壓傷高風險病人使用矽膠泡棉敷料是否可以降低骶骨壓傷發生率

Can the Pressure Injuries High-risk Patients Reduce the Incidence of Sacrum Pressure Injuries by Using Silicone Foam Dressings?

10.6647/CN.202312_30(4).0008

林怡雯(Yi-Wun Lin)；賴冠文(Kuan-Wen Lai)；陳靜儀(Ching-Yi Chen)

壓傷 ； 矽膠泡棉敷料 ； pressure injuries ； silicone foam dressing

彰化護理

30卷4期（2023 / 12 / 01）

65 - 81

繁體中文;英文

背景及目的：2011年起台灣醫院評鑑暨醫療品質策進會將壓力性損傷列入臨床成效指標計畫（Taiwan clinical performance indicators, TCPI）的重要監測項目之一。壓傷不僅會造成病人疼痛，增加感染機率、護理時數及住院天數等，甚至會影響生活品質及併發死亡，臨床中也曾遇到家屬向護理人員提問：是否可以在尾骶骨貼上泡棉敷料來預防或改善壓傷情形？因此引發筆者想藉由實證探討「壓傷高風險病人骶骨使用矽膠泡棉敷料是否可以降低壓傷發生率」，期能提供護理人員在執行臨床照護時的依據，進而提升護理品質。方法：以PICO擬定關鍵字，搜尋中英文電子資料庫，符合納入條件之研究，使用CASP評析工具進行文獻資料評價及精粹。結果與結論：經由文獻篩選後共納入2篇隨機對照試驗文章及1篇系統性文獻回顧與統合分析文獻進行評讀，得知矽膠泡棉敷料的使用確實可以降低骶骨壓傷發生，且無造成相關傷害事件，故可將此研究運用在向病人及家屬推廣降低骶骨壓傷之預防衛教上，然仍須考量病人疾病與傷口狀態、家屬的經濟能力、護理人員對壓瘡傷口照護及技能等素養，以做出合宜的臨床決策，以降低壓傷的發生及惡化，促進病人身心舒適。

Background and Purpose: Taiwan clinical performance indicators included pressure injury as one of the important monitoring items of the clinical performance indicator program since 2011. Pressure injuries not only make patients feel pain, but also increase infection rate, nursing hours, length of stay, affect the quality of life, and even cause death. Healthcare provider usually suggest that patients and their families buy silicone foam dressing and put it on patients' bony prominence, such as sacrum. But someone may ask "Does silicone foam dressing work?" Therefore, the author wants to explore: Can the pressure injuries high-risk patients reduce the incidence of sacrum pressure injuries by using silicone foam dressings? We expect this article provide the evidence for healthcare provider, so that they can answer patients and their families' question, use correct intervention, improving the quality of nursing Methods: PICO was used to formulate keywords, and the Chinese and English electronic databases were searched, and CASP checklist was used to evaluate and summarize the literature. Results and Conclusion: A total of 2 Randomized controlled trial of literature and 1 systematic reviews and meta-analyses of literature were selected for critical appraisal. It was found that using silicone foam dressings can reduce the incidence of sacrum pressure injury without obvious side effect. Therefore, this article can be used to prove silicone foam dressing effective, provide health education about prevent sacrum pressure injury happen to patients and their families. However, it is still necessary to comprehensively consider factors such as the patient's condition, wound status, financial ability of families, and the quality of pressure ulcer nursing care, and make appropriate clinical decisions to reduce the occurrence and deterioration of pressure ulcers and promote patient comfort.

1. 葉子綺,鄧佩如,陳麗貞,許美惠(2020)。降低外傷急症加護病房病人壓力性損傷發生率。長庚護理，31(3)，368-381。
   連結：
2. Agency for Health Care Research and Quality. (2011, October 19). Pressure ulcer in adults: Prediction and prevention. AHCPR supported clinical practice guidelines. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK63915/
3. Alderden, J. G.,Shibily, F.,Cowan, L.(2020).Best Practice in Pressure Injury Prevention Among Critical Care Patients.Critical care nursing clinics of North America,32(4),489-500.
4. Beekman, D.,Fourie, A.,Raepsaet, C.,Van Damme, N.,Manderlier, B.,De Meyer, D.,Beele, H.,Smet, S.,Demarré, L.,Vossaert, R.,de Graaf, A.,Verhaeghe, L.,Vandergheynst, N.,Hendrickx, B.,Hanssens, V.,Keymeulen, H.,Vanderwee, K.,Van De Woestijne, J.,Verhaeghe, S.,Hulstaert, F.(2021).Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial.The British journal of dermatology,185(1),52-61.
5. Davies, P.(2016).Role of multi-layer foam dressings with Safetac in the prevention of pressure ulcers: a review of the clinical and scientific data.Journal of wound care,25(Sup1),S1-S23.
6. Forni, C.,Gazineo, D.,Allegrini, E.,Bolgeo, T.,Brugnolli, A.,Canzan, F.,Chiari, P.,Evangelista, A.,Grugnetti, A. M.,Grugnetti, G.,Guberti, M.,Matarese, M.,Mezzalira, E.,Pierboni, L.,Prosperi, L.,Sofritti, B.,Tovazzi, C.,Vincenzi, S.,Zambiasi, P.,Zoffoli, C.,Zanelli, S.(2022).Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: Randomized controlled trial.International Journal of nursing studies,127,104172.
7. Hahnel, E.,El Genedy, M.,Tomova-Simitchieva, T.,Hauß, A.,Stroux, A.,Lechner, A.,Richter, C.,Akdeniz, M.,Blume-Peytavi, U.,Löber, N.,Kottner, J.(2020).the effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial.The British Journal of dermatology,183(2),256-264.
8. Rahman-Synthia, S. S.,Kumar, S.,Boparai, S.,Gupta, S.,Mohtashim, A.,Ali, D.(2023).Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis.Enfermeria clinica (English Edition),33(1),4-13.
9. Worsley, P. R.,Clarkson, P.,Bader, D. L.,Schoonhoven, L.(2017).Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation.Physiotherapy,103(3),304-310.
10. 蔡思盈,鄒孟婷(2019)。壓傷的整體評估及處理。台北市醫師公會會刊，63(3)，37-42。