Jiang Q X, Wang Y L, Yijie Y J, Liu X Q, Xu J, Zheng M C, Feng H, Wang W W, Sun H L, Zhu S L, Li W J, Zhao N
Department of Burns and Plastic Surgery, the General Hospital of the Eastern Theater Command of PLA, Nanjing 210002, China.
Nursing Department, the Army Medical Center, Chongqing 400042, China.
Zhonghua Shao Shang Za Zhi. 2021 May 20;37(5):429-436. doi: 10.3760/cma.j.cn501120-20210116-00023.
To investigate the status and influencing factors of skin cleaning outside wound (hereinafter referred to as skin) in adult trauma patients. A multicenter cross-sectional investigation was conducted. From September 1 to 30, 2020, a total of 952 adult trauma patients who met the inclusion criteria were admitted to wound care clinics or trauma surgery wards of 13 military or local Grade Ⅲ Level A hospitals, including the General Hospital of the Eastern Theater Command of People's Liberation Army and the Army Medical Center, etc. A self-designed questionnaire on cleaning status of skin in trauma patients was released through the "questionnaire star" website to investigate basic information such as gender, age, education level, living status, and self-care ability, trauma information such as cause of injury, wound duration, trauma site, trauma depth, wound pain, wound peculiar smell, and wound cleaning solution, and skin cleaning status after injury such as whether to clean or not, cleaning method, cleaning frequency, cleaning duration in each time, or reasons for not cleaning. The patients who cleaned skin regularly after injury were included in cleaning group, and the other patients were included in no cleaning group. The basic information, trauma information, and skin cleaning status after injury of patients in 2 groups were investigated. Data were statistically analyzed with chi-square test, and binary multivariate logistic regression analysis was performed on indicators with statistically significant differences between the two groups to screen the independent influencing factors of skin cleaning in trauma patients. A total of 952 questionnaires were received, and the recovery rate was 100%. Three invalid questionnaires were eliminated, and 949 valid questionnaires were obtained, with an effective rate of 99.68%. In 949 patients, there were 461 (48.6%) males and 488 (51.4%) females, aged 18-100 (50±18) years. Most patients were less than 60 years old, lived with their families, and could take care of themselves completely. Nearly half of the patients were with junior high school or below education level. The main causes of injury were sharp cutting injury and falling injury, the wound duration was 2-365 days, most of the injured parts were limbs and trunk, the wound depth was mostly full-thickness injury, and most patients had wound-related pain and no peculiar smell and used 5 g/L iodophor to clean the wound. Totally 684 (72.1%) patients cleaned their skin after injury, mainly by scrubbing with warm water, the cleaning frequency was mainly once or twice a week, and the cleaning time was mainly 10 or 15 min for each time. Totally 265 (27.9%) patients didn't clean their skin after injury, and the main causes for not cleaning were following the doctor's advice, followed by worrying about wound infection and loss of self-care ability. There were significantly statistical differences in constituent ratios of education level, self-care ability, cause of injury, wound pain, and wound peculiar smell of patients in 2 groups (=12.365, 24.519, 22.820, 9.572, 92.342, <0.01). Education level, self-care ability, cause of injury, wound pain, and wound peculiar smell were potential influencing factors of skin cleaning in patients. Binary multivariate logistic regression analysis showed that self-care ability, wound pain, and wound peculiar smell were independent influencing factors of skin cleaning in patients (odds ratio=1.51, 0.52, 3.72, 95% confidence interval=1.08-2.12, 0.42-0.89, 2.66-5.22, <0.05 or <0.01). Self-care ability, wound pain, and wound peculiar smell are independent influencing factors of skin cleaning in adult trauma patients.
探讨成年创伤患者伤口外皮肤清洁(以下简称皮肤清洁)现状及影响因素。进行多中心横断面调查。2020年9月1日至30日,解放军东部战区总医院、陆军军医大学第一附属医院等13家军队或地方三级甲等医院的伤口护理门诊或创伤外科病房共收治952例符合纳入标准的成年创伤患者。通过“问卷星”网站发放自行设计的创伤患者皮肤清洁状况调查问卷,调查患者的性别、年龄、文化程度、居住状况、自理能力等基本信息,致伤原因、伤口持续时间、创伤部位、创伤深度、伤口疼痛、伤口异味、伤口清洁液等创伤信息,以及伤后皮肤清洁状况(是否清洁、清洁方法、清洁频率、每次清洁时长或未清洁原因)。将伤后定期清洁皮肤的患者纳入清洁组,其他患者纳入未清洁组。调查两组患者的基本信息、创伤信息及伤后皮肤清洁状况。数据采用χ²检验进行统计学分析,对两组间差异有统计学意义的指标进行二元多因素Logistic回归分析,筛选创伤患者皮肤清洁的独立影响因素。共回收问卷952份,回收率100%。剔除无效问卷3份,获得有效问卷949份,有效率99.68%。949例患者中,男性461例(48.6%),女性488例(51.4%),年龄18~100(50±18)岁。多数患者年龄<60岁,与家人同住,能完全自理。近半数患者文化程度为初中及以下。主要致伤原因是锐器切割伤和摔伤,伤口持续时间2~365天,受伤部位多为四肢和躯干,伤口深度多为全层伤,多数患者有伤口相关疼痛,无异味,使用5 g/L碘伏清洁伤口。伤后共684例(72.1%)患者清洁皮肤,主要采用温水擦洗,清洁频率多为每周1~2次,每次清洁时间多为10或15分钟。伤后共265例(27.9%)患者未清洁皮肤,未清洁的主要原因是遵医嘱,其次是担心伤口感染和自理能力丧失。两组患者文化程度、自理能力、致伤原因、伤口疼痛、伤口异味构成比差异有统计学意义(χ²=12.365、24.519、22.820、9.572、92.342,P<0.01)。文化程度、自理能力、致伤原因、伤口疼痛、伤口异味是患者皮肤清洁的潜在影响因素。二元多因素Logistic回归分析显示,自理能力、伤口疼痛、伤口异味是患者皮肤清洁的独立影响因素(比值比=1.51、0.52、3.72,95%可信区间=1.08~2.12、0.42~0.89、2.66~5.22,P<0.05或P<0.01)。自理能力、伤口疼痛、伤口异味是成年创伤患者皮肤清洁的独立影响因素。