Prediction of pressure ulcer deterioration focused on persistent erythema, and development and evaluation of a new protective skin dressing

该项目的最终研究是对一种新开发的敷料的有效性进行评估，该敷料可以防止卧床不起的老年患者出现持续性红斑和压疮，并在不增加皮肤酸碱度的情况下改善皮肤的保水能力。剪切力和皮肤干燥在持续性红斑和压疮的发展中起着重要作用。为了消除这些风险，我们开发了一种敷料，以减少剪切力，提高保水能力。然而，这种敷料在临床环境中的效果仍不清楚。2004年，日本一家医院对37名卧床不起的老年患者进行了一项实验性的双边对比研究，这些患者有发生压疮的风险。将敷料随机涂在右侧或左侧大转子上，为期三周。另一侧不敷料作为对照。在为期三周的应用期间，每周监测皮肤是否有持续性红斑和压疮的发展。在干预期间和脱下敷料后的一周内，还评估了皮肤水合和pH值。干预区持续性红斑发生率显著低于对照区[P=0.007.0 5，RR 0.18(95%C：0.0 5~0.73)和NNT 4.11(2.5 0~11.6 3)]。干预区和对照组均未发生压疮。敷料使用过程中皮肤水份显著增加，去除后皮肤水份仍高于对照组(P&lt；0.001)。皮肤pH值在使用过程中显著下降(P&lt；0.001)，但在去除后恢复到对照水平(P=0.38)。这款安全有效的敷料可用于骨骼高度突出、皮肤干燥的患者，防止压疮。

The final study of this project is an evaluation of the effectiveness of a newly-developed dressing for preventing persistent erythema and pressure ulcer development and improving the skin water-holding capacity without increasing the skin pH in bedridden older patients. Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for three weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the three-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for one week after dressing removal. The incidence of persistent erythema was significantly lower in the intervention area than the control area [P=0.007, RR 0.18 (95% C: 0.05-0.73) and NNT 4.11 (2.50-11.63)]. No pressure ulcers occurred in either intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P<0.001) relative to the control area. Skin pH decreased significantly during the application (P<0.001) but returned to control levels after removal (P=0.38). This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers.