比較傷口敷料處置於壓瘡預防之成效

A Comparison of the Efficacy of Different Wound Dressing Management Techniques in Preventing Pressure Ulcers

背景：傷口護理之高科技敷料於國內外臨床上廣為使用，但被用於預防壓瘡之成效，並無實證探討。目的：探討常規翻身護理處置與合併使用親水性敷料或泡棉敷料後，對預防尾薦骨壓瘡發生之成效。方法：採類實驗設計及方便取樣方式，以花蓮某醫院外科加護病患共90位為樣本，隨機分派至「常規翻身組」、「常規翻身合併使用親水性敷料組」或「常規翻身合併使用泡棉敷料組」。以Braden scale作為評估壓瘡風險工具，並採歐洲壓瘡諮詢委員會最新壓瘡分級標準用以每日檢視皮膚。資料分析以t檢定、ANOVA及曼—惠特尼U檢定。結果：「合併使用泡棉敷料組」之病人並未發生任何壓瘡。餘發生壓瘡比率以「常規翻身組」最高，其次為「合併使用親水性敷料組」，發生壓瘡等級以一、二級居多；然此兩組在發生壓瘡的時間上未達顯著差異。檢視「有發生壓瘡組」與「無發生壓瘡組」之間，其性別、高血壓史及身體質量指數變項均達顯著差異（p < .05）。結論／實務應用建議對於臨床上高危險群病患，除了應採落實的更換姿位以及檢視皮膚之外，可視情況介入親水性敷料或泡棉敷料以預防尾薦骨壓瘡。

Background: Although high-technology wound dressings are widely used in clinical care worldwide, no evidence or discussions have been published regarding the efficacy of these dressings in preventing pressure ulcers.Purpose: This study presents a repositioning of routine management combined with hydrocolloid dressing or foam dressing for pressure ulcer prevention.Method: We used a quasi-experimental design and recruited a convenience sample of 90 from a surgical intensive care unit (SICU) at a medical center in Hualien County, Taiwan. Participants were allocated randomly to one of three groups: repositioning of routine management, hydrocolloid dressing, and foam dressing. Study instruments included a pressure ulcer risk table (Braden scale) and the pressure ulcer classification system of the European Pressure Ulcer Advisory Panel. An independent sample t-test, ANOVA, and Mann-Whitney U test were used to verify research hypotheses.Results: The repositioning of routine management group had the highest pressure ulcer incidence rate, followed by the hydrocolloid-dressing group. The foam-dressing group recorded no pressure ulcers. Pressure ulcer occurrence grades were primarily level 1 and 2. There was no significance difference in pressure ulcer occurrence time between the repositioning of routine-management group and the hydrocolloid-dressing group. Finally, there were significant differences (p＜ .05) among gender, hypertension history, and BMI regardless of pressure ulcer incidences.Conclusion: It is recommended that patients in high-risk groups in clinical settings adopt strategies including repositioning and regular visual skin examinations. Also, hydrocolloid or foam dressings may be used as appropriate to prevent sacral pressure ulcers.