Kramer J D, Kearney M
Johns Hopkins Medical Services Corporation, Baltimore, MD, USA.
Adv Skin Wound Care. 2000 Jan-Feb;13(1):17-24.
To examine the associations among selected patient, wound, and treatment factors and healing in pressure ulcers.
Nonexperimental, retrospective study using data extracted from charts of patients having a Stage II, III, or IV pressure ulcer between July 1994 and November 1996.
A long-term-care facility associated with a major metropolitan medical center.
Evidence of healing was significantly associated with patient weight (P < .05) and negatively associated with body temperature (P < .05), time on a pressure-relieving bed (P < .05), amount of exudate (P < .001), and stage of pressure ulcer (P < .001). In a regression analysis, pressure ulcer stage, patient weight, and mean body temperature explained 25% of the variability in healing; specifically, lower pressure ulcer stage, higher patient weight, and lower mean body temperature predicted improved healing. Healing was not predicted by chronologic age, pressure ulcer location, number of illnesses, use of tube feedings, use of pressure-relieving beds, mean arterial pressure, or Braden Scale score. In a regression analysis of patient factors alone, lower body temperature and higher weight together predicted 9% of the variance in healing. When wound variables were analyzed, 19% of the variability in healing was explained by the stage of the pressure ulcer. Of the treatment variables, only shorter time on a pressure-relieving bed predicted healing, explaining 6% of the variance.
Strategies for healing pressure ulcers in nursing home patients should include programs for early recognition of pressure injury and prevention of pressure ulcer progression to higher stages; attention to weight gain and/or weight maintenance in at-risk patients; and early recognition and treatment of infections and febrile episodes.
研究特定患者、伤口及治疗因素与压疮愈合之间的关联。
非实验性回顾性研究，使用从1994年7月至1996年11月期间患有II期、III期或IV期压疮患者的病历中提取的数据。
与一个大型都市医疗中心相关联的长期护理机构。
愈合证据与患者体重显著相关（P < 0.05），与体温呈负相关（P < 0.05），与使用减压床的时间呈负相关（P < 0.05），与渗出量呈负相关（P < 0.001），与压疮分期呈负相关（P < 0.001）。在回归分析中，压疮分期、患者体重和平均体温解释了愈合变异性的25%；具体而言，较低的压疮分期、较高的患者体重和较低的平均体温预示着愈合情况改善。愈合情况无法通过年龄、压疮位置、疾病数量、鼻饲使用情况、减压床使用情况、平均动脉压或Braden量表评分来预测。在仅对患者因素进行的回归分析中，较低的体温和较高的体重共同预测了愈合变异性的9%。当分析伤口变量时，压疮分期解释了愈合变异性的19%。在治疗变量中，只有较短的减压床使用时间预示着愈合，解释了6%的变异性。
疗养院患者压疮愈合策略应包括早期识别压力性损伤和预防压疮进展至更高分期的项目；关注高危患者的体重增加和/或体重维持；以及早期识别和治疗感染及发热发作。
