Wei Li, Bao Yuting, Chai Qianwen, Zheng Jiaqi, Xu Weiwei
Tianjin Medical University Hospital Airport Hospital, Tianjin, China.
Tianjin Medical University Cancer Institute, Tianjin, China.
Wound Manag Prev. 2019 Apr;65(4):24-33.
Critically ill patients with fecal incontinence are at high risk of developing incontinence-associated dermatitis (IAD). Scientific prediction and prevention of IAD are essential.
The purpose of this study was to determine the risk factors for IAD among critically ill patients with fecal incontinence. Based on this information, a predictive risk assessment model was developed to provide research evidence for IAD prevention.
A prospective study was conducted from October 2016 to December 2017. Convenience sampling was used to recruit patients with fecal incontinence treated in intensive care units (ICUs) at Tianjin Medical University General Hospital in China. Trained nurses collected demographic data (age, gender, and ICU type), data related to fecal incontinence (Perineal Assessment Tool [PAT] scores, bowel movement frequency, and stool traits per the Bristol Stool Scale), and clinical data (length of ICU hospitalization, body temperature, diabetes history, hypertension history, consciousness, nutrition support, oxygen supply, number of antibiotic species, sedative use, and albumin levels) from participants and their medical records. The PAT was used to assess patient risk of developing IAD, and the Bristol Stool Scale was used to assess patient stool traits. Names were coded anonymously, and data were entered from paper-and-pencil questionnaires into a software program for statistical analysis. Univariate analysis and multivariate logistic regression were performed to identify risk factors for IAD. A predictive risk factor model was established using a receiver operating characteristic curve.
Among 266 critically ill patients with fecal incontinence (182 male, 84 female; mean age 64.18 ± 17.10), IAD incidence was 65.4%. The use of sedative drugs, coma status, higher PAT score, more frequent bowel movements, and loose stool were found to be independent risk factors for IAD (P <.05). The subsequent risk factor predictive model had a sensitivity and specificity of 99.4% and 96.7%, respectively, and the agreement rate was 98.1%.
The identified risk factors and subsequent predictive model may contribute to timely identification and quantitative risk assessment of IAD among critically ill patients. Additional quantitative research could provide a scientific basis for the development of specific preventive interventions.
患有大便失禁的重症患者发生失禁相关性皮炎（IAD）的风险很高。对IAD进行科学预测和预防至关重要。
本研究旨在确定大便失禁的重症患者发生IAD的危险因素。基于这些信息，开发了一种预测风险评估模型，为IAD预防提供研究证据。
于2016年10月至2017年12月进行了一项前瞻性研究。采用便利抽样法，在中国天津医科大学总医院重症监护病房（ICU）招募大便失禁患者。经过培训的护士收集了人口统计学数据（年龄、性别和ICU类型）、与大便失禁相关的数据（会阴评估工具[PAT]评分、排便频率和根据布里斯托大便分类法的粪便性状）以及临床数据（ICU住院时间、体温、糖尿病史、高血压史、意识、营养支持、供氧、抗生素种类数量、镇静剂使用情况和白蛋白水平），这些数据来自参与者及其病历。PAT用于评估患者发生IAD的风险，布里斯托大便分类法用于评估患者的粪便性状。姓名进行了匿名编码，数据从纸质问卷录入软件程序进行统计分析。进行单因素分析和多因素逻辑回归以确定IAD的危险因素。使用受试者工作特征曲线建立了预测危险因素模型。
在266例大便失禁的重症患者中（男性182例，女性84例；平均年龄64.18±17.10），IAD发生率为65.4%。使用镇静药物、昏迷状态、较高的PAT评分、更频繁的排便和稀便被发现是IAD的独立危险因素（P<.05）。随后的危险因素预测模型的敏感性和特异性分别为99.4%和96.7%，一致率为98.1%。
所确定的危险因素及随后的预测模型可能有助于对重症患者的IAD进行及时识别和定量风险评估。更多的定量研究可为制定具体的预防干预措施提供科学依据。
