情緒，在社會成本方面，壓瘡將增加經濟成本、延長住院天數。雖然有許多文獻及指引論述壓瘡預防與治療方式，但也有文獻指出如果在護理人力不足，沒有足夠的人力協助翻身，或是病人因疾病手術的因素，導致血液動力學不穩，慢性疾病長期使用類固醇等因素下，重症加護病房病人壓瘡仍無法完全被預防。故本文目的為探討重症病人壓瘡問題的預防與照護，將介紹壓瘡的評估及處置，期望臨床照護人員能對於此議題有更深廣的認識，減少壓瘡病人的合併症，進而提昇照護的品質。

關鍵字

重症病人 ； 壓瘡預防 ； 壓瘡處置 ； 傷口

並列摘要

The Taiwan Join Commission on Hospital Accreditation identified pressure ulcers as an important clinical care indicator in 2011. Pressure ulcers are a particularly critical medical care issue in hospital intensive care units. Pressure ulcers can influence patient physiology in terms of greater perceived pain, elevated infection and sepsis incidence, increased unplanned surgical treatments, and reduced activities of daily living (ADL). Pressure ulcers can also affect psychology through induced depression, stress, and anxiety. They can also increase patient and societal costs and prolong hospital stay length. This article explores the prevention and management of pressure ulcer in serious illness patients and introduces effective assessment and management techniques. We hope this article raises clinical nurse awareness of this critical issue and helps decrease the incidence of pressure ulcer-related complications in order to enhance overall quality of care.

並列關鍵字

critical patient ； pressure ulcer prevention ； pressure ulcer treatment ； wounds

參考文獻

Acaroglu, R., & Sendir, M. (2005). Pressure ulcer prevention and management strategies in Turkey. Journal of Wound, Ostomy, and Continence Nursing, 32(4), 230－237. doi:10.1097/00152192-200507000-00007

Brindle, C. T., & Wegelin, J. A. (2012). Prophylactic dressing application to reduce pressure ulcer formation in cardiac surgery patients. Journal of Wound, Ostomy, and Continence Nursing, 39(2), 133－142. doi:10.1097/WON.0b013e318247cb82

Compton, F., Hoffmann, F., Hortig, T., Strauss, M., Frey, J., Zidek, W., & Schäfer, J. H. (2008). Pressure ulcer predictors in ICU patients: Nursing skin assessment versus objective parameters. Journal of Wound Care, 17(10), 417－424.

Cox, J. (2011). Predictors of pressure ulcers in adult critical care patients. American Journal of Critical Care, 20(5), 364－375. doi:10.4037/ajcc2011934

Heidegger, C. P., Darmon, P., & Pichard, C. (2008). Enteral vs. parenteral nutrition for the critically ill patient: A combined support should be preferred. Current Opinion in Critical Care, 14(4), 408－414. doi:10.1097/MCC .0b013e3283052cdd