| This study contains two parts,meta analysis:[Objective] To determine the optimal repositioning frequency for patients at risk of pressure ulcer lying on pressure-relieving mattress,in order to provide the evidence for clinical selection of appropriate turnning frequency.[Method]The computer retrieved the Cochrane Library、Web of Knowledge、PubMed、 CINAHL、MEDLINE、Springer、EBSCO、EMbase、CBMdisc, CNKI, Wanfang and VIP to collect randomized controlled trails(RCTs). We eliminated the repeated researches by Note Express2, and then confirmed the included studies through reading the literatures.The quality of RCTs was critically appraised and data were extracted by 2 reviewers independently. Meta analysis was conducted for the eligible RCTs.[Result] A total of 12 RCTs and 2891 cases were included..Meta analysis results showed that the bedridden patients lying on effective decompression mattress can be turned once evrey 4 hours; 2 studies showed using pressure-relieving mattress with 4-h turning scheme did not increase the incidence of pressure ulcer and improved the comfort degree of patients; 1 study shows 4-h turning scheme produced less nursing workload, and decreased device-related adverse events.[Conclusion] The meta analysis showed that patients at risk of pressure ulcer lying on the pressure-relieving mattress can be turned once evey 4 hours, which improved the comfort of patients, decreased the workload of nurses and device-related adverse events. The clinical study:[Objective] To apply and test the conclusions of meta analysis and compair the effectiveness and convenience of decompression scheme of gel-sponge mattress with 4-h turning and conventional therapy for intensive care patients, in order to provide evidence for clinical selection of appropriate mattress and the optimal repositioning frequency.[Method] ①We recruited 377cases from Nanjing General Hospital of Nanjing military command and Zhongda Hospital Southeast University from October,2013 to October, 2014.The consents of the patient or his family were obtained,the subjects all signed the informed consents.②Grouping method:377 cases at risk of pressure ulcer were randomly divided into two groups,of which 189 cases used the dynamic air mattress with 2-h turning scheme,188 cases used gel-sponge mattress with 4-h turning scheme, researchers observed the incidence of pressure ulcer for 7 days.③Outcome measures:the main observation indexes:the incidence of pressure ulcer (the number of patients with pressure ulcers in one group/total number of patients in this group x 100%), pressure ulcer staging (using the National Pressure Ulcers Advisory Panel (NPUAP), pressure ulcers grading system including Ⅰ, Ⅱ,Ⅲ, Ⅳ stage, Unstageable and suspected deep tissue injury pressure ulcers). Secondary outcome measures:scoring the risk of pressure ulcer by Braden scale(see in appendix 2,score 6-23 points, the lower score says higher risk of pressure ulcer, the scale includes six factors:perception, moisture, activity, mobility nutrition, friction and shear forces),the convenience evaluation by nurse about using the two support surfaces:according to the time needed for sorting or replacementing sheets and checking the mattress(using grade standard evaluation,including inconvenient, a little convenient, convenient, very convenient).④Data management and statistical analysis:case report forms (see in appendix 3) were filled by personnel who were have been trained,following the principle of complete, accurate and true, research personnel responsible for the research inspectioned the case report forms regularly, and collected the completed studies on time. All the data were analyzed by SPSS 20.0 software package, measurement data using (x±s), t-test was used for two group mean differences,number and percentage were provided in categorical data and grading materials analysis, the rate diffrence of two groups were compared with chi-square test,, P<0.05 was considered significant.[Result] Three cases of pressure ulcers occured in control group,which were two Ⅰ stage of pressure ulcers and one Ⅱ stage of pressure ulcer,the incidence of pressure ulcers in the two groups were1.58% and 0%, respectively, which were not statistically significant different.Score of Braden scale of patients differed in different times (F=9.339, P<0.01).intervention measures had no interaction with time, the results of Braden scores showed no significant difference between the two groups.Nursing staff in experamental group thought more convenient.[Conclusion] Braden scores improved with time,Turning once every 4 hours for patients lying on gel-sponge mattress can effectively prevent pressure ulcers, and the effect is equivalent with the conventional therapy,the nursing staff thought gel-sponge mattress were more convenient. |
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