目的:本系统评价分析了与危重失禁患者失禁相关性皮炎(IAD)危险因素相关的证据。
方法:系统评价和荟萃分析。
方法:八个数据库,包括PubMed,Embase,CINAHL,科克伦图书馆,和WebofScience,搜索以英语发表的研究。中国国家知识基础设施,万方数据,和中国科学期刊数据库还搜索了以中文发表的评估重症失禁患者IAD风险的研究。
结果:纳入24项具有中等至高方法学质量的研究。发生IAD的重要危险因素年龄较大[优势比(OR)=1.06,95%置信区间(CI):1.02-1.10,P=.007],发热(OR=2.57,95%CI:1.87-3.57,P<.00001),诊断为意识障碍(OR=5.70,95%CI:2.28-14.22,P=.0002),具有较高的急性生理学和慢性健康评估(APACHE)II评分(OR=1.71,95%CI:1.25-2.35,P=.0009),较低的Braden评分(OR=0.73,95%CI:0.56-0.96,P=0.02),较低的氧饱和度(OR=2.76,95%CI:1.52-5.00,P=.0008),双失禁(OR=4.10,95%CI:2.34-7.17,P<.00001),液便(OR=6.55,95%CI:4.12-10.41,P<.00001),频繁尿失禁(OR=1.21,95%CI:1.03-1.43,P=.02),会阴评估工具(PAT)得分较高(OR=3.18,95%CI:1.76-5.76,P=0.0001)。
结论:本系统综述和荟萃分析的结果表明,医疗保健提供者应考虑风险因素,例如年龄,发烧,意识障碍,APACHEII评分更高,在制定危重失禁患者IAD的预防和管理策略时,较低的Braden评分和双重失禁问题。
OBJECTIVE: This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients.
METHODS: Systematic review and meta-analysis.
METHODS: Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The
China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language.
RESULTS: Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.02-1.10, P = .007], fever (OR = 2.57, 95% CI: 1.87-3.57, P < .00001), diagnosed with consciousness disorder (OR = 5.70, 95% CI: 2.28-14.22, P = .0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.71, 95% CI: 1.25-2.35, P = .0009), lower Braden score (OR = 0.73, 95% CI: 0.56-0.96, P = .02), lower oxygen saturation (OR = 2.76, 95% CI: 1.52-5.00, P = .0008), double incontinence (OR = 4.10, 95% CI: 2.34-7.17, P < .00001), liquid stool (OR = 6.55, 95% CI: 4.12-10.41, P < .00001), frequent incontinence (OR = 1.21, 95% CI: 1.03-1.43, P = .02), and higher perineal assessment tool (PAT) score (OR = 3.18, 95% CI: 1.76-5.76, P = .0001).
CONCLUSIONS: Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.