应用 PUSH 工具治疗糖尿病足溃疡的前瞻性研究。
A prospective study of the PUSH tool in diabetic foot ulcers.
机构信息
The University of Iowa, College of Nursing, Iowa City, IA, USA.
出版信息
J Wound Ostomy Continence Nurs. 2011 Jul-Aug;38(4):385-93. doi: 10.1097/WON.0b013e31821e4dbd.
PURPOSE
The purpose of this study was to examine the predictive validity of Pressure Ulcer Scale for Healing (PUSH; v. 3.0) in monitoring healing of neuropathic foot ulcers in patients with diabetes mellitus.
DESIGN
This is a 13-week descriptive, prospective study describing the trajectory of change over time and the time-to-heal associated with PUSH scores. The study monitored a convenience sample of 18 subjects with Wagner 2 or greater neuropathic, nonischemic ulcers on the plantar surface of the foot, which healed completely over a 13-week follow-up period. Every 2 weeks, the study ulcers were evaluated via PUSH. Healing was defined as complete reepithelialization.
RESULTS
PUSH scores were modeled using a piecewise linear regression. PUSH values decreased significantly (P < .0001) at a rate of 0.6656 per week, until 2 weeks before healing, and then decreased significantly (P < .0001) at a rate of 2.2496 per week for the last 2 weeks of healing. Conversely, the time-to-heal (in weeks) increased significantly (P < .0001), at a rate of 0.6412 per each unit increase in PUSH for PUSH values of 4 or less, and then significantly (P < .0001) increased at a rate of 1.072 for PUSH values greater than 5. In predicting time-to-heal, the subitem of length × width alone (R = 0.81) is comparable to the total PUSH score (R = 0.76). Individually, exudate (R = 0.36) and tissue type (R = 0.42) are not nearly as useful as length × width.
CONCLUSION
Our findings indicate that PUSH scores significantly decrease over time in healing neuropathic diabetic foot ulcers (DFUs) that have no arterial etiologic component. Findings also suggest that total PUSH scores predict time-to-heal for DFU. We showed that a DFU with a PUSH score of 10 would be expected to heal in 8.8 weeks (95% CI: 7.4-10.2) and a DFU with a PUSH score of 4 in 2.6 weeks (95% CI: 1.88-3.25). Finally, measurements of size alone predict healing time for neuropathic DFU. This finding could greatly simplify clinical assessments.
目的
本研究旨在检验伤口愈合压力量表（PUSH；v.3.0）在监测糖尿病患者神经病变性足部溃疡愈合方面的预测效度。
设计
这是一项为期 13 周的描述性、前瞻性研究，描述了随时间变化的变化轨迹以及与 PUSH 评分相关的愈合时间。该研究监测了 18 名受试者的便利样本，这些受试者患有 Wagner 2 级或更高级别的神经病变性、非缺血性足底溃疡，在 13 周的随访期间完全愈合。每 2 周，通过 PUSH 评估研究性溃疡。愈合定义为完全再上皮化。
结果
使用分段线性回归对 PUSH 评分进行建模。PUSH 值以每周 0.6656 的速度显著下降（P<.0001），直到愈合前 2 周，然后在愈合的最后 2 周以每周 2.2496 的速度显著下降（P<.0001）。相反，愈合时间（以周为单位）显著增加（P<.0001），PUSH 值为 4 或以下时，每增加一个单位 PUSH 值，愈合时间就会增加 0.6412 周，而 PUSH 值大于 5 时，愈合时间则会显著增加（P<.0001），速度为 1.072。在预测愈合时间方面，长度×宽度的子项（R=0.81）与总 PUSH 评分（R=0.76）相当。单独来看，渗出物（R=0.36）和组织类型（R=0.42）的作用远不如长度×宽度。
结论
我们的研究结果表明，在没有动脉病因的情况下，愈合的神经病变性糖尿病足溃疡（DFU）的 PUSH 评分随时间显著下降。研究结果还表明，总 PUSH 评分可预测 DFU 的愈合时间。我们发现，PUSH 评分为 10 的 DFU 预计将在 8.8 周（95%CI：7.4-10.2）内愈合，PUSH 评分为 4 的 DFU 将在 2.6 周（95%CI：1.88-3.25）内愈合。最后，单独测量大小即可预测神经病变性 DFU 的愈合时间。这一发现可以大大简化临床评估。
Zotero 插件