老年人皮肤完整性的系统评价。

PubMed ID
发表日期 2020年Mar月

原始出处 国际护理研究杂志
International journal of nursing studies
作者 Lichterfeld-Kottner  A  El Genedy  M  Lahmann  N  Blume-Peytavi  U  Büscher  A  Kottner  J 

文献标题 老年人皮肤完整性的系统评价。
Maintaining skin integrity in the aged: A systematic review.

文献摘要 BACKGROUND

在老年护理接受者中,不良皮肤状况的患病率很高,如皮肤干燥、间质癣、压疮或皮肤撕裂。适当的皮肤护理策略是维持和提高该人群皮肤健康和完整性的有效方法。

OBJECTIVES

目的是总结非药物局部皮肤护理干预对促进和维持老年人皮肤完整性和皮肤屏障功能的效果和有效性的经验证据,以确定该领域的结果域和结果测量工具。

DESIGN

对2013年发布的先前系统性评论进行了更新。

DATA SOURCES

数据库MEDLINE和EMBASE通过OvidSP和CINAHL(原始搜索1990年1月至2012年8月,更新2012年9月至2018年5月)和参考列表。在科学网中进行了前向搜索。

METHODS

审查方案在Prospero注册(CRD42018100792)。主要纳入标准为1990年至2018年期间发表的主要干预研究,报告了年龄范围下限为50岁的老年人的基本皮肤护理策略的治疗效果。初步的实证研究包括实验研究设计,包括随机对照试验和准实验设计。使用Cochrane Collaboration的偏倚风险评估工具评估随机对照试验的方法学质量。所有纳入研究的证据水平都被分配。

RESULTS

最终分析包括63篇文章,报告了治疗和/或预防皮肤干燥、瘙痒、一般皮肤屏障改善、尿失禁相关皮炎、皮肤撕裂和压疮的干预效果。含有合成物或两性表面活性剂的洁面乳与标准肥皂和水相比能改善皮肤干燥。含保湿剂的产品的亲油性叶子可以减少皮肤干燥和瘙痒。pH值为4的产品改善了皮肤屏障。皮肤保护剂和结构化皮肤护理方案的应用降低了尿失禁相关皮炎的严重程度。含有甘油和凡士林的配方可以降低皮肤撕裂的发生率。35个结果域被确定为近100种不同的结果测量工具。

CONCLUSION

纳入的研究表明,在设计、干预措施和结果方面存在很大的异质性。基本护肤策略包括低刺激性清洁剂和含亲油性保湿剂的叶面产品,有助于治疗干性皮肤和改善皮肤屏障。低pH值的产品可以改善皮肤屏障。不同结果域的数量出人意料地高。我们建议确定皮肤护理领域的关键结果域,以使未来的试验结果更具可比性,并测量不同护肤策略和产品之间可能存在的性能差异。


BACKGROUND

In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population.

OBJECTIVES

The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field.

DESIGN

An update of a previous systematic review published in 2013 was conducted.

DATA SOURCES

Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted.

METHODS

A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies.

RESULTS

Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments.

CONCLUSION

Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.


获取全文 10.1016/j.ijnurstu.2019.103509