目的 探讨Braden量表诊断老年人压力性损伤的适用性和最佳界值,为临床正确使用Braden量表提供依据.方法 招募全国52所医疗机构,1067名培训合格的护士每2～3人一组,采用目的抽样法纳入60岁以上住院患者,检查其全身皮肤并收集相关资料,判断是否存在压力性损伤及其分期,同时采用Braden量表预测评分.使用统计软件分析老年人压力性损伤流行特征和Braden量表预测诊断压力性损伤受试者工作特征曲线下面积(area under the curve,AUC)、灵敏度、特异度和约登指数.结果 在33769例有效资料中,压力性损伤总现患率为3.12％(1054/33769),其中医院获得性压力性损伤发生率为0.79％(267//33769).分层分析显示,Braden量表预测诊断不同年龄、性别、种族和不同医疗机构中老年患者压力性损伤的AUC为0.85～0.96,灵敏度和特异度分别为0.83～0.96和0.71～0.86.总分≤15、≤16、≤17、≤18、≤19、≤20分6个界值的AUC为0.67～0.82,灵敏度和特异度分别为0.67～0.84和0.54～0.68,约登指数为0.25～0.49,≤20分的约登指数和AUC最大.结论 Braden量表适用于不同年龄、性别、种族和不同医疗机构中的老年患者评估预测压力性损伤风险,总分≤20分作为最佳界值可提高预测效能.

背景Braden量表是全球公认的有良好信效度的压力性损伤危险预测工具，但因应用人群不同，其最佳预测界值也存有争议。该量表在我国临床应用的预测界值为≤16分，欧美国家多以≤18分为界值，但其在我国住院患者中的预测作用的研究较少。目的 横断面调研全国13个省/自治区、46所三级医院成年住院患者压力性损伤的流行病学特征，分析Braden量表及其6个分量表预测压力性损伤发生的效能及其最佳界值。方法 由解放军东部战区总医院负责成立多中心合作研究课题组，在全国公开招募≥500张床位的三甲医院，经过资格审查和签订合作研究双向协议后，共纳入13个省/自治区、46所符合条件的医院作为多中心研究单位，纳入住院时间≥24 h、年龄≥18岁的患者为研究对象。入选护龄≥2年的伤口护理骨干护士作为调研人员，共入选1 060名调研护士。在2021-03-30和2021-05-29，使用专用调查记录表记录患者的一般情况；检查全身皮肤，判断是否发生压力性损伤及分期情况；采用Braden量表（从感知觉、潮湿度、活动能力、移动能力、营养、摩擦和剪切力6个分量表逐项评分）判断压力性损伤的发生危险。绘制受试者工作特征（ROC）曲线，分析Braden量表及其6个分量表预测成年住院患者发生压力性损伤的效能及其最佳界值。结果 本次调研共获得60 555例有效数据，其中压力性损伤现患率为1.67%（1 010/60 555），医院获得性压力性损伤现患率为0.74%（448/60 555）。男性压力性损伤现患率[2.08%（677/32 518）]高于女性[1.19%（333/28 037）]（χ2=73.394,P＜0.001）。≥80岁和ICU患者压力性损伤现患率最高，分别为5.98%（311/5 198）和10.58%（324/3 061）。多因素Logistic回归分析结果显示，年龄、性别、血清白蛋白、血红蛋白、失禁类型、卧床、Braden量表总分是成年住院患者发生压力性损伤的影响因素（P＜0.05）。Braden量表预测成年住院患者发生压力性损伤的ROC曲线下面积（AUC）为0.95[95%CI（0.94,0.95）]，灵敏度和特异度分别为96%和83%，约登指数为0.79，对应的最佳界值为17.50分。Braden量表预测不同科室和年龄患者发生压力性损伤的AUC为0.78～0.97，灵敏度为83%～97%，特异度为61%～91%，约登指数为0.47～0.88，最佳界值为13.5～18.5分。摩擦和剪切力、移动能力和活动能力3个分量表预测成年住院患者压力性损伤发生危险的AUC分别为0.87、0.84、0.80，约登指数分别为0.56、0.56、0.54，最佳界值分别为1.50、2.50、1.50分。结论 本次调研得出我国13个省/自治区、46所三级医院成年住院患者压力性损伤现患率为1.67%（1 010/60 555），医院获得性压力性损伤现患率为0.74%（448/60 555）。Braden量表适用于我国三级医院住院患者预测压力性损伤发生危险，总分≤18分有更好的预测作用，其中摩擦和剪切力、移动能力和活动能力分量表的预测作用最大，在人员紧张或特殊环境下可采用此3个分量表预测压力性损伤危险，最佳界值的预测作用需在应用中进一步验证。

目的:探讨复方黄柏涂剂治疗糖尿病足溃疡的临床效果.方法:选取60例2018年9月-2020年12月于江南大学附属医院治疗的糖尿病足溃疡患者作为研究对象进行回顾性分析,根据溃疡创面治疗方法不同分为观察组(30例)和对照组(30例).对照组使用生理盐水及双氧水冲洗溃疡创面,观察组在生理盐水、双氧水冲洗的基础上给予复方黄柏涂剂治疗.比较两组创面愈合情况、中医症候积分、炎性因子水平及足部血供.结果:治疗1、2个月后,两组创面面积明显缩小,观察组面积较对照组明显小(P<0.05);两组治疗后中医症候积分降低,观察组较对照组低(P<0.05);两组治疗后白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平明显降低,观察组水平较对照组低(P<0.05);两组治疗结束后6个月踝肱压力指数(ABI)及趾肱压力指数(TBI)明显提高,观察组较对照组高(P<0.05).结论:糖尿病足溃疡患者使用复方黄柏涂剂治疗,能够促进创面愈合,改善临床症状,降低炎性因子水平,改善足部血供,值得临床借鉴.

目的：横断面调研全国13个省46所三级医院住院患者压力性损伤的流行特征，分析Braden量表及其六个分量表预测压力性损伤和医院获得性压力性损伤危险的作用。方法：招募入选46所医院参与横断面调研， 1060名培训合格的护士采用便利抽样，在统一时间内使用一致的调研工具、方法和流程，纳入18岁以上的成年住院患者，检查全身皮肤是否发生压力性损伤，并采用Braden量表从感知觉、潮湿度、活动能力、移动能力、营养摄入、剪切和摩擦力六个分量表逐项评分，总分6-23分，分数越低发生压力性损伤危险越高。统计软件分析Braden量表及其六个分量表预测压力性损伤和医院获得性压力性损伤的受试者工作特征曲线下面积（AUC）及其敏感度、特异度和约登指数。 结果：共获得有效资料60555例，男性32518例（53.70%），女性28037例（46.30%），平均年龄55.88±17.16岁，压力性损伤总现患率1.67%（n=1010），其中医院获得性压力性损伤现患率0.74%（n=448）。男性现患率高于女性（2.08%vs 1.19%），ICU和≥80岁者压力性损伤现患率最高（10.58%和5.98%）。Braden量表预测成人压力性损伤和医院获得性压力性损伤危险的AUC分别为 0.95和 0.91 ，敏感度分别为0.92和0.90， 特异度分别为0.87和0.79，约登指数分别为0.79和0.69。Braden量表≤19分界值预测压力性损伤危险的AUC和约登指数最大（0.83和0.51），其中活动能力、摩擦和剪切力、移动能力三个分量表预测压力性损伤发生危险的AUC（0.92-0.81）和约登指数最大（075-0.71）。结论：Braden量表适用于我国三级医院住院患者预测压力性损伤发生危险，总分≤19分有更好的预测作用，其中活动能力、摩擦和剪切力以及移动能力分量表的预测作用最大，在人员紧张或特殊环境下采用三个分量表预测压力性损伤危险，可提高效率，节约时间。

Background Population aging is a major challenge in the global healthcare field. Due to pathological and physiological changes in ageing skin, skin injuries are highly prevalent in older population. And epidemiological studies on skin injuries in this population has become a research hotspot recently. Objective To examine the prevalence and epidemiological characteristics of three types of skin injuries 〔pressure injuries (PI) , incontinence-associated dermatitis (IAD) and skin tears (ST) 〕in elderly inpatients using a multicenter cross-sectional study, providing a basis for formulating strategies for the prevention of skin injuries in older people. Methods A multicenter study was carried out in 52 hospitals selected from 16 provinces, two autonomous regions and two municipalities of China, from which 1 067 nurses who had completed the online homogenization training conducted by our research group and passed the relevant examination were selectedas investigators. Every 2-3 nurses were divided into a investigation group. Eligible older inpatients were selected as participants. Full body skin examination for screening skin injuries was conducted in participants in each hospital by nurses using the same tools and methods. PI, IAD and ST were defined and classified by relevant international guideline or expert consensus, respectively. Then demographics, length of stay (LOS) , chronic disease history, use of medications in the past month, living independence and risk of PI assessed by the Braden Scale of the participants were collected. After that, two nurses of each group signed to confirm the results, and uploaded to https://www.wjx.cn. SPSS 22.0 was used for statistical analysis. Results A total of 14 675 elderly inpatients were investigated, and all of them responded effectively (100.0%) . The respondents had an average age of (73.5±9.0) years and a median LOS of 7 (4, 13) days, among whom 56.3% (8 262/14 675) were men, and 43.7% (6 413/14 675) were women; 95.5% (14 020/14 675) were Han people, and 4.5% (655/14 675) were 19 ethnic minorities. The overall prevalence of the three types of skin injuries was 6.0% (881/14 675) , of which the prevalence of PI, IAD, ST and at least two types of skin injuries was 3.3% (484/14 675) , 1.4% (199/14 675) , 0.8% (110/14 675) and 0.6% (88/14 675) , respectively. Epidemiologic characteristics: Han people had higher prevalence of skin injuries compared with ethnic minorities (6.2% vs 2.9%, P=0.001) . Eighty-year-olds had higher prevalence of skin injuries than 71-80-year-old (10.2% vs 6.1%, P<0.001) and 60-70-year-old (10.2% vs 3.8%, P<0.001) . Those suffering from at least two chronic diseases had higher prevalence of skin injuries compared with those without chronic diseases (5.7%-12.0% vs 2.9%, P<0.005) or those with only one chronic disease (5.7%-12.0% vs 4.4%, P<0.005) . Users of two or more medications had higher prevalence of skin injuries compared with non-medication users (6.1%-10.2% vs 2.7%, P<0.005) or users of one medication (6.1%-10.2% vs 4.6%, P<0.005) . Those with LOS of over 30 days had higher prevalence of skin injuries compared with those with LOS of 8-30 days (10.7% vs 4.4%, P<0.016 7 ) or ≤7 days (10.7% vs 7.1%, P<0.016 7) . The prevalence of skin injuries in those with PI risk was higher than that in those without risk (20.5% vs 1.6%, P<0.05) . The prevalence of skin injuries in dependent-living individuals was higher than that of independent-living individuals (7.0% vs 0.9%, P<0.05) . The frequently-occurring sites were caudal sacral (57.9%) and heel (14.3%) for PI, peri-anal region (68.3%) and hip fissure (24.6%) for IAD, and lower limbs (38.2%) and upper limbs (28.2%) for ST. PI combined with IAD mostly occurred in sacrococcygeal region (71.0%) . PI combined with ST were common in sacrococcygeal region (50.0%) and heel (35.7%) . ST combined with IAD mostly occurred in caudal sacral (33.3%) , perianal region (33.3%) and gluteal fissure (33.3%) . PI, IAD and ST coexisted mostly in caudal sacral (50.0%) and gluteal fissure (50.0%) . Conclusion The prevalence of skin injuries in Chinese older people is high, and may increase with age, prevalence of chronic diseases and use of systemic medications, and dependent-living. In particular, PI risk may be associated with significantly higher possibility of developing skin injuries. Coexistence of multiple types and anatomical sites of skin injuries are important characteristics. The above-mentioned epidemiologic characteristics should be considered when formulating prevention strategies of skin injuries in the elderly.

背景 创伤后洗浴是保持皮肤清洁的重要手段,但如何洗浴一直存有争议,有研究报道术后温水淋浴不增加伤口感染率,居家洗浴是否可行尚缺乏证据支持.目的 多中心调查创伤伤口患者居家洗浴及伤口感染的现况,分析居家洗浴与伤口感染的相关性以及伤口感染的影响因素,为选择适宜的洗浴方法提供依据.方法 2020年9月纳入13所医院伤口护理门诊创伤伤口患者为研究对象,设计创伤伤口患者居家洗浴与伤口感染现况的调查问卷,包括人口学资料、创伤伤口资料、创伤后洗浴及伤口感染资料等.通过问卷星链接或二维码自愿完成在线问卷的匿名填写及提交.分别采用描述性分析和多因素Logistic回归分析居家洗浴和伤口感染的现况及其影响因素.结果 共收到949份问卷,剔除2份无效问卷,有效问卷947份,有效率为99.8％.(1)基本资料:男460例,女487例;年龄18～100岁,平均年龄(50.2±17.9)岁.创伤持续时间(42.7±66.7)d,全皮层损伤和部分皮层损伤分别占55.8％(528/947)和44.2％(419/947);致伤原因中以利器切割伤和跌倒外伤为主,分别占43.4％(411/947)和27.8％(263/947).(2)伤后居家洗浴现况:伤后从未洗浴者占28.0％(265/947),带伤居家洗浴者占72.0％(682/947);洗浴方式以温水擦浴为主,占76.7％(523/682),包裹和敞开伤口温水淋浴分别占18.3％(125/682)和5.0％(34/682);洗浴以1次/周最多,占38.4％(262/682),其次为2次/周37.4％(255/682)和3次/周24.2％(165/682).(3)伤口感染现况:伤口总感染率为36.0％(341/947),带伤居家洗浴者伤口感染率为24.6％(168/682),伤后从未洗浴者伤口感染率为65.3％(173/265),差异有统计学意义(χ2=136.900,P<0.001);其中温水擦浴、包裹和开放伤口温水淋浴者伤口感染率分别为25.8％(135/523)、20.0％(25/125)和23.5％(8/34),差异无统计学意义(χ2=1.860,P=0.395);居家洗浴频次1次/周者、2次/周者和3次/周者伤口感染率分别为32.8％(86/262)、22.4％(57/255)和15.2％(25/165),差异有统计学意义(χ2=18.173,P<0.001).(4)伤口感染影响因素分析:以伤口是否感染分组进行单因素分析,结果显示,伤口感染组居家洗浴情况、洗浴频次、抗生素治疗情况、创伤持续时间、致伤原因、创伤深度、创伤部位比例与无伤口感染组比较,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,居家洗浴情况〔OR=0.30,95％CI(0.20,0.44),P<0.001〕、洗浴频次〔OR=0.60,95％CI(0.39,0.93),P=0.023〕、抗生素治疗情况〔OR=1.67,95％CI(1.20,2.33),P=0.002〕、创伤持续时间〔OR=1.64,95％CI(1.19,2.76),P=0.003〕和创伤部位〔OR=5.69,95％CI(2.72,11.90),P<0.001〕是伤口感染的影响因素.结论 居家洗浴和增加洗浴频次不增加伤口感染率,是可行的皮肤清洗方法.抗生素治疗、创伤持续时间超过30 d和腰臀部及四肢伤口可能增加伤口感染风险,患者可根据自理能力和伤口疼痛、伤口异味等因素选择适宜的洗浴方式和频次.

Objective: To investigate the status and influencing factors of skin cleaning outside wound (hereinafter referred to as skin) in adult trauma patients. Methods: 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. Results: 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 (χ2=12.365, 24.519, 22.820, 9.572, 92.342, P<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, P<0.05 or P<0.01). Conclusions: Self-care ability, wound pain, and wound peculiar smell are independent influencing factors of skin cleaning in adult trauma patients.

On August 2nd, 2014, 35 patients with extremely severe burns involved in August 2nd Kunshan factory aluminum dust explosion accident, including 18 males and 17 females, aged from 21 to 50 years, were admitted to our unit. According to the patient's condition, the rescue members divided the participants into groups according to their characteristics, and used the multi-disciplinary cooperative treatment and management mode of integrating critical care medicine, anesthesia, traditional Chinese medicine, rehabilitation, and nursing led by burn medicine. Totally 27 patients were successfully treated, with a success rate of 77.14%.

The treatment of mass burn patients is related to social stability, life saving, and disability reducing. It is also an important opportunity to accumulate, summarize, and improve clinical rescue and treatment experience. Aiming at August 2nd Kunshan factory aluminum dust explosion, this article reviews and summarizes experience and problems about rescue reserve, first-aid system, multidisciplinary cooperation, and integration of usual time and emergent time treatment, so as to propose corresponding strategies and provide reference for the treatment of mass burn patients and critically burned patients.

Objective To investigate the prevalence and risk factors of skin tears among inpatients and to provide the evidence for prevention.Methods In January and April 2015, adult patients(≥18 years) from a tertiary first-ranked general hospital were selected using convenient cluster sampling method to research on skin tears and related factors. The research tool of skin tears was designed by the research group of Nanjing Genearl Hospital and revised 3 rounds based on the Delphi method. Results Among 1 646 adult patients, 23 patients with skin tears were identified, making the prevalence of 1.39%, which was near to 1.58% of the prevalence of pressure ulcer among 12 inpatients. Most of the skin tears were categorized into 1a in STAR Classification System. By univariate analysis, age(≥60 years) , traumatic fractures, lying in bed and Braden score≤16 were significantly associated with skin tears development( P<0.05) . By logistic regression analysis, age(≥60 years) ( OR=4.89,P=0.028) and traumatic fractures ( OR=5.84,P=0.017) turned out to be risk factors of skin tears for inpatients.Conclusions The prevalence of skin tears among inpatients is near to the prevalence of pressure ulcer. Patients with older ages(≥60 years) and traumatic fractures have a higher risk of skin tears, who should receive special care for prevention and intervention.

目的:探讨四磨汤口服液联合耳穴埋豆在骨折便秘患者中应用.方法:80例骨折术后卧床便秘患者,随机分为A组(对照组)和B组(干预组),各40例.A组患者给予四磨汤口服液,B组患者则在对照组基础上增加耳穴埋豆,观察两组患者治疗效果.结果 治疗后,B组治疗总有效率为92.5％,显著高于A组的70.0％,差异有统计学意义(P＜0.05).结论 耳穴埋豆联合四磨汤口服液在在骨折便秘患者中具有良好的缓解便秘的效果.

压疮又称压力性溃疡，是指在压力或复合有剪切力和（或）摩擦力作用下发生在骨隆突处皮肤或皮下组织的局限性损伤［1-3］。目前，压疮已成为全球性健康问题，在给患者带来身心痛苦的同时延长患者住院时间，增加医疗成本，影响患者生存质量，严重者可导致其他多种并发症甚至死亡。负压伤口治疗（ negative pressure wound therapy ， NPWT ）是近十几年来提出的伤口治疗新方法，通过填充和封闭伤口，并为伤口提供连续或间断的负压，以达到充分引流渗液，促进伤口血液循环，减轻伤口及周围水肿，清除细菌并抑制其生长，促进细胞增殖及各种生长因子表达的效果，最终促进伤口愈合［4-5］。目前NPWT已经广泛应用于各种伤口，在压疮治疗中亦效果显著，现综述如下。

>患者男,88岁,因"咳嗽咳痰、发热3 d"于2011年1月19日入院。入院诊断为:肺部感染;高血压病;冠脉粥样硬化性心脏病;初老期痴呆(Alzheimer病);脑萎缩。入院全身评估:体温38.5℃,心率100次/min,律不齐,尿管在位通畅,大便正常;血常规示白细胞及中性粒细胞计数升高,生化全套示C-反应蛋白升高,血糖升高,低蛋白血症。入院给予联合抗感染治疗,同时给予化痰止咳、注意免疫增强及全身营养支持等治疗,入院后患者肺部感染控制良好,但出现全身

[目的]探讨负压封闭辅助闭合技术(VAC)在促进交通挤压伤愈合和功能恢复中的应用效果。[方法]采用智能化负压伤口治疗仪和标准操作流程对11例交通事故所致小腿软组织挤压伤伤口实施负压伤口治疗,压力值均为-125mmHg,吸引模式为吸引5min、停2min,每日治疗4h,连续治疗2周～3周。每72h测量伤口面积、深度并计分,评价效果,直至愈合。[结果]11例病人VAC治疗时间为(19.00±6.89)d,1例VAC治疗结合湿性疗法治疗后转外科手术治愈,10例VAC治疗结合湿性疗法治愈,总治愈率100%,愈合时间为(65.64±31.06)d。[结论]VAC治疗适用于软组织挤压伤,可有效促进伤口愈合及其功能恢复。

Silver dressing is a novel wound care material with a broad-spectrum antimicrobial effect.The major components of silver dressing are silver ions or silver nanocrystallines,which interfere with the cellular respiration chains,damage the cellular membrane,inhibit gene replication,transcription and translation,and thus exert a strong antimicrobial effect on various microorganisms.Silver dressing,which combines silver particles with novel dressing,can constantly and effectively control the microbial burden within the wound environment,and thus enhance wound healing.

Vacuum-assisted closure(VAC) is a new method of wound healing in the past decade.The option of negative pressure values now becomes an important direction for this research field.This review focuses on the changes of wound blood flow,exudate removal,bacterial clearance and granulation tissue formation under the application of different negative pressure values.

Diabetic foot ulcer(DFU) is a common complication of diabetes mellitus.DFU pain is a rare clinical symptom,but significantly influences the patient's quality of life as well as the prognosis of DFU.However,because of its relatively low incidence,its management is often overlooked clinically.This article presents an overview on the pathogenesis and management of DFU pain as well as the role of nursing in its treatment.