Bergstrom N, Braden B
Department of Nursing Education, Administration and Science, College of Nursing, University of Nebraska Medical Center, Omaha 68198-5330.
J Am Geriatr Soc. 1992 Aug;40(8):747-58. doi: 10.1111/j.1532-5415.1992.tb01845.x.
To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly.
Cohort study.
250-bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days.
Two hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay greater than 10 days, at risk for pressure sore development (Braden Scale score less than or equal to 17) but free of existing pressure sores were studied for 12 weeks or until discharge.
Skin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks.
Presence/absence and stage of pressure sores.
Stage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P less than 0.001) and had lower systolic and diastolic blood pressure (P less than 0.001) and higher body temperature (P less than 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age.
Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.
确定饮食摄入、营养状况及其他身体指标是否为老年人发生压疮的危险因素。
队列研究。
拥有250张床位的专业护理机构及90张长期护理床位，平均住院时间为28天。
200名新入院居民（70%为女性，95%为白种人），年龄超过65岁，预计住院时间超过10天，有发生压疮的风险（Braden量表评分小于或等于17）且无现存压疮，研究为期12周或直至出院。
每周进行皮肤评估、Braden量表评分、血压、体温、人体测量学及饮食摄入情况的研究。连续4周每周及接下来8周每两周进行血常规、血清白蛋白、血清总蛋白、血清铁、铁结合能力、血清锌和铜以及血清维生素C的研究。
压疮的有无及分期。
70名（35%）居民发生了I期压疮，77名（38.5%）居民发生了2期或更严重的压疮。发生压疮的受试者比未发生压疮的受试者年龄更大（P<0.001），收缩压和舒张压更低（P<0.001），体温更高（P<0.001）。发生压疮的受试者所有营养素的饮食摄入量更低。使用逻辑回归分析，压疮发生的最佳预测指标为Braden量表评分、舒张压、体温、饮食蛋白质摄入量和年龄。
建议在入住养老院时及入院后第一个月每周进行风险评估。结合年龄、血压、体温和饮食蛋白质摄入量的知识，使用Braden量表可有效预测风险状态。
