Keller B Paul J A, Wille Jan, van Ramshorst Bert, van der Werken Christian
Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Intensive Care Med. 2002 Oct;28(10):1379-88. doi: 10.1007/s00134-002-1487-z. Epub 2002 Sep 7.
Review of the literature concerning pressure ulcers in the intensive care setting. DATA SOURCE AND STUDY SELECTIONS: Computerized databases (Medline from 1980 until 1999 and CINAHL from 1982 until 1999). The indexing terms for article retrieval were: "pressure ulcers", "pressure sores", "decubitus", and "intensive care". Nineteen articles met the selection criteria, and seven more were found from the references of these articles. One thesis was also analyzed.
Data on prevention, incidence, and costs of pressure ulcers in ICU patients are scarce. Overall there are no conclusive studies on the identification of pressure ulcer risk factors. None of the existing risk-assessment scales was developed especially for use in ICU patients. It is highly questionable to what extent these scales can be used in this setting as they are not even reliable in "standard care". The following risk factors might play a role in pressure ulcer development: duration of surgery and number of operations, fecal incontinence and/or diarrhea, low preoperative protein and albumin concentrations, disturbed sensory perception, moisture of the skin, impaired circulation, use of inotropic drugs, diabetes mellitus, too unstable to turn, decreased mobility, and high APACHE II score. The number of patients per study ranged from 5 from 638. The definition of "pressure ulcer" varied widely between authors or was not mentioned.
Meaningful comparison cannot be made between the various studies because of the use of different grading systems for pressure ulcers, different methods of data collection, different (or lack of) population characteristics, unreported preventive measures, and the use of different inclusion and exclusion criteria. There is a need for well-conducted studies covering all these aspects.
综述重症监护环境下有关压疮的文献。
计算机数据库（1980年至1999年的Medline以及1982年至1999年的CINAHL）。用于文章检索的索引词为：“压疮”、“压力性溃疡”、“褥疮”以及“重症监护”。19篇文章符合入选标准，另外从这些文章的参考文献中又发现7篇。还分析了1篇论文。
关于重症监护病房患者压疮的预防、发生率及成本的数据稀缺。总体而言，对于压疮危险因素的识别尚无定论性研究。现有的风险评估量表均不是专门为重症监护病房患者设计的。这些量表在这种环境下能在多大程度上使用非常值得怀疑，因为它们在“标准护理”中甚至都不可靠。以下危险因素可能在压疮形成中起作用：手术持续时间和手术次数、大便失禁和/或腹泻、术前低蛋白和白蛋白浓度、感觉障碍、皮肤潮湿、循环受损、使用强心药物、糖尿病、过于不稳定无法翻身、活动减少以及高APACHE II评分。每项研究的患者数量从5例到638例不等。作者之间对“压疮”的定义差异很大，或者未提及。
由于压疮分级系统不同、数据收集方法不同、人群特征不同（或缺乏）、未报告预防措施以及使用不同的纳入和排除标准，各研究之间无法进行有意义的比较。需要开展涵盖所有这些方面的高质量研究。
