皮肤温度监测在压力性损伤风险预警中的应用研究

doi:10.3761/j.issn.0254-1769.2020.01.005

摘要/Abstract

摘要：

目的分析皮肤温度变化与压力性损伤发生的相关性,以温度变化情况量化风险水平,探讨该指标监测在压力性损伤风险预警中的应用价值。方法采用连续整群抽样法选取温州市某三级甲等医院综合ICU、神经外科ICU、呼吸科ICU、急诊科ICU、CCU患者415例,获取患者人口学特征和临床基线数据,以及每日骶尾部皮肤温度变化情况。采用Spearman秩相关分析皮肤相对温差与压力性损伤的相关性。以X-tile分析计算皮肤相对温差预测压力性损伤的最佳截断值,采用受试者操作特征曲线评价其预测效果。采用Kaplan-Meier生存曲线分析和COX比例风险回归模型比较不同皮肤相对温差与压力性损伤的发生风险。结果骶尾部皮肤相对温差与压力性损伤发生存在负相关关系（P<0.001）。该指标预测压力性损伤的最佳截断值为-0.1 ℃,受试者操作特征曲线下面积为0.901,约登指数为0.753,灵敏度为85.37%,特异度为89.89%。当皮肤相对温差≤-0.1 ℃时,压力性损伤发生率显著增加,以入院后第4、5天压力性损伤发生率最高（3.44%）,其发生风险是皮肤相对温差>-0.1 ℃时的6.63倍[HR=6.36,95%CI（3.91~10.36）]。结论皮肤温度监测能够较好地预测压力性损伤的发生,建议应密切关注患者入院后第4、5天骶尾部皮肤温度变化情况,当皮肤温度降低（相对温差≤-0.1 ℃）时,压力性损伤发生风险增加,应及时采取预防措施,以降低压力性损伤的发生率。

关键词: 压力性损伤, 皮肤温度, 危险度评估, 重症监护病房, 护理

Abstract:

Objective To explore the application value of skin temperature in early warning of pressure injury through analyzing the correlation between skin temperature and pressure injury and quantifying the risk level by temperature indicator. Methods A total of 415 inpatients from comprehensive ICU,neurosurgical ICU,respiratory ICU,emergency department ICU and CCU in a tertiary hospital in Wenzhou were selected by continuous cluster sampling. Demographic and clinical data were obtained,as well as daily skin temperature of sacral area. The correlation between skin temperature and pressure injury was analyzed by Spearman rank correlation. The X-tile analysis was used to acquire the optimal cutoff value of skin temperature,and the prediction effect was evaluated by the receiver operating characteristic curve. The occurrence risk of pressure injury with different skin temperature was compared by Kaplan-Meier survival curve analysis and COX proportional hazard regression model. Results There was a negative correlation between the relative skin temperature of sacral area and the occurrence of pressure injury（P<0.001）. The optimal cutoff value of this indicator for predicting pressure injury was -0.1 ℃. The area under the receiver operating characteristic curve of this indicator was 0.901,with the Youden index of 0.753,the sensitivity of 85.37%,the specificity of 89.89%. When the relative temperature in sacral area was below -0.1 ℃,the incidence of pressure injury increased significantly,with the highest incidence rate on the 4th and 5th day after admission（3.44%）. The risk was 6.63 times higher than that of the temperature above -0.1 ℃[HR=6.36,95%CI（3.91~10.36）]. Conclusion Skin temperature monitoring can effectively predict the occurrence of pressure injury. It is recommended to pay close attention to changes of the skin temperature at sacral area on the 4th and 5th day after admission. The decreased skin temperature（the relative temperature≤-0.1℃） means the higher risk of pressure injury,and precautions should be taken timely to reduce the incidence of pressure injury.

Key words: Pressure Injury, Skin Temperature, Risk Assessment, Intensive Care Units, Nursing Care

江小琼, 蔡福满, 侯祥庆, 邓海松, 凌翔伟, 郭海雷, 卢中秋. 皮肤温度监测在压力性损伤风险预警中的应用研究[J]. 中华护理杂志, 2020, 55(1): 32-38.

JIANG Xiaoqiong, CAI Fuman, HOU Xiangqing, DENG Haisong, LING Xiangwei, GUO Hailei, LU Zhongqiu. Application research of skin temperature monitoring in early warning of pressure injury[J]. Chinese Journal of Nursing, 2020, 55(1): 32-38.

图/表 7

表1 研究对象的一般资料分析[例数（百分比,%）]

图1 压力性损伤未发生组皮肤相对温差变化散点图

图2 压力性损伤发生组皮肤相对温差变化散点图

表2 不同时间皮肤相对温差与发生压力性损伤的Spearman秩相关

图3 皮肤相对温差预测压力性损伤的最佳截断值

图4 皮肤相对温差预测压力性损伤发生的ROC曲线

图5 皮肤相对温差与压力性损伤发生的K-M生存曲线

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