创伤性伤口患者居家皮肤清洁行为影响因素及干预策略的研究进展

doi:10.3761/j.issn.0254-1769.2026.02.018

摘要/Abstract

摘要：

目的分析创伤性伤口患者居家皮肤清洁行为的障碍和促进因素，并归纳可能有效的行为干预策略，为临床护理实践提供借鉴。方法检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据知识服务平台、维普数据库和中国生物医学文献数据库，检索时限为建库至2025年4月。采用混合方法评价工具评估纳入研究的质量。依据行为改变理论的能力、机会、动机、行为维度和理论领域框架识别潜在的障碍因素和促进因素，并归纳干预策略。结果最终纳入32篇文献，确定了影响创伤性伤口患者居家皮肤清洁行为依从性的17条障碍因素和20条促进因素，以及35条可能有效的行为干预策略。结论尽管皮肤清洁对创伤性伤口患者的益处已得到广泛认可，但在实际中，患者实施清洁行为仍存在诸多障碍因素。今后，需进一步完善、评估和验证该研究总结的影响因素并制订清洁方案，促进创伤性伤口患者居家皮肤清洁行为，以达到促进伤口愈合和提高舒适度的目标。

关键词: 创伤性伤口, 皮肤清洁, 促进因素, 障碍因素, 整合综述, 护理

Abstract:

Objective To analyze the facilitators and barriers of systemic skin cleaning behavior adherence in traumatic wound patients，and to identify potentially effective behavioral intervention strategies to reduce the risk of wound infection，promote wound healing，and improve patient comfort. Methods Totally 8 Chinese and English databases，including PubMed，Web of Science，Cochrane Library，CNKI，Wanfang Database and VIP Database，were searched from the establishment of the databases to April 2025. A mixed-method evaluation tool was used to assess the quality of the included studies. Potential barriers and facilitators were identified based on the capacity，opportunity，motivation，behavioral dimensions and theoretical domain framework of the theory of behavior change. Results A total of 32 studies were included，and 17 barriers，20 facilitators，and 35 potentially effective behavioral intervention strategies were identified. Conclusion Although the benefits of skin cleansing for trauma patients have been widely recognized，there are still many barriers to the implementation of cleansing behaviors in practice. In the future，it is necessary to further refine，evaluate and validate the influencing factors summarized in this study and develop a cleaning protocol to improve the adherence of cleaning behavior of trauma patients to achieve the goals of promoting healing and improving comfort.

Key words: Traumatic Wound, Skin Cleansing, Facilitators, Barriers, Integration Review, Nursing Care

陈琳, 彭青. 创伤性伤口患者居家皮肤清洁行为影响因素及干预策略的研究进展[J]. 中华护理杂志, 2026, 61(2): 275-282.

CHEN Lin, PENG Qing. Research progress on influencing factors and intervention strategies of home-based skin cleansing behaviors in patients with traumatic wounds[J]. Chinese Journal of Nursing, 2026, 61(2): 275-282.

图/表 1

参考文献 43

[1]	Ozgok Kangal MK, Regan JP. Wound healing[M]. Treasure Is-land(FL): StatPearls Publishing Copyrightt, 2021.
[2]	Sartelli M, Guirao X, Hardcastle TC, et al. 2018 WSES/SISE consensus conference:recommendations for the management of skin and soft-tissue infections[J]. World J Emerg Surg, 2018, 13:58. DOI PMID
[3]	蒋琪霞, 展颖颖, 魏巍, 等. 皮肤损伤患者温水淋浴与伤口感染的相关性及其影响因素[J]. 医学研究生学报, 2021, 34(8):834-839.
	Jiang QX, Zhan YY, Wei W, et al. Correlation between warm water shower and wound infection in patients with skin injury and its influencing factors[J]. J Med Postgrad, 2021, 34(8):834-839.
[4]	蒋琪霞, 王亚玲, 解怡洁, 等. 成年创伤患者创面以外皮肤清洗现况及影响因素的多中心横断面调查[J]. 中华烧伤杂志, 2021, 37(5):429-436.
	Jiang QX, Wang YL, Xie YJ, et al. Multicenter cross-sectional investigation on the cleaning status and influencing factors of skin cleaning outside the wound in adult trauma patients[J]. Chin J Burns, 2021, 37(5):429-436.
[5]	周晓慧, 季芳, 杨王建. 皮肤创伤急诊处理后皮肤清洗情况与伤口感染的关系研究[J]. 中国实用护理杂志, 2023, 39(8):625-630.
	Zhou XH, Ji F, Yang WJ. Study on the relationship between skin cleaning and wound infection after emergency treatment of skin trauma[J]. Chin J Pract Nurs, 2023, 39(8):625-630.
[6]	Yu YH, Chao S, Lin YK, et al. The gap between currently avai-lable evidence and awareness in clinical practice of wound care:it is the time to shower earlier[J]. Surgery,2018:S0039-6060(18)30029-1.
[7]	郭丽娜, 谢钰莹, 张孟羽, 等. 脑卒中患者能力-机会-动机-行为潜剖面特征及影响因素研究[J]. 中华现代护理杂志, 2024, 30(25):3374-3381.
	Guo LN, Xie YY, Zhang MY, et al. Study on the characteristics and influencing factors of the capability-opportunity-motiva-tion-behaviour profile of stroke patients[J]. Chin J Mod Nurs, 2024, 30(25):3374-3381.
[8]	魏燕. 理论域框架在理解患者安全问题中的应用[J]. 南京医科大学学报(社会科学版), 2020, 20(6):564-567.
	Wei Y. Application of theoretical domains framework in under-standing patient safety issues[J]. J Nanjing Med Univ Soc Sci, 2020, 20(6):564-567.
[9]	Lockwood C, Munn Z, Porritt K. Qualitative research synthesis:methodological guidance for systematic reviewers utilizing meta-aggregation[J]. Int J Evid Based Healthc, 2015, 13(3):179-187. DOI URL
[10]	Hong QN, Gonzalez-Reyes A, Pluye P. Improving the useful-ness of a tool for appraising the quality of qualitative,quantitative and mixed methods studies,the mixed methods appraisal tool(MMAT)[J]. J Eval Clin Pract, 2018, 24(3):459-467. DOI URL
[11]	胡雁. 如何开展质性研究的系统评价和Meta整合[J]. 上海护理, 2020, 20(7):1-5.
	Hu Y. How to carry out systematic review and meta-synthesis of qualitative studies[J]. Shanghai Nurs, 2020, 20(7):1-5.
[12]	刘晓晴, 蒋琪霞, 宋思平. 伤口患者皮肤清洗研究进展[J]. 中西医结合护理(中英文), 2020, 6(8):295-299.
	Liu XQ, Jiang QX, Song SP. Research progress on the clean-ing of the skin and wounds[J]. Nurs Integr Tradit Chin West Med, 2020, 6(8):295-299.
[13]	魏林立, 周琴, 邹小梅, 等. 烧伤患者浸浴室的安全管理[J]. 中华现代护理杂志, 2013, 19(22):2713-2714.
	Wei LL, Zhou Q, Zou XM, et al. Safety management of bath-room for burn patients[J]. Chin J Mod Nurs, 2013, 19(22):2713-2714.
[14]	仲宇, 魏惠燕, 林淑洁, 等. 下肢静脉溃疡周围皮肤护理的最佳证据总结[J]. 中华护理杂志, 2024, 59(12):1446-1453. DOI
	Zhong Y, Wei HY, Lin SJ, et al. Summary of the best evide-nce for surrounding skin management in venous leg ulcers[J]. Chin J Nurs, 2024, 59(12):1446-1453.
[15]	Mdoe MB, Mselle LT, Kibusi SM. An integrative review of home care recommendations for women after Caesarean section[J]. Nurs Open, 2024, 11(3):e2145. DOI URL
[16]	Chang IW. Early versus delayed post-operative bathing or show-ering to prevent wound complications:a Cochrane review sum-mary[J]. Int J Nurs Stud, 2016, 61:258-259. DOI PMID
[17]	Dayton P, Feilmeier M, Sedberry S. Does postoperative shower-ing or bathing of a surgical site increase the incidence of infection? A systematic review of the literature[J]. J Foot Ankle Surg, 2013, 52(5):612-614. DOI PMID
[18]	Milne J. The importance of skin cleansing in wound care[J]. Br J Nurs, 2019, 28(12):S20-S22. DOI PMID
[19]	赵婷, 蒋琪霞, 徐慧黎, 等. 创伤性伤口患者居家带伤洗浴方案的安全性及有效性研究[J]. 医学研究与战创伤救治, 2023, 36(10):1077-1081.
	Zhao T, Jiang QX, Xu HL, et al. The safety and efficacy of bath at home in patients with trauma[J]. J Med Res Combat Trauma Care, 2023, 36(10):1077-1081.
[20]	邓茹, 王艳霞. 浸浴疗法在烧伤病人难愈创面治疗中的应用[J]. 护理研究, 2018, 32(2):276-277.
	Deng R, Wang YX. Application of immersion therapy in treat-ing refractory wound among patients with burn[J]. Chin Nurs Res, 2018, 32(2):276-277.
[21]	姜明敏, 王军, 张宁, 等. 温泉水疗综合训练法对军事训练伤的康复治疗效果探讨[J]. 中国疗养医学, 2023, 32(7):717-720. DOI
	Jiang MM, Wang J, Zhang N, et al. Exploration of the rehabi-litation treatment effect of hot spring hydrotherapy compre-hensive training method on military training injuries[J]. Chin J Conval Med, 2023, 32(7):717-720.
[22]	Hsieh PY, Chen KY, Chen HY, et al. Postoperative showering for clean and clean-contaminated wounds:a prospective,rando-mized controlled trial[J]. Ann Surg, 2016, 263(5):931-936. DOI URL
[23]	Neues C, Haas E. Beeinflussung der postoperativen wundhei-lung durch duschen[J]. Der Chir, 2000, 71(2):234-236.
[24]	Riederer SR, Inderbitzi R. Gefährdet das duschen die postope-rative wundheilung?[J]. Der Chir, 1997, 68(7):715-717.
[25]	赵婷, 蒋琪霞, 徐慧黎, 等. 创伤性伤口患者居家带伤洗浴方案的构建与初步验证研究[J]. 中国全科医学, 2024, 27(14):1729-1734. DOI
	Zhao T, Jiang QX, Xu HL, et al. Construction and preliminary validation of bathing with wounds at home scheme for patients with traumatic wounds[J]. Chin Gen Pract, 2024, 27(14):1729-1734.
[26]	蒋琪霞, 徐娟, 王亚玲, 等. 创伤伤口患者居家洗浴与伤口感染现况调查及伤口感染影响因素分析:一项多中心研究[J]. 中国全科医学, 2021, 24(29):3757-3762. DOI
	Jiang QX, Xu J, Wang YL, et al. Inventory survey of home bathing and wound infection in patients with traumatic wounds and analysis of the influencing factors of wound infection:a multicenter study[J]. Chin Gen Pract, 2021, 24(29):3757-3762.
[27]	蒋琪霞, 徐娟, 刘晓晴, 等. 创伤性伤口患者皮肤清洗现况及原因的多中心横断面研究[J]. 创伤外科杂志, 2020, 22(9):646-650,654.
	Jiang QX, Xu J, Liu XQ, et al. A multicenter cross-sectional study on the current situation and causes of skin cleaning in patients with traumatic wounds[J]. J Trauma Surg, 2020, 22(9):646-650,654.
[28]	Alheggi A, Alzakry L, Khunayn RB, et al. Skin cleansing and wound care practice in patients with epidermolysis bullosa[J]. J Dermatol Dermatol Surg, 2022, 26(1):13-17. DOI URL
[29]	Takehara K, Amemiya A, Mugita Y, et al. The association bet-ween tinea pedis and feet-washing behavior in patients with diabetes:a cross-sectional study[J]. Adv Skin Wound Care, 2017, 30(11):510-516. DOI PMID
[30]	蒋琪霞, 周济宏, 程东瑞, 等. 132例手术切口感染患者临床特征及干预效果分析[J]. 医学研究生学报, 2020, 33(2):178-183.
	Jiang QX, Zhou JH, Cheng DR, et al. Clinical characteristics and prognosis of 132 patients with surgical site infection[J]. J Med Postgrad, 2020, 33(2):178-183.
[31]	Yoo JS, Lee H, Kim SE, et al. Effects of early postoperative shower after cardiac surgery[J]. Ann Palliat Med, 2022, 11(8):2562-2568. DOI URL
[32]	刘晓晴, 蒋琪霞, 宋思平. 皮肤清洗对术后切口感染影响的病例对照研究[J]. 中西医结合护理(中英文), 2020, 6(10):216-218.
	Liu XQ, Jiang QX, Song SP. Effect of skin cleaning on pre-venting incisional wound infection after surgery:a case-control study[J]. Nurs Integr Tradit Chin West Med, 2020, 6(10):216-218.
[33]	Sano H, Ichioka S. Which cleansing care is better,foot bath or shower? Analysis of 236 limb ulcers[J]. Int Wound J, 2015, 12(5):577-580. DOI URL
[34]	Jayathilake A, Jayaweera JAAS, Kumbukgolla WW, et al. Inf-luence of early postoperative showering in undressed surgical wound for better clinical outcome[J]. J Perioper Pract, 2020, 30(6):163-169. DOI PMID
[35]	Ferhatoglu MF, Kartal A, Ekici U, et al. Effects of bathing habits on postoperative wound complications following sacro-coccygeal pilonidal sinus surgery:a retrospective analysis of 67 adolescent patients[J]. Wounds, 2019, 31(11):292-296. PMID
[36]	Ogawa H, Tahara S. Postoperative showering for patients with closed suction drainage:a retrospective cohort study of deep inferior epigastric perforator flap breast reconstructions[J]. Cu-reus, 2022, 14(3):e23665.
[37]	Feilmeier M, Dayton P, Sedberry S, et al. Incidence of surgical site infection in the foot and ankle with early exposure and showering of surgical sites:a prospective observation[J]. J Foot Ankle Surg, 2014, 53(2):173-175. DOI PMID
[38]	王盈, 强万敏, 李静, 等. 皮肤清洁对癌症患者放射性皮炎影响效果的系统评价[J]. 护士进修杂志, 2020, 35(5):426-432.
	Wang Y, Qiang WM, Li J, et al. Skin cleanness for radiation induced skin reaction in cancer patients:a systematic review[J]. J Nurses Train, 2020, 35(5):426-432.
[39]	Copeland-Halperin LR, Reategui Via Y Rada ML, Levy J, et al. Does the timing of postoperative showering impact infection rates? A systematic review and meta-analysis[J]. J Plast Re-constr Aesthet Surg, 2020, 73(7):1306-1311.
[40]	张媛, 郭锦丽, 刘宏, 等. 慢性伤口患者创面操作性疼痛管理的最佳证据总结[J]. 中华护理杂志, 2024, 59(14):1761-1768.
	Zhang Y, Guo JL, Liu H, et al. The best evidence summary of wound procedural pain management in patients with chronic wounds[J]. Chin J Nurs, 2024, 59(14):1761-1768.
[41]	张媛, 郭锦丽. 沉浸式虚拟现实技术在创面操作性疼痛管理中的应用进展[J]. 中华护理杂志, 2023, 58(2):243-249. DOI
	Zhang Y, Guo JL. Application progress of immersive virtual reality technology in wound procedural pain management[J]. Chin J Nurs, 2023, 58(2):243-249. DOI
[42]	孙红玲, 兰美娟, 王惠, 等. 医联体内慢性伤口护理联动管理障碍因素的质性研究[J]. 中华护理杂志, 2025, 60(18):2246-2251. DOI
	Sun HL, Lan MJ, Wang H, et al. Qualitative research on the barriers of chronic wound linkage management in medical consortium[J]. Chin J Nurs, 2025, 60(18):2246-2251. DOI
[43]	严雪芹, 柏素萍, 刘巧艳, 等. 烧伤后创面瘙痒患者非药物干预的最佳证据总结[J]. 中华护理杂志, 2024, 59(5):610-617. DOI
	Yan XQ, Bai SP, Liu QY, et al. Best evidence summary of non-pharmacological interventions in post-burn itch[J]. Chin J Nurs, 2024, 59(5):610-617. DOI