Schnelle J F, Adamson G M, Cruise P A, al-Samarrai N, Sarbaugh F C, Uman G, Ouslander J G
Borun Center for Gerontological Research, Reseda, CA 91335, USA.
J Am Geriatr Soc. 1997 Oct;45(10):1182-8. doi: 10.1111/j.1532-5415.1997.tb03767.x.
To provide data needed to design an intervention trial to prevent or treat skin disorders in a high risk, incontinent nursing home population.
The incidence and prevalence of nine common skin disorders were measured prospectively over a 60-day period using trained observers. Urinary and fecal incontinence frequency were measured over 24 hours, and mobility was measured with subjects both in and out of bed. Direct measures of skin moisture were taken with an impedance device in the presence and absence of urinary incontinence. Multiple regression analyses were used to relate the incontinence and mobility variables to the presence and development of skin disorders.
Four nursing homes.
One hundred incontinent nursing home residents.
Prospective measures of nine common skin disorders and skin moisture in four perineal regions under continent and incontinent conditions.
All subjects had at least one skin condition identified during the 60-day data collection period. The most commonly observed skin condition was blanchable erythema, which occurred in 94% of the subjects, predominantly in the front and back regions that were closest to the urethra and rectum. Twenty-one percent of residents developed either a Stage 1 (nonblanchable erythema) or 2 pressure ulcer. All skin conditions were transient when measured every 3 weeks with the exception of blanchable erythema, which showed stability. Stage 3 or greater pressure ulcers and edema were not observed, and interrater reliability for the measure of papules was poor. Measures of urinary and fecal incontinence severity were correlated with blanchable erythema severity, and blanchable erythema and low bed mobility were predictive of pressure ulcer severity. Blanchable erythema severity was also predictive of Stage 1 and 2 pressure ulcers. Skin moisture levels in the back perineal farthest from the rectum (peripheral) were affected most by urinary incontinence.
A trial to detect a 50% preventive effect on Stage 1 and 2 pressure ulcers would require that 167 subjects be monitored for 60 days. The transient nature of the skin effects require that skin be monitored at least once a week. Because blanchable erythema is so prevalent and appears to be associated with more severe skin conditions, it would make an excellent marker for beginning to assess the potential preventive effects of various interventions on the incidence of pressure ulcers and other related skin disorders in incontinent patients. It is likely that the back area peripheral to the urethra and rectum would experience the greatest benefit from an intervention trial to reduce moisture caused by incontinence.
提供设计干预试验所需的数据，以预防或治疗高危、大小便失禁的养老院人群中的皮肤疾病。
使用经过培训的观察员，在60天内前瞻性地测量九种常见皮肤疾病的发病率和患病率。在24小时内测量尿失禁和大便失禁的频率，测量受试者在床上和下床时的活动能力。在有无尿失禁的情况下，使用阻抗装置直接测量皮肤水分。采用多元回归分析，将失禁和活动能力变量与皮肤疾病的存在和发展联系起来。
四家养老院。
100名大小便失禁的养老院居民。
在大小便失禁和无失禁情况下，对四个会阴区域的九种常见皮肤疾病和皮肤水分进行前瞻性测量。
在60天的数据收集期内，所有受试者至少被查出有一种皮肤状况。最常见的皮肤状况是可压褪色红斑，94%的受试者出现这种情况，主要出现在最靠近尿道和直肠的前后区域。21%的居民出现了1期（不可压褪色红斑）或2期压疮。除可压褪色红斑显示出稳定性外，每3周测量一次时，所有皮肤状况都是短暂的。未观察到3期或更严重的压疮和水肿，丘疹测量的观察者间信度较差。尿失禁和大便失禁严重程度的测量与可压褪色红斑严重程度相关，可压褪色红斑和低床活动能力可预测压疮严重程度。可压褪色红斑严重程度也可预测1期和2期压疮。离直肠最远的会阴后部（周边）的皮肤水分水平受尿失禁影响最大。
一项旨在检测对1期和2期压疮有50%预防效果的试验，需要对167名受试者进行60天的监测。皮肤效应的短暂性要求至少每周对皮肤进行一次监测。由于可压褪色红斑非常普遍，且似乎与更严重的皮肤状况有关，因此它将成为一个很好的指标，用于开始评估各种干预措施对失禁患者压疮和其他相关皮肤疾病发病率的潜在预防效果。尿道和直肠周边的背部区域可能会从减少失禁引起的水分的干预试验中获益最大。
