——邵思语 翟雨婷 卢 璇张建薇*

【摘要】目的 降低老年心电监测患者医用粘胶相关性皮肤损伤发生率。方法 开展问题解决型品管圈活动，针对电极片处发生刺激性皮炎和移除电极片时表皮剥脱两大症结进行深入分析，构建了皮肤损伤预防方案，优化了相关流程。结果 老年心电监测患者医用粘胶相关性皮肤损伤发生率从14.3%下降至9.5%。结论 应用品管圈工具可以降低老年心电监测患者医用粘胶相关性皮肤损伤发生率，具有推广价值。

【关键词】 品管圈；问题解决型品管圈；老年患者；心电监测；医用粘胶相关性皮肤损伤

中图分类号：R197.323文献标识码：B

Reducing the Incidence of Medical Adhesive-Related Skin Injury in Elderly Patients with Electrocardiogram Monitoring/SHAO Siyu,ZHAI Yuting,LU Xuan, et al.//Chinese Health Quality Management，2022,29(9):58-63

Abstract Objective To reduce the incidence of medical adhesive-related skin injury in elderly patients with electrocardiogram monitoring.Methods The problem solving quality control circle activities were carried out to explore and improve the two main causes of irritant dermatitis and skin peeling when removing the electrode. The pre-control program of skin injury was constructed, and the procedures were optimized.Results The incidence of medical adhesive-related skin injury decreased from 14.3% to 9.5%. Conclusion The application of the quality control circle tool can reduce the incidence of medical adhesive-related skin injury in elderly patients with electrocardiographic monitoring, and it has popularization value.

Key words Quality Control Circle; Problem Solving Quality Control Circle; Elderly Patients; Electrocardiogram Monitoring; Medical Adhesive-Related Skin Injury

First-author's address Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing,Jiangsu, 210008, China

1主题选定

全体圈员根据优先次序矩阵法，分别评价重要性、迫切性、圈能力、上级重视程度四个维度的权重。然后，结合权重法，以“5-3-1”打分法［1］对所有备选主题进行评价，选定得分第一顺位的“降低老年心电监测患者医用粘胶相关性皮肤损伤发生率”为本期活动主题。

名词定义：医用粘胶相关性皮肤损伤（Medical Adhesive-Related Skin Injury,MARSI）即医用粘胶移除后，皮肤出现持续30 min甚至更长时间的红斑，伴或不伴水泡、糜烂或撕裂伤等皮肤异常症状［2］。

衡量指标：老年心电监测患者MARSI发生率=单位时间内老年心电监测患者发生MARSI人数/同期老年心电监测患者总人数×100%。

选题背景：MARSI不仅会引起患者疼痛、伤口感染等后果，而且会引发患者烦躁情绪，使患者依从性下降。对于危重患者，MARSI还影响生命体征监测及病情观察，不利于及时抢救，增加了医疗风险。Farris MK等［2］发现，MARSI发生率为13.5%～58.3%；Konya C等［3］研究显示，MARSI发生率为10.7%～38.4%。随着年龄增加，患者体内水分、电解质等流失严重，皮肤表面弹性降低，导致皮肤屏障功能减弱；同时，皮脂含量降低，造成角质层无法得到充足滋润，皮肤表面湿度降低，干燥问题随之产生。基于以上皮肤特点，老年患者在接触医用胶粘剂时，更容易发生皮肤损伤。尽管MARSI发生率高且危害严重，但临床医务人员对其的知晓率和预防措施落实率较低。如：Clothier A［4］对918名临床护士的调查显示，仅31.3%的护士听说过MARSI；郑文雅等［5］发现，34.4%的护士从未听说过MARSI，40.4%的护士缺乏相关预防技能；吕娟等［6］发现，70%的老年科护士对MARSI相关知识了解较少，8.7%的护士从未听说过MARSI。

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