50所医院老年患者皮肤损伤现状及危险因素分析

doi:10.3761/j.issn.0254-1769.2022.09.012

摘要/Abstract

摘要：

目的通过多中心横断面调查,分析老年住院患者压力性损伤（pressure injury,PI）、失禁相关性皮炎（incontinence-associated dermatitis,IAD）和皮肤撕裂伤（skin tear,ST） 3类皮肤损伤的现患率及危险因素,为预防皮肤损伤提供依据。方法 2021年3月31日,来自20个省（区、市）50所医院的1 067名护士对所在医院年龄≥60岁的患者进行全身皮肤检查,以判断皮肤损伤发生情况及类型,并收集患者的一般资料、病情资料和有无PI发生危险等资料。使用Logistic回归分析3类皮肤损伤的独立危险因素。结果共调查14 470例老年住院患者,年龄为（73.35±8.90）岁,皮肤损伤总现患率为6.69%,PI、IAD、ST的现患率分别为3.91%、1.89%和0.89%。Logistic回归分析显示,有PI发生危险、协助自理、低蛋白血症、汉族、贫血、慢性病数量≥2种和年龄≥71岁为老年住院患者发生PI的独立危险因素;有PI发生危险、协助自理、低蛋白血症、慢性病数量≥2种、住院时间≥8 d和年龄>80岁为IAD的独立危险因素;有PI发生危险、低蛋白血症为ST的独立危险因素（均P<0.05）。结论老年住院患者3类皮肤损伤均为多因素综合作用的结果,不同类型皮肤损伤的危险因素不尽相同。制订预防策略时既要关注危险因素的独立作用,也要考虑其联合作用,采取综合预防措施,以提高预防效果。

关键词: 伤口和损伤, 老年人, 横断面调查, 危险因素, 多中心研究, 护理

Abstract:

Objective To analyze the prevalence and risk factors of 3 types of skin injuries in the elderly through multicenter cross-sectional survey,so as to provide bases for formulating prevention strategies for skin injuries in the elderly. Methods On March 31,2021,1 067 nurses from 50 hospitals in 16 provinces,2 autonomous regions and 2 municipalities included inpatients over 60 years old and inspected their skin from head to toes to identify pressure injury（PI）,incontinence-associated dermatitis（IAD） and skin tear（ST）,and meanwhile collected demographic,healthcare condition and PI risk assessment data. Statistical software was used for descriptive analysis,Pearson correlation analysis and logistic regression analysis. Results Totally,14 470 cases were obtained. The average age was（73.35±8.90） years old. The total prevalence of skin injuries was 6.69%,and the prevalence of PI,IAD and ST was 3.91%,1.89% and 0.89%,respectively. Logistic regression analysis showed that the risk of PI,inability of self-care,hypoproteinemia and anemia,comorbidity over 2 chronic diseases and ≥70 years old were the independent risk factors of PI in the elderly. The risk of PI,inability of self-care,hypoproteinemia,comorbidity over 2 chronic diseases,length of hospital stay≥8 days and the age of over 80 years were the independent risk factors of IAD in the elderly. The risk of PI and hypoproteinemia were independent risk factors of ST in the elderly. Conclusion Skin injuries of the hospitalized elderly are the result of multiple factors,while PI and IAD are the most typical ones,and the risk factors of different types of skin injuries are also different. When formulating prevention strategies,we should not only pay attention to the independent role of risk factors,but also consider the combined role of risk factors,take comprehensive preventive measures to improve the prevention effect.

Key words: Wound and Injury, Aged, Cross-Sectional Survey, Risk Factors, Multicenter Study, Nursing Care

蒋琪霞, 唐永利, 洪艳燕, 匡丹, 王静, 展颖颖, 潘迎春, 高艳红, 郝景平, 陈锐, 刘海燕, 俞萍, 蔡蕴敏, 黄玲, 王祖晶. 50所医院老年患者皮肤损伤现状及危险因素分析[J]. 中华护理杂志, 2022, 57(9): 1105-1112.

JIANG Qixia, TANG Yongli, HONG Yanyan, KUANG Dan, WANG Jing, ZHAN Yingying, PAN Yingchun, GAO Yanhong, HAO Jingping, CHEN Rui, LIU Haiyan, YU Ping, CAI Yunmin, HUANG Ling, WANG Zujing. Analysis on the prevalence and risk factors of skin injuries in the elderly in 50 hospitals in China[J]. Chinese Journal of Nursing, 2022, 57(9): 1105-1112.

图/表 4

表1 调查对象的一般资料（n=14 470）

Table 1 Sample demographic characteristics（n=14 470）

表2 老年住院患者3类皮肤损伤的单因素分析[例（百分率,%）]

Table 2 Univariate analysis of three types of skin injuries in elderly inpatients[cases（prevalence rate,%）]

表3 自变量赋值表

Table 3 Assignment of independent variable

表4 老年住院患者3类皮肤损伤危险因素的回归分析结果

Table 4 Regression analysis of three types skin injuries risk factors in the elderly inpatients

参考文献 23

[1]	Bocheva G, Slominski RM, Slominski AT. Neuroen-docrine aspects of skin aging[J]. Int J Mol Sci, 2019, 20(11):2798-2817. DOI URL
[2]	Wollina U, Lotti T, Vojvotic A, et al. Dermatoporosis-the chronic cutaneous fragility syndrome[J]. Open Access Maced J Med Sci, 2019, 7(18):3046-3049. DOI PMID
[3]	金琇泽, 路云. 中国老年人共病状况及其对医疗卫生支出的影响研究[J]. 中国全科医学, 2019, 22(34):4166-4172. DOI
	Jin XZ, Lu Y. Prevalence of comorbidity among the elderly and its impact on healthcare expenditure in China[J]. Chin Gen Pract, 2019, 22(34):4166-4172.
[4]	Wei M, Yang DL, Chen L, et al. The prevalence and prevention of pressure ulcers:a multicenter study of nine nursing homes in Eastern China[J]. J Tissue Viability, 2021, 30(1):133-136. DOI URL
[5]	Gabriel S, Hahnel E, Blume-Peytavi U, et al. Prevalence and associated factors of intertrigo in aged nursing home residents:a multi-center cross-sectional prevalence study[J]. BMC Geriatr, 2019, 19(1):105-113. DOI URL
[6]	Rayner R, Carville K, Leslie G, et al. A risk model for the prediction of skin tears in aged care residents:a prospective cohort study[J]. Int Wound J, 2019, 16(1):52-63. DOI PMID
[7]	Hahnel E, Blume-Peytavi U, Trojahn C, et al. Associations between skin barrier characteristics,skin conditions and health of aged nursing home residents:a multi-center prevalence and correlational study[J]. BMC Geriatr, 2017, 17(1):263-275. DOI URL
[8]	Hahnel E, Blume-Peytavi U, Kottner J. Associations of dry skin,skin care habits,well-being,sleep quality and itch in nursing home residents:results of a multicentre,observational,cross-sectional study[J]. Nurs Open, 2019, 6(4):1501-1509. DOI URL
[9]	Bliss DZ, Gurvich OV, Mathiason MA, et al. Prevention of incontinence-associated skin damage in nursing homes[J]. West J Nurs Res, 2017, 39(5):643-659. DOI URL
[10]	Parker CN, Finlayson KJ, Edwards HE, et al. Exploring the prevalence and management of wounds for people with dementia in long-term care[J]. Int Wound J, 2020, 17(3):650-659. DOI URL
[11]	Jiang QX, Song SP, Zhou JH, et al. The prevalence,characteristics,and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID-19:a multicenter,cross-sectional study[J]. Adv Wound Care(New Rochelle), 2020, 9(7):357-364.
[12]	方积乾. 生物医学研究的统计方法[M]. 北京: 高等教育出版社, 2010:284.
	Fang JQ. Statistical methods in biomedical research[M]. Beijing: Higher Education Press, 2010:284.
[13]	郭艳侠, 蒋琪霞. Delphi法在压疮及皮肤其他损伤流行病学调研工具构建中的应用[J]. 护理研究, 2015, 29(23):2829-2832.
	Guo YX, Jiang QX. Application of Delphi method in construction of epidemiological investigation tool for pressure ulcers and other skin injuries[J]. Chin Nurs Res, 2015, 29(23):2829-2832.
[14]	蒋琪霞. 压疮护理学[M]. 北京: 人民卫生出版社, 2015:29-32.
	Jiang QX. Pressure ulcer nursing science[M]. Beijing: People’s Medical Publishing House, 2015:29-32.
[15]	European Pressure Ulcer Advisory Panel,National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries:clinical practice guideline. 3rd edition[EB/OL].(2019-11-16)[2021-08-10]. http://www.internationalguideline.com/.
[16]	Woo KY, Beeckman D, Chakravarthy D. Management of moisture-associated skin damage:a scoping review[J]. Adv Skin Wound Care, 2017, 30(11):494-501. DOI URL
[17]	van Tiggelen H, LeBlanc K, Campbell K, et al. Standardizing the classification of skin tears:validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries[J]. Br J Dermatol, 2020, 183(1):146-154. DOI PMID
[18]	Lechner A, Lahmann N, Neumann K, et al. Dry skin and pressure ulcer risk:a multi-center cross-sectional prevalence study in German hospitals and nursing homes[J]. Int J Nurs Stud, 2017, 73:63-69. DOI PMID
[19]	蒋琪霞, 江智霞, 郑美春, 等. 医院内皮肤撕裂伤现患率及流行特征的多中心横断面调查[J]. 中国护理管理, 2017, 17(5):631-636.
	Jiang QX, Jiang ZX, Zheng MC, et al. Multicenter cross-sectional survey on prevalence and epidemiologic features of Skin Tears in hospitals[J]. Chin Nurs Manag, 2017, 17(5):631-636.
[20]	蒋琪霞, 王建东, 董珊, 等. 两种皮肤保护方法在负压治疗慢性伤口中的应用研究[J]. 中华护理杂志, 2020, 55(1):39-44.
	Jiang QX, Wang JD, Dong S, et al. Comparative study of two methods of protecting skin for patients with chronic wounds treated by negative pressure wound therapy[J]. Chin J Nurs, 2020, 55(1):39-44.
[21]	朱守林, 蒋琪霞, 李来娟, 等. 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.
	Zhu SL, Jiang QX, Li LJ, et al. Study on moisture-associated skin damage of patients with negative pressure wound therapy[J]. Chin J Nurs, 2020, 55(11):1642-1647.
[22]	Munro EL, Hickling DF, Williams DM, et al. Malnutrition is independently associated with skin tears in hospital inpatient setting-findings of a 6-year point prevalence audit[J]. Int Wound J, 2018, 15(4):527-533. DOI PMID
[23]	Cao CW, Xiao ZC, Wu YL, et al. Diet and skin aging-from the perspective of food nutrition[J]. Nutrients, 2020, 12(3):E870.