Sato Miwa, Sanada Hiromi, Konya Chizuko, Sugama Junko, Nakagami Gojiro
Nursing Department, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Int Wound J. 2006 Dec;3(4):355-62. doi: 10.1111/j.1742-481X.2006.00267.x.
The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty-one stage I pressure ulcers in 30 patients in a long-term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36.4%, 95.0%, 80.0%, 73.1% and 7.28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment.
I期压疮的预后无法预测；因此，预防其恶化的护理干预措施尚未明确确立。本研究描述了I期压疮的临床病程，并前瞻性地调查了与其恶化相关的因素。对一家长期护理机构中30例患者的31处I期压疮进行了研究，每天评估其形态变化，直至溃疡愈合或恶化。通过超声检查和热成像评估生理变化。20处溃疡愈合，11处恶化。恶化的特征如下：（1）双重红斑；（2）通过玻璃板压迫确定的整个区域不可褪色的红斑；（3）远离骨突尖端的红斑；（4）次日红斑扩大。我们分析了双重红斑和距骨突尖端距离这两个恶化指标用于诊断的敏感性、特异性、阳性预测值、阴性预测值和阳性似然比，这两个指标无需使用任何特殊设备即可立即评估。其值分别为36.4%、95.0%、80.0%、73.1%和7.28。这些结果表明，临床医生可以通过初始评估预测I期压疮的预后，并根据评估提供适当的护理。
