Nixon Jane, Cranny Gillian, Bond Senga
Clinical Trials Research Unit, University of Leeds, 17 Springfield Mount, Leeds LS2 9NG, UK.
Int J Nurs Stud. 2007 Jul;44(5):655-63. doi: 10.1016/j.ijnurstu.2006.02.010. Epub 2006 Apr 24.
The pathology literature suggests three types of pressure ulcer with six possible mechanisms leading to tissue breakdown. A limitation of current evidence is the difficulty in replicating the clinical situation and in determining the point at which a tissue assault becomes irreversible and results in tissue breakdown. In particular clinical observations of alteration in darkly pigmented skin, blanching erythema, non-blanching erythema and non-blanching erythema with other skin changes including induration, oedema, pain, warmth or discolouration have not been assessed in relation to subsequent skin/tissue loss and their pathophysiological and aetiological importance is not fully understood.
To assess the validity of clinical signs of erythema as predictors of pressure ulcer development and identify variables which independently are predictive of Grade 2 pressure ulcer development.
Prospective cohort study.
109 general, vascular and orthopaedic hospital patients, aged over 55 years with an expected length of stay of 5 days were recruited. Of these 97 were pressure ulcer free at baseline and/or had complete follow-up including 59 women and 38 men with a median age of 75 years (range 55-95).
Single centre large acute UK NHS hospital.
To identify clinical signs of erythema predictive of skin loss, the odds of pressure ulcer development were examined using logistic regression. To identify variables independently predictive of Grade 2 pressure ulcer development logistic regression modeling was undertaken.
There was significantly increased odds of pressure ulcer development associated with non-blanching erythema (7.98, p=0.002) and non-blanching erythema with other skin changes (9.17, p=0.035). Logistic regression modeling identified non-blanching erythema, pre-operative albumin, weight loss, and intra-operative minimum diastolic blood pressure, as independent predictors of Grade > or =2 pressure ulcer development.
Non-blanching erythema with or without other skin changes is distinct from normal skin/blanching erythema and is associated with subsequent pressure ulcer development.
病理学文献提出了三种类型的压疮以及导致组织破损的六种可能机制。当前证据的一个局限性在于难以复制临床情况，也难以确定组织损伤在何时变得不可逆转并导致组织破损。特别是对于深色皮肤改变、苍白性红斑、非苍白性红斑以及伴有硬结、水肿、疼痛、发热或变色等其他皮肤变化的非苍白性红斑，尚未就其与随后的皮肤/组织损失的关系进行评估，其病理生理和病因学重要性也未得到充分理解。
评估红斑临床体征作为压疮发生预测指标的有效性，并确定独立预测2级压疮发生的变量。
前瞻性队列研究。
招募了109名年龄超过55岁、预期住院时间为5天的综合医院、血管外科和骨科医院患者。其中97名在基线时无压疮且/或有完整的随访资料，包括59名女性和38名男性，中位年龄为75岁（范围55 - 95岁）。
英国国民健康服务体系（NHS）的一家单中心大型急症医院。
为确定可预测皮肤损失的红斑临床体征，采用逻辑回归分析压疮发生的几率。为确定独立预测2级压疮发生的变量，进行逻辑回归建模。
与非苍白性红斑（比值比7.98，p = 0.002）以及伴有其他皮肤变化的非苍白性红斑（比值比9.17，p = 0.035）相关的压疮发生几率显著增加。逻辑回归建模确定非苍白性红斑、术前白蛋白、体重减轻和术中最低舒张压为≥2级压疮发生的独立预测因素。
伴有或不伴有其他皮肤变化的非苍白性红斑与正常皮肤/苍白性红斑不同，且与随后的压疮发生相关。
