徐一松 高莹

[摘要] 目的 探讨重症患者失禁性皮炎预防方法。 方法 选择2015年11月～2017年5月在我科住院的重症患者60例为研究对象，随机分为试验组与对照组，各30例。试验组采用会阴部评估工具（PAT）、Braden量表对患者失禁性皮炎危险性进行评估，对具有失禁性皮炎高风险的患者给予紫草制剂预防干预;对照组采用经验性评估，对具有高风险的患者给予紫草制剂预防干预。比较两组出院时PAT、Braden评分，肛周皮肤反应、IAD严重程度。 结果 （1）兩组出院时PAT评分均较入院时下降，差异有统计学意义（P<0.05）;试验组出院时时PAT评分低于对照组，差异有统计学意义（P<0.05）。（2）两组出院时Braden评分均较入院时升高，差异有统计学意义（P<0.05）;试验组出院时Braden评分高于对照组，差异有统计学意义（P<0.05）。（3）出院时，两组肛周皮肤反应分度均较入院时显著改善，差异有统计学意义（P<0.05）;出院时，试验组肛周皮肤反应分度显著低于对照组，差异有统计学意义（P<0.05）。（4）出院时IAD严重程度评分较入院时明显下降，差异有统计学意义（P<0.05）;出院时，试验组IAD严重程度评分显著低于对照组，差异有统计学意义（P<0.05）。 结论 采用PAT、Braden量表对重症患者失禁性皮炎风险进行评价更科学、更准确，在其指导下采用自制紫草膏对患者进行预防干预，可达到较好的预防治疗效果。

[关键词] 重症患者;失禁性皮炎;会阴部评估工具;Braden量表

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2020）16-0172-04

Clinical study on prevention of incontinence dermatitis in severe patients

XU Yisong   GAO Ying

Department of Critical Care Medicine，Tongde Hospital of Zhejiang Province， Hangzhou   310012， China

[Abstract] Objective To explore the prevention methods of incontinence dermatitis in severe patients. Methods Sixty severe patients who were hospitalized in our department from November 2015 to May 2017 were selected as the research subjects， and they were randomly divided into study group and control group， with 30 cases in each group. The study group used the perineal evaluation tool（PAT） and Braden scale to evaluate the risk of incontinence dermatitis， and the patients with high-risk of incontinence dermatitis were given arnebia euchroma preparation for preventive intervention. The control group used empirical evaluation and the high-risk patients were given arnebia euchroma preparation for preventive intervention. The PAT， Braden scores， perianal skin reactions， and IAD severity at the time of discharge were compared between the two groups. Results （1）The PAT scores at discharge in the two groups were lower than those at admission， and the differences were statistically significant（P<0.05）. The PAT scores at discharge in the study group were lower than those in the control group， and the differences were statistically significant（P<0.05）. （2）The Braden scores at discharge in the two groups were higher than those at admission， and the differences were statistically significant（P<0.05）. The Braden scores in the study group were higher than those in the control group， and the differences were statistically significant（P<0.05）. （3） The perianal skin reaction index of the two groups at discharge was significantly improved compared with that at admission， and the difference was statistically significant（P<0.05）. The perianal skin reaction index of the study group at discharge was significantly lower than that of the control group， and the difference was statistically significant（P<0.05）. （4） The incontinence—associated dermatitis（IAD） severity score at discharge was significantly lower than that at admission， and the difference was statistically significant（P<0.05）. The IAD severity score at discharge in the study group was significantly lower than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion The application of PAT and Braden scales to evaluate the risk of incontinence dermatitis in severe patients is more scientific and accurate， under which， the use of arnebia euchroma cream can achieve better treatment effects.

[Key words] Severe patients; Incontinence dermatitis; Perineal evaluation tool; Braden scale

失禁性皮炎（Incontinence-associated dermatitis，IAD）也称失禁相关性皮炎，是皮肤长期暴露于尿液和（或）粪便中导致的皮肤炎症，是重症患者，尤其是大小便失禁患者最常见的并发症[1，2]。2007年Gery等提出失禁性皮炎（Incontinence-associated dermatitis，IAD）的概念。在不同的护理单元，IAD的患病率和发病率有所不同，重症患者是高发人群[3]。IAD的发生与失禁的类型、失禁的频率有关，与患者本身的皮肤和营养状况、药物、自身的活动性等也有关[4]。IAD床上预防更为重要，良好有效的预防方法可减轻患者痛苦。单纯的尿失禁处理相对容易，大便失禁或者双失禁处理困难。为失禁性皮炎患者制定一套完善的预防方法是临床重症患者护理的重点问题之一。本文探讨重症患者失禁性皮炎预防方法，以期为临床预防护理提供参考，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年11月～2017年5月在我科住院的重症患者60例为研究对象。……