改良式男用尿布對成人失禁性皮膚炎之成效探討

Effectiveness of Improved Male Diaper on Adults with Incontinence-Associated Dermatitis

目的
探討改良式男用尿布，結構改良的皮膚保護隔離措施，對男性外生殖器官處成人失禁性皮膚炎的改善成效。
方法
採兩組前後測類實驗研究設計。以中部某區域教學醫院，安養中心性質病房單位為研究對象共64人。收案期間107年7月14日至108年10月2日，選案條件為大小便失禁尿布依賴，男性外生殖器官處，患有成人失禁性皮膚炎的臥床病人，分成實驗組與控制組各32人。實驗組使用改良式男用尿布，搭配黏貼式尿布採半粘貼方式；控制組為臨床常規尿片，搭配黏貼式尿布封閉包覆。2週後以皮膚損傷程度及紅斑面積為炎症程度指標；酸鹼值、濕潤度、溫度為生理指標，作為評值前後測成效依據，資料採匿名編碼處理，以成對t檢定、卡方檢定，SPSS18.0統計軟體分析。
結果
炎症程度指標以皮膚紅斑最多，實驗組29位及控制組30位佔92.2％；紅斑面積兩組總平均值為27.65cm2；生理指標酸鹼值為7.84；濕潤度99.84％；溫度36.81℃。皮膚的損傷程度改善，兩組達顯著差異（p<0.05），紅斑面積也達顯著差異（p<0.001）；生理指標也降低了皮膚酸鹼值、濕潤度及溫度，實驗組皆優於控制組，達顯著差異（p<0.001）。
結論
男性外生殖器官以陰囊處紅斑最常見，改良式男用尿布相較於臨床封閉包覆，能間接改善皮膚損傷程度及減少紅斑；也使皮膚酸鹼值更趨酸性，並降低原高濕潤度環境與溫度，對成人失禁性皮膚炎有顯著改善成效。

Purposes
This study examined the effectiveness of skin-protective isolation of improved male diapers with an improved structure to ameliorate incontinence-associated dermatitis around the external genitalia of adult males.
Methods
A quasi-experimental pretest-posttest design was used, enrolling 64 patients in the nursing wards in a teaching hospital in central Taiwan between July 14, 2018 and October 2, 2019. The inclusion criterion was bedridden, diaper-dependent male patients with urinary/fecal incontinence who experienced adult incontinence-associated dermatitis in the genital area. The participants were divided into experimental and control groups with 32 patients each. In the experimental group, improved male diapers were paired with semi-taped diapers to close them, while in the control group, conventional clinical incontinence pads were paired with taped diapers, creating a sealed wrap. Two weeks later, the pretest/posttest results of the level of skin damage and the erythema area as indicators of inflammation, and pH, humidity, and temperature as the physiological indicators, were evaluated. The data were encrypted for anonymization, and paired t-test, chi-squared test, and SPSS 18.0 statistical software were used for analysis.
Results
Erythema was the most prevalent among the inflammation indicators, accounting for a total of 92.2% with 29 patients in the experimental group and 30 patients in the control group; the combined mean erythema area of the two groups was 27.65cm2. The physiological indicators showed a pH of 7.84, humidity of 99.84%, and temperature of 36.81℃. In addition, there was a reduction in skin damage, and the two groups manifested a significant difference (p<0.05), while there was also a significant difference in terms of the erythema area (p<0.001). The experimental group performed better than the control group for reductions in the physiological indicators (skin pH, humidity, and temperature), showing significant differences (p<0.001).
Conclusions
Erythema in males most often appears in the scrotum area of the genitalia. Compared with clinically sealed diapers, improved male diapers can indirectly minimize skin damage and reduce the erythema area. Additionally, the improved diapers are significantly effective in mitigating adult incontinence-associated dermatitis by effectively shifting the skin pH toward the acidic end and decreasing both humidity and temperature.