Alderden Jenny, Rondinelli June, Pepper Ginette, Cummins Mollie, Whitney JoAnne
Boise State University, 1910 W University Drive, Boise, Idaho 83725, United States; University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT 84112, United States; St. Luke's Meridian Medical Center, 520 S Eagle Road, Meridian, Idaho 83642, United States.
Kaiser Permanente Southern California Health Services, 393 E Walnut Street 7th Floor, Pasadena, CA 91188, United States.
Int J Nurs Stud. 2017 Jun;71:97-114. doi: 10.1016/j.ijnurstu.2017.03.012. Epub 2017 Mar 28.
To identify risk factors independently predictive of pressure injury (also known as pressure ulcer) development among critical-care patients.
We undertook a systematic review of primary research based on standardized criteria set forth by the Institute of Medicine.
We searched the following databases: CINAHL (EBSCOhost), the Cochrane Library (Wilson), Dissertations & Theses Global (ProQuest), PubMed (National Library of Medicine), and Scopus. There was no language restriction.
A research librarian coordinated the search strategy. Articles that potentially met inclusion criteria were screened by two investigators. Among the articles that met selection criteria, one investigator extracted data and a second investigator reviewed the data for accuracy. Based on a literature search, we developed a tool for assessing study quality using a combination of currently available tools and expert input. We used the method developed by Coleman et al. in 2014 to generate evidence tables and a summary narrative synthesis by domain and subdomain.
Of 1753 abstracts reviewed, 158 were identified as potentially eligible and 18 fulfilled eligibility criteria. Five studies were classified as high quality, two were moderate quality, nine were low quality, and two were of very low quality. Age, mobility/activity, perfusion, and vasopressor infusion emerged as important risk factors for pressure injury development, whereas results for risk categories that are theoretically important, including nutrition, and skin/pressure injury status, were mixed. Methodological limitations across studies limited the generalizability of the results, and future research is needed, particularly to evaluate risk conferred by altered nutrition and skin/pressure injury status, and to further elucidate the effects of perfusion-related variables.
Results underscore the importance of avoiding overinterpretation of a single study, and the importance of taking study quality into consideration when reviewing risk factors. Maximal pressure injury prevention efforts are particularly important among critical-care patients who are older, have altered mobility, experience poor perfusion, or who are receiving a vasopressor infusion.
确定重症监护患者发生压力性损伤（又称压疮）的独立预测风险因素。
我们根据医学研究所制定的标准化标准对原发性研究进行了系统评价。
我们检索了以下数据库：护理学与健康领域数据库（EBSCOhost）、考克兰图书馆（威尔逊）、全球博硕士论文数据库（ProQuest）、医学期刊数据库（美国国立医学图书馆）和Scopus。无语言限制。
一名研究馆员协调检索策略。由两名研究人员筛选可能符合纳入标准的文章。在符合选择标准的文章中，一名研究人员提取数据，另一名研究人员检查数据的准确性。基于文献检索，我们结合现有工具和专家意见开发了一种评估研究质量的工具。我们采用科尔曼等人在2014年开发的方法生成证据表，并按领域和子领域进行总结叙述性综合分析。
在审查的1753篇摘要中，158篇被确定为可能符合条件，18篇符合资格标准。五项研究被归类为高质量，两项为中等质量，九项为低质量，两项为极低质量。年龄、活动能力/活动情况、灌注和血管活性药物输注是压力性损伤发生的重要风险因素，而理论上重要的风险类别（包括营养以及皮肤/压力性损伤状况）的结果则参差不齐。各研究的方法学局限性限制了结果的普遍性，需要开展进一步研究，特别是评估营养改变和皮肤/压力性损伤状况所带来的风险，并进一步阐明与灌注相关变量的影响。
研究结果强调了避免对单一研究过度解读的重要性，以及在审查风险因素时考虑研究质量的重要性。在年龄较大、活动能力改变、灌注不良或正在接受血管活性药物输注的重症监护患者中，最大限度地预防压力性损伤尤为重要。
