成人加護單位失禁皮膚炎相關危險因子探討

Research on Risk Factors of Incontinence-Associated Dermatitis in Adult Intensive Care Unit

趙慧玲(Hui-Lin Chao) ； 李怡旻(Yi-Min Li) ； 黃惠如(Hui-Ju Huang) ； 尹文琪(Wen-Chi Yin)

《榮總護理》 33卷4期 (2016/12) Pp. 388-396

https://doi.org/10.6142/VGHN.33.4.388

摘要

失禁性皮膚炎(incontinence-associated dermatitis, IAD) 為失禁病人常見的問題，發生失禁性皮膚炎易延長治療時間及增加治療成本，本研究旨在探討成人加護單位失禁性皮膚炎之危險因子，以做為未來預防及改善參考。採橫斷性相關研究設計，以方便取樣選取北部三家綜合醫院2012 年特定兩時間點在加護單位之成人病人。本研究共收案129 位，研究對象其平均年齡69.15±16.17 歲、男性共72 位(55.8%)、17 位(13.17%) 發生IAD，研究結果發現BMI、有無腹瀉、抗生素使用、最近一週排便次數、是否使用皮膚保護用品，會陰部皮膚狀況評估量表(perineal assessment tool, PAT) 總分及其各項目、Braden 量表總分及其各項目中的感覺知覺程度、潮濕程度、移動力、摩擦力/ 剪力，均為影響IAD 的風險因子，進一步以多元邏輯斯迴歸分析發現，PAT 總分與BMI 能預測失禁性皮膚炎的發生，Nagelkerke R^2 為0.52。PAT 總分每增加一分，得到IAD 的風險機率高2.76倍(95% 信賴區間為1.71-4.46)，而BMI 每增加一單位得到IAD 的風險增加1.23倍(95% 信賴區間為1.05-1.44)。建議依本研究結果針對高風險病人提供完整的照護處置，以預防IAD 之發生。

關鍵字

失禁性皮膚炎 ； 會陰部皮膚狀況評估量表 ； 危險因子

並列摘要

Incontinence-associated dermatitis (IAD) is a highly prevalent medical issue among patients with incontinence that prolongs the treatment period and increases the cost of treatment. This study was conducted to investigate the risk factors related to IAD in adult intensive care unit for determining future methods for the prevention of IAD and determining clinical improvements. Cross-sectional analysis was employed to collect patient samples from three general hospitals in northern Taiwan in June and September, 2012. In total, 129 patients with an average age of 69.15±16.17 years participated in this study. Male participants comprised 55.8% of the participants (n = 72), and 17 (13.17%) patients had IAD. This study observed the following risk factors impacting IAD: BMI, diarrhea, antibiotics usage, defecation frequency, application of skin protection products, perineal assessment tool (PAT) scores, Braden scores, perception function, skin moisture levels, mobility, and friction/ shear force. After further conducting multiple logistic regression, the IAD risk prevalence was 2.76 (95% confidence interval: 1.71-4.46) times higher when the PAT score was increased by 1 point. Moreover, IAD prevalence risk was 1.23 (95% confidence interval: 1.05-1.44) times higher when BMI was raised by 1 unit (Nagelkerke R^2 0.52). In summary, the higher the PAT score and BMI, the higher the possibility of IAD occurring. The results of this study suggested that training methods for IAD care for team members should be improved and also that a comprehensive care system/procedure should be provided for high-risk groups for the prevention of IAD.

並列關鍵字

incontinence-associated dermatitis (IAD) ； perineal assessment tool (PAT) ； risk factors

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