Dhandapani Manju, Dhandapani Sivashanmugam, Agarwal Meena, Mahapatra Ashok K
National Institute of Nursing Education, PGIMER, Chandigarh, India.
J Clin Nurs. 2014 Apr;23(7-8):1114-9. doi: 10.1111/jocn.12396. Epub 2013 Sep 21.
To assess the factors associated with development of pressure ulcer in patients with severe traumatic brain injury (TBI) and study its prognostic significance with respect to neurological outcome at three months.
Patients with severe TBI are prone to develop pressure ulcer due to various factors, which have never been studied in detail.
Prospective longitudinal study.
Eighty-nine patients of TBI in age group 20-60 years admitted with Glasgow Coma Scale (GCS) 4-8 without serious systemic disorder were enrolled for the study. Patient characteristics, haemoglobin, serum albumin levels at admission and their weekly changes till 21 days were noted along with daily assessment for presence of pressure ulcer. Mortality was assessed at 21 days and neurological outcome at three months through telephonic interview.
Of 89 patients studied, pressure ulcer was observed in 6 (7%) and 14 (16%) at the end of two and three weeks, respectively. Pressure ulcer in univariate analysis was significantly associated with poorer GCS (p = 0·05), delayed enteral feeding (p = 0·005) and fall in haemoglobin at two weeks (p = 0·005). Only the latter two were found significant in multivariate analysis. Age, gender, surgical intervention, tracheostomy, prolonged fever and change in albumin had no significant association with pressure ulcer development. Presence of pressure ulcer was significantly associated with mortality at 21 days (p = 0·006) and unfavourable neurological outcome at three months (p = 0·01).
The significant factors influencing pressure ulcer development in patients with TBI were delayed enteral feeding and fall in haemoglobin. Pressure ulcer had significant association with mortality at 21 days and recovery status at three months.
Early nutritional supplementation and monitoring of haemoglobin should be an important part of nursing care interventions for patients at increased risk of developing pressure ulcer.
评估重度创伤性脑损伤（TBI）患者发生压疮的相关因素，并研究其对三个月时神经功能预后的意义。
重度TBI患者由于多种因素容易发生压疮，但此前从未进行过详细研究。
前瞻性纵向研究。
纳入89例年龄在20 - 60岁、格拉斯哥昏迷量表（GCS）评分为4 - 8分且无严重全身性疾病的TBI患者进行研究。记录患者的特征、入院时的血红蛋白、血清白蛋白水平及其至21天的每周变化情况，同时每天评估是否存在压疮。通过电话随访评估21天时的死亡率以及三个月时的神经功能预后。
在研究的89例患者中，分别在两周和三周结束时观察到6例（7%）和14例（16%）发生压疮。单因素分析中，压疮与较差的GCS评分（p = 0.05）、延迟肠内喂养（p = 0.005）以及两周时血红蛋白下降（p = 0.005）显著相关。多因素分析中仅发现后两者具有显著性。年龄、性别、手术干预、气管切开、长期发热以及白蛋白变化与压疮发生无显著关联。压疮的存在与21天时的死亡率（p = 0.006）以及三个月时不良神经功能预后（p = 0.01）显著相关。
影响TBI患者发生压疮的重要因素是延迟肠内喂养和血红蛋白下降。压疮与21天时的死亡率以及三个月时的恢复状况显著相关。
早期营养补充和血红蛋白监测应成为压疮发生风险增加患者护理干预的重要组成部分。
