中国全科医学 ›› 2022, Vol. 25 ›› Issue (21): 2569-2576.DOI: 10.12114/j.issn.1007-9572.2022.0258

所属专题: 老年人群健康最新文章合集 老年问题最新文章合集

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中国老年人皮肤损伤患病率及其流行特征的多中心横断面研究

蒋琪霞1, 解怡洁2, 白育瑄3, 封海霞4, 陈倩竹5, 陈德凤6, 高艳红7, 王学红8, 张燕双9, 潘晓红10, 潘迎春11, 赵静12, 于金美13, 索惠娟14, 洪艳燕15, 展颖颖16, 李冬梅17, 刘海燕18, 李霞19, 匡丹20, 彭青21, 王静22, 俞萍23, 陈锐24, 蔡蕴敏25, 黄玲26, 王祖晶27, 王光扬28, 郝景平29, 朱冬梅30,*()   

  1. 1.210002 江苏省南京市,东部战区总医院烧伤整形科
    2.214062 江苏省无锡市,江南大学附属医院门诊部
    3.325027 浙江省温州市,浙江医鼎医用敷料有限公司临床学术部
    4.210009 江苏省南京市,东南大学附属中大医院护理部
    5.400016 重庆市,重庆医科大学附属第一医院骨科
    6.530021 广西壮族自治区南宁市,广西壮族自治区人民医院胃肠外科
    7.137400 内蒙古自治区兴安盟乌兰浩特市,兴安盟人民医院护理部
    8.223800 江苏省宿迁市,南京鼓楼集团医院宿迁市第一人民医院护理部
    9.215500 江苏省常熟市第二人民医院
    10.434000 湖北省荆州市中心医院
    11.246003 安徽省安庆市第一人民医院护理部
    12.210009 江苏省南京市,江苏省人民医院门诊治疗室
    13.225200 江苏省扬州市江都人民医院
    14.221300 江苏省邳州市人民医院普外科
    15.210001 江苏省南京市中医院护理部
    16.210008 江苏省南京市,东部战区总医院秦淮医疗区门诊部
    17.543099 广西壮族自治区梧州市,广西壮族自治区桂东人民医院伤口造口失禁护理门诊
    18.223700 江苏省泗阳县中医院护理部
    19.241000 江苏省芜湖市第五人民医院伤口造口门诊
    20.214062 江苏省无锡市,江南大学附属医院护理部
    21.210002 江苏省南京市,东部战区总医院门诊伤口护理中心
    22.200090 上海市,同济大学附属杨浦医院护理部
    23.214002 江苏省无锡市第二人民医院重症医学科
    24.332001 江西省九江市第一人民医院管理办公室
    25.201508 上海市,复旦大学附属金山医院创面诊疗中心
    26.409900 重庆市秀山县人民医院
    27.215000 江苏省苏州市立医院胃肠外科
    28.661199 云南省红河州第一人民医院伤口造口治疗中心
    29.223800 江苏省宿迁市中医院护理部
    30.210002 江苏省南京市,东部战区总医院护理部
  • 收稿日期:2021-12-06 修回日期:2022-04-08 出版日期:2022-07-20 发布日期:2022-04-29
  • 通讯作者: 朱冬梅
  • 蒋琪霞,解怡洁,白育瑄,等.中国老年人皮肤损伤患病率及其流行特征的多中心横断面研究[J].中国全科医学,2022,25(21):2569-2576. [www.chinagp.net]
    作者贡献:蒋琪霞提出研究思路,设计研究方案,招募、审核参研医院,培训参研护士,组织实施调研和质量控制,负责论文起草和最终修订,对论文整体负责;解怡洁、白育瑄负责数据收集、校对、建立数据库、统计学分析、绘制图表等;封海霞、陈倩竹、陈德凤、高艳红、王学红、张燕双、潘晓红、潘迎春、赵静、于金美、索惠娟、洪艳燕、展颖颖、李冬梅、刘海燕、李霞、匡丹、彭青、王静、俞萍、陈锐、蔡蕴敏、黄玲、王祖晶、王光扬、郝景平、朱冬梅负责本单位参研护士选择和考核、调查对象的选取、组织本单位参研护士收集资料、监控本单位调研过程的质量。
  • 基金资助:
    上海王正国创伤医疗发展基金会课题(WZGF20200101)

Prevalence and Epidemiologic Features of Skin Injuries in Chinese Older Adults: a Multicenter Cross-sectional Study

Qixia JIANG1, Yijie XIE2, Yuxuan BAI3, Haixia FENG4, Qianzhu CHEN5, Defeng CHEN6, Yanhong GAO7, Xuehong WANG8, Yanshuang ZHANG9, Xiaohong PAN10, Yingchun PAN11, Jing ZHAO12, Jinmei YU13, Huijuan SUO14, Yanyan HONG15, Yingying ZHAN16, Dongmei LI17, Haiyan LIU18, Xia LI19, Dan KUANG20, Qing PENG21, Jing WANG22, Ping YU23, Rui CHEN24, Yunmin CAI25, Ling HUANG26, Zujing WANG27, Guangyang WANG28, Jingping HAO29, Dongmei ZHU30,*()   

  1. 1. Department of Burns and Plastic Surgery, General Hospital of Eastern Theater Command, Nanjing 210002, China
    2. Department of Outpatient, Affiliated Hospital of Jiangnan University, Wuxi 214062, China
    3. Clinical Academic Department, Zhejiang Top-medical Medical Dressing Co., Ltd., Wenzhou 325027, China
    4. Nursing Department, Zhongda Hospital, Southeast University, Nanjing 210009, China
    5. Orthopedics Department, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
    6. Department of Gastrointestinal Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
    7. Nusing Department, Xing'anmeng People's Hospital, Ulanhot 137400, China
    8. Nursing Department, Suqian First People's Hospital of Nanjing Drum Tower Hospital Group, Suqian 223800, China
    9. Changshu No.2 People's Hospital, Changshu 215500, China
    10. Jingzhou Central Hospital, Jingzhou 434000, China
    11. Nursing Department, Anqing First People's Hospital of Anhui Province, Anqing 246003, China
    12. Department of Outpatient Treatment, Jiangsu Province Hospital, Nanjing 210009, China
    13. Yangzhou Jiangdu People's Hospital, Yangzhou 225200, China
    14. Department of General Surgery, Pizhou People's Hospital, Pizhou 221300, China
    15. Nursing Department, Nanjing Hospital of Chinese Medicine, Nanjing 210001, China
    16. Outpatient Department, Qinhuai Medical Branch, General Hospital of Eastern Theater Command, Nanjing 210008, China
    17. Wound, Ostomy and Continence Nursing Clinic, Guidong People's Hospital of Guangxi Zhuang Autonomous Region, Wuzhou 543099, China
    18. Nursing Department, Siyang Hospital of Chinese Medicine, Suqian 223700, China
    19. Wound and Ostomy Clinic, the Fifth People's Hospital of Wuhu, Wuhu 241000, China
    20. Nursing Department, Affiliated Hospital of Jiangnan University, Wuxi 214062, China
    21. Outpatient Wound Care Center, General Hospital of Eastern Theater Command, Nanjing 210002, China
    22. Nursing Department, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China
    23. ICU, Wuxi No.2 People's Hospital, Wuxi 214002, China
    24. Hospital Management Office, Jiujiang No.1 People's Hospital, Jiujiang 332001, China
    25. Wound Care Center, Jinshan Hospital of Fudan University, Shanghai 201508, China
    26. People's Hospital of Xiushan County, Chongqing 409900, China
    27. Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Suzhou 215000, China
    28. Wound and Ostomy Care Center, the First People's Hospital of Honghe State, Honghe 661199, China
    29. Nursing Department, Suqian Chinese Medicine Hospital, Suqian 223800, China
    30. Nursing Department, General Hospital of Eastern Theater Command, Nanjing 210002, China
  • Received:2021-12-06 Revised:2022-04-08 Published:2022-07-20 Online:2022-04-29
  • Contact: Dongmei ZHU
  • About author:
    JIANG Q X, XIE Y J, BAI Y X, et al. Prevalence and epidemiologic features of skin injuries in Chinese older adults: a multicenter cross-sectional study [J]. Chinese General Practice, 2022, 25 (21) : 2569-2576.

摘要: 背景 人口老龄化是全球医疗保健领域面临的重大挑战,由于病理和生理性皮肤衰老使老年人成为皮肤损伤的高发人群,因此,近年来老年人皮肤损伤的流行病学研究成为研究热点。 目的 多中心横断面调研住院老年患者压力性损伤(PI)、失禁相关性皮炎(IAD)、皮肤撕裂伤(ST)3种皮肤损伤的患病率和流行特征,为制订老年人皮肤损伤预防策略提供依据。 方法 以16个省、2个自治区和2个直辖市52所不同等级医院作为多中心调研单位,1 067名护士经过课题组线上同质化培训并考试合格后作为资料调研员,2~3人一组采用相同工具和方法对参研医院符合纳入、排除标准的老年人进行全身皮肤检查,发现皮肤损伤者,分别按照国际指南或专家共识推荐的PI定义和分期、IAD定义和分级、ST定义和分级进行识别,同时获取人口学资料、住院时间、既往慢性病史、近1个月用药情况、生活自理情况及有无PI发生风险(采用Braden量表评估)等资料,每组双人签名确定结果,原始数据通过"问卷星"网站上传。采用SPSS 22.0软件进行统计学分析。 结果 共调研14 675例老年患者,问卷有效率100.0%。男、女分别占56.3%(8 262/14 675)和43.7%(6 413/14 675);平均年龄(73.5±9.0)岁;中位住院时间7(4,13)d;汉族和19个少数民族老年患者分别占95.5%(14 020/14 675)和4.5%(655/14 675)。PI、IAD、ST及其多种皮肤损伤的总患病率为6.0%(881/14 675),其中PI、IAD和ST患病率分别为3.3%(484/14 675)、1.4%(199/14 675)和0.8%(110/14 675),多种皮肤损伤(≥2种共存)患病率为0.6%(88/14 675)。流行特征:汉族老年患者皮肤损伤患病率高于少数民族(6.2% vs 2.9%,P<0.05),>80岁老年患者患病率高于71~80岁和60~70岁者(10.2% vs 6.1% vs 3.8%,P<0.016 7),患2种及以上慢性病老年患者皮肤损伤患病率高于无慢性病者和患1种慢性病者(5.7%~12.0% vs 2.9% vs 4.4%,P<0.005),使用2种及以上药物的老年患者皮肤损伤患病率高于未用药和使用1种药物者(6.1%~10.2% vs 2.7% vs 4.6%,P<0.005),住院时间>30 d老年患者皮肤损伤患病率高于住院时间8~30 d和≤7 d者(10.7% vs 4.4% vs 7.1%,P<0.016 7),有PI发生风险者皮肤损伤患病率高于无PI发生风险者(20.5% vs 1.6%,P<0.05),生活不能自理者皮肤损伤患病率高于完全自理者(7.0% vs 0.9%,P<0.05)。损伤部位:PI多发于尾骶部(57.9%)与足跟(14.3%),IAD多发于肛周(68.3%)与臀裂(24.6%),ST多发于下肢(38.2%)与上肢(28.2%),PI合并IAD多发于骶尾部(71.0%),PI合并ST多发于尾骶部(50.0%)和足跟(35.7%),ST合并IAD多发于尾骶部(33.3%)、肛周(33.3%)和臀裂(33.3%),PI、IAD和ST共存多发于尾骶部(50.0%)和臀裂(50.0%)。 结论 我国老年患者皮肤损伤患病率处于较高水平,且随着年龄增长而升高,患有慢性病、全身用药、生活不能自理和有PI发生风险者皮肤损伤患病率明显增高,多重损伤和多部位损伤是老年人皮肤损伤的重要特征,制订老年人皮肤损伤预防策略时应关注上述特征。

关键词: 创伤和损伤, 老年人, 患病率, 流行病学研究特征, 老年压力性损伤, 失禁相关性皮炎, 皮肤撕裂伤, 多中心研究, 横断面研究

Abstract:

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.

Key words: Wounds and injuries, Aged, Prevalence, Epidemiologic study characteristics, Pressure injury, Incontinence-associated dermatitis, Skin tear, Multicenter study, Cross-sectionalsurvey