ObjectiveTo explore the pressure injury incidence and influencing factors in elderly patients with different activity levels.MethodsA multicenter cross⁃sectional survey was conducted,enrolling elderly patients aged≥65 years from eight tertiary hospitals. Data on general information,health status,skin examination,and implementation of preventive measures were collected using uniformly trained research tools and methods.ResultsA total of 4 851 elderly patients were included,of whom 107 developed pressure injuries,resulting in an incidence rate of 2.2%.Among the independently mobile group,7(0.2%) developed pressure injuries.Among the crutches/assistance/wheelchairs group,16(1.9%) developed pressure injuries.Among the bedridden group,84(7.9%) developed pressure injuries.In the independently mobile group,age,dietary status,and type of dressing at pressure sites were independent risk factors for pressure injuries.In the crutches/assistance/wheelchair group,the Braden score was an independent risk factor.In the bedridden group,education level,Braden score and type of dressing at pressure sites were independent risk factors.ConclusionsThe incidence of pressure injuries in elderly patients is closely related to their activity levels,with lower activity levels associated with higher incidence rates.Risk factors for pressure injuries vary among patients with different activity levels.Targeted stratified prevention strategies should be implemented for independently mobile,crutches/assistance/wheelchair,and bedridden patients,focusing on key factors such as advanced age,nutrition,Braden score,medication use,and local dressing applications to effectively reduce the risk of pressure injuries.

PURPOSE:The purpose of this study is to provide a decision-making basis for skin care of older hospitalized patients through a penalized statistical prevalence association model. DESIGN:We reviewed nine eligible institutions as multi-center research centers in China. SUBJECTS AND SETTING:We conducted a multicenter cross-sectional study on July 17, 2023, from which 4851 valid questionnaires were collected. METHODS:LASSO regression with 10‑fold cross‑validation was first used to select candidate variables. Variables with a selection frequency >0.8 after 1000 bootstrap resampling steps were retained as stable identify. To address rare‑events bias, Firth's penalized logistic regression was then applied. Model discrimination was assessed using the ROC curve, AUC, and C‑index with 95% CI via bootstrap. Calibration was evaluated by calibration plots, slope, intercept, and the Brier score. A leave-one-center-out generalizability assessment was performed to evaluate model applicability across centers. Clinical utility was examined using decision curve analysis (DCA). RESULTS:Seven variables (age, albumin, hemoglobin, diabetes, painkillers, antipsychotics, Braden score were identified. The model demonstrated excellent discrimination (AUC = 0.916, 95% CI [0.892,0.916]; C-index = 0.916 [0.890,0.939]; sensitivity 0.91, specificity 0.80) and good calibration (slope 1.035, intercept -0.001, Brier score 0.018). In the leave-one-center-out generalizability assessment, the model demonstrated a mean cross-center AUC of 0.905 [0.835-0.967]. Decision curve analysis confirmed clinical utility within the 0-15% threshold probability range. CONCLUSIONS:This large-sample multi-center prevalence association model based on penalization and resampling techniques provides an accurate, stable, and clinically applicable tool for individualized pressure injury risk assessment in hospitalized older patients.

Background The elderly are at high risk for COVID-19 and incontinence, as well as a vulnerable population for incontinence-associated dermatitis (IAD). There has been a continuous exploration of how to provide good incontinence care to improve the effectiveness of preventing and treating IAD. Objective To investigate the effectiveness of two incontinence care plans based on guidelines for elderly COVID-19 patients with incontinence, in order to provide a reference basis for good incontinence care and prevention of IAD in such patients. Methods Using an exploratory intervention study design, 60 eligible patients with COVID-19 were selected as the study subjects from the surgical and internal medicine departments of Eastern Theater General Hospital, PLA, Daping Hospital, Amy Medical University, PLA, and Sir Run Run Hospital, Nanjing Medical University from December 26, 2022 to March 30, 2023. The study subjects were nonrandomly divided into the intervention group and control group, with 30 patients from the Eastern Theater Command General Hospital of PLA included in the intervention group and 30 patients from the other two hospitals included in the control group. Patients with IAD in both groups were also included in the intervention and control subgroups. The characteristics and types of incontinence in elderly COVID-19 patients were analyzed, the "AIMS Four Step Improved Incontinence" care plan (AIMS care plan) for the assessing incontinence and skin (A), identifying and managing risk (I), managing incontinence (M), and skin care (S) was modified based on the recommendations of the guidelines. The intervention group adopted the modified AIMS care plan, while the control group adopted a structured skin care plan, with continuous intervention for at least 14 days. The skin was inspected every shift and international standards were used to determine the occurrence of IAD and changes. The primary outcome indicator was the incidence of IAD in both groups of patients, and the secondary outcome indicators were the healing rate and healing time of IAD. The relevant clinical data of the two groups before and after intervention was collected and compared. Results The general data of the both groups of patients showed no statistically significant differences, which included gender, age, types of incontinence, frequency of incontinence, chronic comorbidities, serum albumin, hemoglobin, blood glucose, pulse oxygen concentration, and Braden scores (P>0.05). The incidence of IAD in 60 elderly COVID-19 patients with incontinence was 33.3% (20/60), of which the incidence of IAD was 43.3% (13/30) in the control group and 23.3% (7/30) in the intervention group; There was no statistically significant difference in the incidence of IAD between the two groups of patients (P>0.05). There was no statistically significant difference in the grading, and healing rate of IAD between the two subgroups of patients (P>0.05). Patients in the intervention subgroup had a delayed time to IAD occurrence (t=3.225, P=0.005), shorter time to IAD healing (t=2.644, P=0.020), and shorter hospitalization time (t=4.364, P<0.001) than those in the control subgroup. Conclusion Both incontinence care plans based on guidelines can effectively prevent IAD and promote healing in elderly incontinent patients. However, the modified AIMS care plan is more effective and can be referred to and used in clinical care.

Background: Pressure injury (PI) is a significant health concern among older inpatients, particularly in regions with diverse ethnic populations. Understanding the epidemiological characteristics and preventive measures is crucial for improving patient outcomes. Purpose: To analyze the epidemiological characteristics, prevention status, and influencing factors of pressure injury (PI) in older inpatients of Zhuang and Han nationality in Guangxi, China. Methods: A total of 2206 inpatients age 60 years or older in 2 class III grade A general hospitals in the Guangxi Zhuang Autonomous Region between April 1, 2021, and May 27, 2021, were included in this cross-sectional study. Epidemiological characteristics—including age, sex, educational background, race, ethnicity, and hospitalization information—were collected using a general information questionnaire designed by the researchers. The PI risk factors were evaluated using the Braden Scale. Prevention status was assessed using the Epidemiology and Prevention Skin Injuries in the Elderly Scale and Skin Injury Survey Scale. Results: Of the total 2206 patients included in the study, 555 (25.16%) were of Zhuang nationality and 1651 (74.84%) were of Han nationality. The overall PI incidence was 2.58%, with PI prevalence of 1.80% and 2.85% in Zhuang and Han patients, respectively. The main influencing factor for PI in Zhuang patients was caregivers (P < .05), whereas in Han patients the main influencing factors were urinary conditions, Alzheimer disease, sedatives, and antihypertensive drugs (P < .05). Conclusion: The PI prevalence rates were similar in both ethnic groups. Health care staff in high-risk departments for PI must remain vigilant and take appropriate action.

目的 探讨移动平台理论授课和创伤模拟人仿真训练培训伤口护理小组护士掌握伤口护理关键技术理论和操作的效果,旨在提高护士处理战创伤的救护能力.方法 纳入东部战区总医院各院区伤口护理小组护士 105 名作为培训对象,培训前 2 周采用问卷星进行战创伤伤口护理相关理论摸底考核,接着通过移动办公平台线上培训结合培训视频播放混合模式进行理论授课,培训后 2 周采用问卷星考核理论.再录制可视化战创伤伤口处理操作视频推送至培训对象,对照视频反复练习 1 周,利用创伤模拟人进行仿真实训和训练前后的操作考核.理论和操作考核满分均为 100 分.结果 105 名护士培训前理论得分(62.50±7.03)分,操作得分(83.75±15.16)分;培训后理论得分(73.50±10.64)分,操作得分(96.41±1.66)分,差异均有统计学意义(P＜0.05).结论 移动平台和创伤模拟人培训能够显著提升伤口护理小组护士的战创伤理论知识及伤口处理操作技能.

Background Due to aging characteristics such as dry,loose and inelastic skin,and decreased skin tolerance,the elderly are more vulnerable to injuries caused by pressure. An appropriate decompression mattress is the key to preventing pressure injury. Objective To compare the decompression effects of two types of mattresses by analyzing the pressures and temperatures of sacrococcygeal skin in bedridden elderly patients in the supine position. Methods By convenience sampling,45 bedridden elderly patients who were admitted to Cadre Internal Medicine Ward,General Hospital of Eastern Theater Command from January 2021 to March 2022 were selected as the participants（all of them were male since most of the patients in the ward were male）. They were assigned to group A（n=23,use of gel mattress,repositioned every two hours for seven days） or group B（n=22,use of air mattress,repositioned every two hours for seven days） according to their willingness. The maximal sacrococcygeal pressure and skin temperature were measured at three fixed defined time points every day during supine position[at the beginning（baseline）,and at one and two hours in the position]. Maximal sacrococcygeal pressure was measured using a continuous bedside pressure mapping system,and the skin temperature in the same location was measured using a hand-held thermometer. The linear mixed-effects model was used to analyse the changes in sacrococcygeal pressure and skin temperature of the elderly bedridden patients and compare the decompression effects of the two mattresses.Results There were no pressure injuries in both groups during the intervention. The interaction effect between group and day was not statistically significant on the changes in sacrococcygeal pressure(F group*day =0.07,P group*day =0.999),while the interaction effect between group and time on them was statistically significant(F group*time =6.45,P group*time =0.012). Therefore,the mixedeffects model analysis was conducted again after removing the interaction between the group and day. The results indicated that the sacrococcygeal pressures in the gel mattress group were lower than those in the air mattress group after one and two hours after the supine position（P＜0.05）. For the changes in skin temperature,the interaction effect between group and day was not statistically significant(F group*day =0.12,P group*day =0.994),while the interaction effect between group and time was statistically significant(F group*time =16.90,P group*time ＜0.001). Therefore,the mixed-effects model analysis for temperature was conducted again after removing the interaction between the group and day. The results demonstrated that the sacrococcygeal pressure changes in the gel mattress group were lower than those in the air mattress group after one and two hours in the supine position（P＜0.05）.Conclusion Both the sacrococcygeal pressures and skin temperatures of bedridden hospitalized elderly male patients were increased after using the gel mattress or air mattress for one or two hours in supine position. The pressure and skin temperature increments were less from the gel mattress than from the air mattress,indicating that gel mattress was superior to air mattress in mitigating sacrococcygeal pressure and skin temperature.

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.

声光弹是集声、光效应为一体,利用爆炸时产生的巨大声响和眩目强光刺激有生目标的耳朵和眼睛,使其暂时致聋、致盲的一种非致命性弹药,属于非致命武器( non-lethal weapon,NLW)的一种[1].NLW指利用声、光、电、磁和化学等技术手段,使对方暂时丧失战斗能力或使对方作战装备遭受到破坏,以致暂时或永久地丧失正常机能,而不造成人员死亡的一种特种武器[2-3].NLW是军队和执法部门在维稳和处置暴骚乱等非战争行动中广泛采用的武器 [1-3] ,在实际使用中,声光弹爆炸时产生的脉冲声压和冲击波超压、烟雾、声响及光强等仍存在较大的安全隐患,稍有不慎,就会造成永久性伤害或致人死亡[1-2,4-6].2022年7月12日—8月1日东部战区总医院烧伤整形科收治某部声光弹训练致头面部爆炸伤伤员3例,采用第一阶段急诊科医护合作的快速处理( FAST )和第二阶段住院病房医护合作的序贯处理( FACE)对3例伤员进行了身心整体干预,分别于干预后14d和40d头面部伤口愈合,2例出院归队,1 例右眼球损害,转眼科继续治疗.

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 构建战创伤伤口护理关键技术操作流程,提高军队医院护士战创伤伤口护理水平和能力.方法 经过检索文献,课题组讨论,制订战创伤伤口护理关键技术操作流程初稿.采用德尔菲法进行 2 轮专家咨询,最终确定战创伤伤口护理关键技术操作流程.结果 21 名专家参加函询,2 轮专家咨询问卷回收率为 95.5%、100%,专家权威系数 0.87、0.87,肯德尔和谐系数分别为 0.239、0.222(均P＜0.01),形成 7 项一级条目(评估技术、伤口清洗技术、组织清创技术、敷料使用和包扎技术、局部氧治疗技术、负压伤口治疗技术和心理支持技术),29 项二级条目的战创伤伤口护理关键技术操作流程.结论 战创伤伤口护理关键技术操作流程的构建为应对战争及突发灾害事件中批量伤员伤口护理提供科学管理依据.

Background Trauma is a highly prevalent and costly global health problem.Prevention and control of infection is a major challenge in the management of traumatic wounds,while prolonged absence of skin washing after trauma will increase the incidence of wound infection,as well as the discomfort.Although many patients are willing to take a bath after trauma,the timing and method of bathing remains unclear.Therefore,it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean.Objective To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China,and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing.Methods Database at home and abroad were searched to obtain original literature,the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence-based analysis,generalization,group discussion.Fifteen wound care experts with associate or higher titles were included,and Delphi consultation was used to modify and improve the bathing with wounds scheme,with an interval of one week for each round of correspondences,the reliability of the consultation results was evaluated by the expert positive and authority coefficients.The consistency of the consultation results was evaluated by the coefficient of variation,a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25,which means that the expert opinions tend to be consistent.Thirty patients with traumatic wounds were enrolled in the pre-test,Likert 5-point scale was used to verify the convenience,safety and patient compliance of the bathing with wounds scheme,and the final scheme was developed after discussion and modification.Results After the inclusion of 23 related papers,the first draft of bathing with wounds scheme was developed through evidence-based analysis and discussion,involving three first-level items(including preparation befor bathing,bathing operation and treatment after bathing),seven second-level items,nine third-level items and four fourth-level items.The opinions of the 15 experts converged after 2 rounds of correspondence,with recall rates of 93.75%and 100.00%,with authority coefficients of 0.947 and 0.957,respectively.The variation coefficients of importance and maneuverability of each item in the first round were 0-0.25 and 0-0.23,and those in the second round were 0.09-0.18 and 0.07-0.14,respectively,a total of 2 items were deleted,5 items were modified and 2 items were added,resulting in a revised draft.The 30 enrolled patients with traumatic wounds took baths(2.70±0.47)times per week according to the bathing scheme,with the average bath time of 10-15min,convenience and compliance scores of(4.67±0.48)and(4.70±0.47),and no bathing-related adverse events and wound infection occurred.The pre-test proved that the bathing plan was safe、reliable、simple and have good patient compliance.The final draft of the bathing with wounds scheme for traumatic wound patients included three first-level items,eight second-level items,nine third-level items and three fourth-level items.Conclusion In the construction process of the bathing with wounds scheme for traumatic wound patients,the positive and authority coefficients of experts are high,which has been unanimously approved by corresponding experts.The compliance of 30 patients with traumatic wounds in the pre-test was high,suggesting that the bathing with wounds scheme is safe and convenient,which can be applied to bathing with wounds at home for patients with traumatic wounds in China.

电击伤是常见的创伤之一,伴随高压电流通过身体,通常有一个入口,多个出口,容易出现毁损性损伤、严重的创伤后应激反应及继发感染,病情变化快。血压监测是准确、及时判断病情的常用方法。本文分析对比1例高压电击伤后双上肢、右下肢截肢患者的有创血压(IBP)无创血压(NBP)监测结果,并通过文献复习,总结讨论IBP、NBP监测之间差异性,为临床有效监测重症创伤患者血压提供参考。

目的 通过多中心横断面调查,分析老年住院患者压力性损伤(pressure injury,PI)、失禁相关性皮炎(incontinence-associated dermatitis,IAD)和皮肤撕裂伤(skin tear,ST)3类皮肤损伤的现患率及危险因素,为预防皮肤损伤提供依据.方法 2021年3月31日,来自20个省(区、市)50所医院的1067名护士对所在医院年龄≥60岁的患者进行全身皮肤检查,以判断皮肤损伤发生情况及类型,并收集患者的一般资料、病情资料和有无PI发生危险等资料.使用Logistic回归分析3类皮肤损伤的独立危险因素.结果 共调查14470例老年住院患者,年龄为(73.35±8.90)岁,皮肤损伤总现患率为6.69％,PI、IAD、ST的现患率分别为3.91％、1.89％和0.89％.Logistic回归分析显示,有PI发生危险、协助自理、低蛋白血症、汉族、贫血、慢性病数量≥2种和年龄≥71岁为老年住院患者发生PI的独立危险因素;有PI发生危险、协助自理、低蛋白血症、慢性病数量≥2种、住院时间≥8 d和年龄>80岁为IAD的独立危险因素;有PI发生危险、低蛋白血症为ST的独立危险因素(均P<0.05).结论 老年住院患者3类皮肤损伤均为多因素综合作用的结果,不同类型皮肤损伤的危险因素不尽相同.制订预防策略时既要关注危险因素的独立作用,也要考虑其联合作用,采取综合预防措施,以提高预防效果.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Aging has become a global issue. Due to skin aging, coexistence of multiple chronic diseases, disability and semi-disability, older people are prone to various skin injuries, such as pressure injury, moisture-associated skin damage, skin tear, dry skin. These skin injuries may be single or multiple, and multiple types of injuries may coexist, which impair the quality of life and even threaten the life. Skin health in older people has become a global focus, and the prevention of which has been regarded as a priority in clinical nursing and management. We reviewed recent advances in the epidemiology, types and prevention of skin injuries in older adults, providing a reference for the prevention and management of skin injuries in older Chinese adults.

目的 探讨多中心研究前混合模式和视频播放模式培训不同地区参与研究的三级甲等医院护士掌握老年人四类皮肤损伤知识的效果,为选择适宜方法培训参研人员提供依据.方法 招募入选19个省、自治区和直辖市的34所医院为多中心研究单位,各医院按照调研工作量和纳排标准纳入参研护士,共计766名自愿选择了A和B培训方法,A组523名接受在线培训结合培训视频播放混合模式培训,B组243名接受培训视频播放模式培训.培训内容一致,包含4种皮肤损伤定义、分类标准和检查方法等内容.项目组根据培训内容设计包含20张老年人四类皮肤损伤照片为题干的60个问题试卷,于培训1周后,通过微信将在线考试卷链接推送至参训护士.2组参训护士通过手机独立答题,并在1 h内在线提交.满分为100分,统计2组参训率和参考率及平均得分.结果 A、B 2组护士参训率和参考率均为100％,2组总平均得分相近,四类皮肤损伤的平均得分差异也无统计学意义(均P>0.05).结论 2种培训方法均有满意的参训率和参考率,培训效果相近,适用于多中心研究前不同地区医院参研护士的在职培训.

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。

目的 通过系统评价明确术中获得性压力性损伤(intraoperative acquired pressure injury,IAPI)发生的危险因素,为预防IAPI提供依据.方法 计算机检索PubMed、Web of Science、Cochrane library、OVID、EMBASE、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库,收集关于IAPI危险因素的研究,检索时限为2000年1月-2019年7月.由2名研究员按照标准独立筛选文献、提取资料、评价文献质量.采用软件RevMan 5.3和Stata 15分析数据.结果 共纳入22篇文献,包括267152例研究对象,共13项危险因素.Meta分析显示,年龄、女性、体质量指数(BMI)<23 kg/m2、手术时间、术前Braden量表评分低、侧卧位、仰卧位是发生IAPI重要危险因素.结论 年龄越大、BMI<23 kg/m2、术前Braden量表评分越低、手术时间越长的女性患者发生IAPI的风险越高.目前IAPI危险因素的研究证据尚不充分,且各研究样本量差异较大,其中对性别、合并症、体位、术中特殊用药、体外循环、术中低血压等危险因素的研究较少,证据尚不充分,后期尚需更多高质量研究进行验证.

目的 对连续床边压力图监测系统在临床的应用进行评价与展望,为其临床的进一步推广提供参考.方法 通过对国内外文献进行综合分析,对床边压力图监测系统在临床中应用的现状进行概述,从压力与压力性损伤之间的关系、连续床边压力图监测系统的工作原理、预防压力性损伤的研究现状、对护理管理的启示、未来的研究方向和应用前景进行归纳总结.结果 连续床边压力图监测系统可以降低压力性损伤的发生率,提高医护人员及患者对压力性损伤预防的认知,提高患者翻身的依从性并为减压装置的选择提供依据.结论 目前国内对连续床边压力图监测系统的相关研究处于起步阶段,进一步的研究还需要评估该系统在更长的时间和多种护理环境下,对压力性损伤发生率的作用,以及评估该系统是否具有更广泛的临床实用性.本综述对上述的进一步研究,提供了有效的理论及实践文献参考.

犬咬伤是指犬齿切割人体组织、咬合导致的皮肤破损、组织撕裂、出血和感染等损伤.犬咬伤是目前最常见的动物咬伤类型,在急诊外科中占1％[1].犬咬伤伤口可见于全身各个部位,成人多见于四肢,其中上肢、手部最常见,咬伤位于四肢54％ ～ 85％(其中手部18％～68％),其次头颈部15％～ 27％.随着饲养宠物的人数不断增加,被咬伤的可能性越来越高.正确及时处理伤口是治疗犬咬伤的关键[2-3].本研究报道笔者医院以伤口造口专科护士为主导的多学科诊疗模式(multiple disciplinary team,MDT)治疗多处犬咬伤患者1例.