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

本项目的最终研究是评价一种新开发的敷料在防止卧床不起的老年患者出现持续性红斑和压疮以及改善皮肤持水能力而不增加皮肤pH值方面的有效性。剪切力和皮肤干燥在持续性红斑和压疮的发展中起重要作用。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然未知。2004年在日本的一家医院进行了一项实验性双侧比较研究，其中有37名卧床不起的老年患者有压疮发生的风险。将敷料随机应用于右侧或左侧大转子，持续3周。作为对照，对侧不使用敷料。在三周应用期间每周监测皮肤的持续性红斑和压疮发展。在干预期间和敷料移除后一周，还评估了皮肤水合作用和pH值。干预区持续性红斑的发生率显著低于对照区[P=0.007，RR 0.18（95% C：0.05-0.73）和NNT 4.11（2.50-11.63）]。干预或对照区域均未发生压疮。皮肤水合作用在敷料应用期间显著增加，并且相对于对照区域，在移除敷料后仍保持较高水平（P<0.001）。皮肤pH值在施用期间显著降低（P<0.001），但在移除后恢复到对照水平（P=0.38）。这种安全有效的敷料可用于骨骼高度突出和皮肤干燥的患者，以防止压疮。

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.