CAJ | 학술논문

目的：探讨4R危机管理理论在ICU患者皮肤护理管理中应用的临床效果。方法将2009年9月-2010年12月1937例患者设为对照组，采用传统的管理方法进行护理；2011年1月-2012年4月2129例患者设为观察组，在传统管理方法的基础上，应用4R危机管理理论对患者进行皮肤护理管理。比较两组患者皮肤湿疹、压疮及冻（烫）伤等并发症的发生情况和院外压疮好转情况。结果对照组患者发生湿疹63例；院内压疮25例，其中鼻胃管所致5例，血压袖带所致1例，经鼻气管插管所致18例，骶尾部压疮1例；冻伤0例；胶布及电极片所致皮肤损伤10例。观察组患者发生湿疹21例；院内压疮11例，即经鼻气管插管所致11例；烫伤1例；胶布所致皮肤损伤3例。湿疹、压疮及皮肤破损的发生情况比较，差异有统计学意义（χ2值分别为25．74，6．92，4．48；P＜0．05）。对照组患者院外压疮7例，其中痊愈0例，好转5例，未愈2例。观察组院外压疮9例，其中痊愈4例，好转5例。两组患者院外压疮护理好转情况比较，差异有统计学意义（χ2＝5．45，P＜0．05）。结论应用4R危机管理理论对ICU患者皮肤护理进行管理，有效预防和减少了与皮肤有关的并发症，可以提高护理质量，保障患者的安全。
목적：탐토4R위궤관리이론재ICU환자피부호리관리중응용적림상효과。방법장2009년9월-2010년12월1937례환자설위대조조，채용전통적관리방법진행호리；2011년1월-2012년4월2129례환자설위관찰조，재전통관리방법적기출상，응용4R위궤관리이론대환자진행피부호리관리。비교량조환자피부습진、압창급동（탕）상등병발증적발생정황화원외압창호전정황。결과대조조환자발생습진63례；원내압창25례，기중비위관소치5례，혈압수대소치1례，경비기관삽관소치18례，저미부압창1례；동상0례；효포급전겁편소치피부손상10례。관찰조환자발생습진21례；원내압창11례，즉경비기관삽관소치11례；탕상1례；효포소치피부손상3례。습진、압창급피부파손적발생정황비교，차이유통계학의의（χ2치분별위25．74，6．92，4．48；P＜0．05）。대조조환자원외압창7례，기중전유0례，호전5례，미유2례。관찰조원외압창9례，기중전유4례，호전5례。량조환자원외압창호리호전정황비교，차이유통계학의의（χ2＝5．45，P＜0．05）。결론응용4R위궤관리이론대ICU환자피부호리진행관리，유효예방화감소료여피부유관적병발증，가이제고호리질량，보장환자적안전。
Objective To explore the clinical effect of the application of 4R crisis management theory in skin care of ICU patients .Methods Totals of 1 937 cases of ICU surgical patients from September 2009 to December 2010 in our hospital , who received the traditional management method , were set to be the control group.The other 2 129 cases of ICU surgical patients from January 2011 to April 2012, who received the 4R crisis management theory in skin care based on the traditional management method , were set to be the experiment group .The occurrence of complications such as eczema , pressure ulcer , frostbite and empyrosis and the recovery of the pressure ulcer outside hospital of the two groups were observed and compared .Results In the control group , there were sixty-three cases of eczema , twenty-five cases of pressure ulcer ( five were caused by nasogatric tube , one by blood pressure cuff , eighteen by nasotracheal intubation , one by prominence of sacra) , and ten cases of skin damage caused by adhesive plaster or electrode pads ;In experiment group , there were twenty-one cases of eczema , eleven cases of pressure ulcer ( eleven by nasotracheal intubation ) , one case of scald, three cases of skin damage caused by adhesive plaster .The experiment group in improvement of eczema, pressure ulcer, and skin damage was statistically significantly better than those in the control group (χ2 =25.74, 6.92,4.48, respectively;P<0.05).In the control group, seven cases appeared pressure ulcer from outside the hospital, among which no one healed, five improved, and two not improved.While pressure ulcer from outside the hospital were nine in the experiment group , among which four healed and five improved , with a statistically significant difference between the two groups (χ2 =5.45, P<0.05).Conclusions The application of 4R crisis management theory in skin care of ICU patients will effectively prevent and reduce the complications related to the skin so that the purpose of improving nursing quality and safeguarding the patients can be achieved.