Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland.
J Clin Nurs. 2011 Sep;20(17-18):2633-44. doi: 10.1111/j.1365-2702.2011.03736.x. Epub 2011 Jun 27.
BACKGROUNDL: Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required.
A pragmatic, multi-centre, open label, prospective, cluster-randomised controlled trial was conducted to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens.
Ethical approval was received. Study sites (n=12) were allocated to study arm using cluster randomisation. The experimental group (n=99) were repositioned three hourly at night, using the 30° tilt; the control group (n=114) received routine prevention (six-hourly repositioning, using 90° lateral rotation). Data analysis was by intention to treat; follow-up was for four weeks.
All participants (n=213) were Irish and white, among them 77% were women and 65% aged 80 years or older. Three patients (3%) in the experimental group and 13 patients (11%) in the control group developed a pressure ulcer (p=0·035; 95% CI 0·031-0·038; ICC=0·001). All pressure ulcers were grade 1 (44%) or grade 2 (56%). Mobility and activity were the highest predictors of pressure ulcer development (β=-0·246, 95% CI=-0·319 to -0·066; p=0·003); (β=0·227, 95% CI=0·041-0·246; p = 0·006).
Repositioning older persons at risk of pressure ulcers every three hours at night, using the 30° tilt, reduces the incidence of pressure ulcers compared with usual care. The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines.
An effective method of pressure ulcer prevention has been identified; in the light of the problem of pressures ulcers, current prevention strategies should be reviewed. It is important to implement appropriate prevention strategies, of which repositioning is one.
压疮很常见，费用高昂，对个人影响负面。压力是主要原因，而活动受限则使个人面临压力。国际指南提倡翻身；然而，对于最佳方法和所需频率存在混淆。
一项实用的、多中心、开放性标签、前瞻性、集群随机对照试验，比较了使用两种不同翻身方案的老年人护理中压疮的发生率。
获得伦理批准。使用集群随机分配将研究地点（n=12）分配到研究臂。实验组（n=99）在夜间每三小时以 30°倾斜翻身；对照组（n=114）接受常规预防（每六小时以 90°侧卧翻身）。分析为意向治疗；随访为四周。
所有参与者（n=213）均为爱尔兰裔白人，其中 77%为女性，65%年龄在 80 岁或以上。实验组中有 3 名患者（3%）和对照组中有 13 名患者（11%）发生压疮（p=0·035；95%CI 0·031-0·038；ICC=0·001）。所有压疮均为 1 级（44%）或 2 级（56%）。活动能力和活动是压疮发展的最高预测因素（β=-0·246，95%CI=-0·319 至 -0·066；p=0·003）；（β=0·227，95%CI=0·041-0·246；p=0·006）。
与常规护理相比，夜间每三小时以 30°倾斜翻身对有压疮风险的老年人进行翻身可降低压疮的发生率。该研究支持 2009 年国际压疮预防指南的建议。
已确定了一种有效的压疮预防方法；鉴于压疮问题，应审查当前的预防策略。实施适当的预防策略很重要，其中翻身是一种策略。
