不同频率钉道护理PPT课件.ppt

Pinsitecareforpreventinginfectionsassociatedwithexternalbonefixatorsandpins Review 不同护理方法对钉道感染率影响的比较 系统评价 骨折外固定的发展背景 1853年Malgaigne提出使用经皮切开内置金属外固定的方法治疗骨折1983年Green总结早期外固定的感染率范围从1 80 1983年Sisk总结钉道感染的后果 牵引无效 骨髓炎 全身感染1988年Behrens总结外固定的优势 固定可靠 易于早期活动 不限制关节活动 可早期功能锻炼1997年Blaiser外固定已广泛应用于骨折的固定 钉道感染没有明确定义 所以很难比较感染率 2001年Lee Smith提出了区分Reaction Colonisation Infection的方法 骨折外固定的发展背景 骨折外固定护理现况 不同的清洁溶液Hydrogenperoxide Jones Walton1991 0 9 normalsalineorcooledboiledwater Sims1996 70 alcoholand0 2 chlorhexidine Grant1992 不同的清洁间隔时长daily Tolo1983 weekly Ahlborg1999 fortnightly Grant1992 骨折外固定护理现况 其他存在争议的问题WhetherornotscabsaroundthepinsitesshouldberemovedWhethermassagetopromotedrainageofexudateshouldbepractised Gordon2000 McKenzie1999 Sims1996 该系统评价的重要性Mostofthestudiesinvestigatingthisissuehascomefromresearchonanimalsorconcernpatientoutcomesobtainedfromcaseseriesordescriptivestudies Asitisunclearwhichcareregimenisthemosteffective asystematicreviewoftheevidencehasbeenundertaken 检索词 数据库 证据内容 Atotalofeleventrials 572participants wereeligibleforinclusioninthereviewbutnotallparticipantscontributeddatatoeachcomparison Threetrialscomparedacleansingregimen saline alcohol hydrogenperoxideorantibacterialsoap withnocleansing applicationofadrydressing Threetrialscomparedalternativesterilecleansingsolutions saline alcohol peroxide povidoneiodine Threetrialscomparedmethodsofcleansing onetrialcomparedidenticalpinsitecareperformeddailyorweeklyandthetwootherscomparedsterilewithnonsteriletechniques 证据内容 Onetrialcompareddailypinsitecarewithnocareandsixtrialscompareddifferentdressings usingdifferentsolutions ointmentsanddryandimpregnatedgauzeorsponges Onesmallblindedstudyof38patientsfoundthattheriskofpinsiteinfectionwassignificantlyreducedwithpolyhexamethylenebiguanide PHMB gauzewhencomparedtoplaingauze RR0 23 95 CI0 12to0 44 infectionrateof1 inthePHMBgroupand4 5 inthecontrolgroup butthisstudywasathighriskofbiasastheunitofanalysiswasobservationsratherthanpatients 证据内容 钉道是否需要清洁 证据不足不同的清洁溶液是否有差异 证据不足不同的清洁方式是否有差异 可信度有限是否需要敷料 两者无差别不同类型敷料是否有差异 不能确定哪一种更有效按摩对于钉道护理是否有影响 无相关RCT 循证决策 Theavailabletrialevidencewasnotextensive wasveryheterogeneousandgenerallyofpoorquality sotherewasinsufficientevidencetobeabletoidentifyastrategyofpinsitecarethatminimisesinfectionrates Adequately poweredrandomisedtrialsarerequiredtoexaminetheeffectsofdifferentpinc