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फ़եՈనဍዦੰ‫܊‬ᓸΚ‫܄‬ཞ໾ϐวғஏࡋ!!
‫ں‬۷ቈ 1 ᗂ‫ؾ‬ઢ 1 ᑋஎ๻ 1 ങ࿅ቈ 1 ᎒Ϟാ 2,3 ଽ‫ؾ‬৕ 1

ᄔ ा Ǻ ՈనဍዦࣽੰΓӢϯᕍ‫܈‬ମᡎ౽෌ࡕխࣝ‫ڋ׭‬ǴܰӢᡏૈ຀১ޮ‫׉‬ਔ໔ߏǴൂՏᓸΚ‫܄‬ཞ໾วғ
ஏࡋҗ 2013 ԃ 0.17%΢ϲԿ 2014 ԃ 0.30%Ǵࡺයఈᙖ஑ਢ௢୏Ԗਏफ़եᓸΚ‫܄‬ཞ໾วғஏࡋǶϩ‫݋‬ᏤӢ
ࣁǺ(1)ៈ౛ৣჹᓸΚ‫܄‬ཞ໾ៈ౛ᇡ‫ޕ‬ό‫ى‬ǹ(2)ៈ౛ৣᓸΚ‫܄‬ཞ໾ϩભղ‫ૈۓ‬Κό‫ى‬ǹ(3)ៈ౛ৣᓸΚ‫܄‬ཞ
໾ྣៈ୺Չό‫ى‬ǹ(4)ҁൂՏٛᓸᇶ‫ڀ‬೛ഢό‫ى‬Ƕ࿶уமӧᙍ௲‫ػ‬Ϸ୻‫ػ‬ᅿηΓ঩Ǵගϲៈ౛ৣჹᓸΚ‫܄‬
ཞ໾Ⴃٛ࣬ᜢᇡ‫ޕ‬ϷᏹբૈΚǴࡌҥᓸΚ‫܄‬ཞ໾ྣៈࢗਡᐒ‫ڋ‬ǴջਔϟΕ፾྽‫ޑ‬ٛᓸ௛ࡼᇶ‫ڀ‬ǴճҔᙌ
‫ي‬ᘍՏკТൂ஭‫܈‬ቹТǴගϲࡰᏤਏૈǴ٠๓Ҕၠሦୱი໗ӝբၗྍǴᓸΚ‫܄‬ཞ໾วғஏࡋёҗ‫ׯ‬๓߻
ѳ֡ 0.30%Πफ़Կ 0.12%ǴёၲҞ኱ॶЪਏ݀ᆢ࡭ԋਏ‫ؼ‬ӳǴԖշ‫ܭ‬ගϲᓸΚ‫܄‬ཞ໾ៈ౛ࠔ፦Ƕ
ᜢᗖຒǺՈ న ဍ ዦ Ǵ ᓸ Κ ‫ ܄‬ཞ ໾
(Ѡ ᡼ ᙴ Ꮲ Formosan J Med 2020;24:324-34) DOI:10.6320/FJM.202005_24(3).0012

߻!‫!ق‬ ౜‫ݩ‬ϩ‫!!݋‬
⡻≃ ⿏㎵ 㗗 嬟䎮冐⸲ 䄏嬟䘬 慵天㊯㧁 ᷳ ΋/ġൂՏᙁϟϷᓸΚ‫܄‬ཞ໾วғஏࡋ౜‫ݩ‬ፓ่ࢗ݀!
!
ᶨ炻䔞䙖兂⍲䙖ᶳ䳬䷼⍿⇘㊩临⡻従炻旣⠆埨㳩炻 㛔╖ỵ䁢埨㵚儓䗌䕭㇧炻䷥⸲㔠ℙ 37 ⸲炻2014
⚈仢埨⮶农仢㯏ˣ⢆㬣炻㈧⍿⡻≃庫⣏㗪炻⎗傥⛐ ⸜⸛⛯Ỽ⸲䌯 98.3%炻⸛⛯ỷ昊㖍 21.8 㖍炻ℙ 20
2-6 ⮷㗪ℏ↢䎦⡻≃⿏㎵ 烊䦣≽≃⍿㈹⇞䁢⡻≃ ỵ嬟䎮ⷓ炻ℐ㖍⸛⛯嬟䕭㭼䁢 8.1炻ᷣ天㓞㱣埨㵚
⿏㎵ 㚨慵天䘬⌙晒⚈⫸炻㤝⹎嘃⻙䘬䕭Ṣ⎗傥⚈ 儓䗌䚠斄䕦䕭冯橐橻䦣㢵䕭Ṣˤ
䦣≽≃⍿㈹⇞侴⺽崟⡻≃⿏㎵ 炻⯌℞ỷ昊⣑㔠攟 㕤 2015 ⸜ 1 㚰 1 㖍军 31 㖍炻㞍㟠 34 ỵ⚈埨
䘬䕭Ṣ㚜㗗⡻≃⿏㎵ 檀⌙晒佌[1,2]ˤᶨ㖎⡻≃⿏ 㵚儓䗌ℍ昊㍍⍿⊾䗪䕭Ṣ炻℞ᷕ檀忼 30 ỵℙ 88.2%
㎵ 䘤䓇㗪炻⭡㖻⮶农デ㝻⮯⦩傭䓇␥炻⺞攟ỷ昊 䕭Ṣ炻⚈⊾䗪喍䈑䓊䓇橐橻㈹⇞侴⮶农ℐ埨䎫Ỷᶳ
⣑㔠炻⡆≈䄏栏屈匟⍲慓䗪ㆸ㛔[3]ˤ 㛇攻䵕㊩䲬 2~3 忙炻忈ㆸ橼傥嘃⻙炻䴻姒婯⍲奨⮇
2013 ⸜㛔埨㵚儓䗌䕭㇧⡻≃⿏㎵ 䘤䓇⭮⹎ ⸛⛯再⸲㗪攻檀忼 18.8 ⮷㗪/⣑烊⎎䦣㢵⼴䕭Ṣ⚈
䁢 0.17%炻2014 ⸜㖶栗ᶲ⋯军 0.30%炻㚱揹㕤埨㵚 栆⚢愯ἧ䓐⍲ GVHD 䙖兂↢䎦䔘ⷠ䲭䕡僓䙖⍵ㅱ
儓䗌䕭Ṣ⊾䗪⼴⚈橐橻㈹⇞∗ἄ䓐炻忈ㆸ⃵䕓傥≃ 侭Ỽ 13.8%炻⡆≈⡻≃⿏㎵ 桐晒⍲姽Ộ⚘暋⹎ˤ
⍲ℐ埨䎫Ỷᶳ炻⭡㖻䘤䓇䘤䅺䫱幓橼ᶵ怑䕯䉨炻悐 2014 ⸜╖ỵ⡻≃⿏㎵ 䘤䓇⭮⹎檀忼 0.30%烪(䕭
↮㍍⍿䔘橼橐橻䦣㢵䕭Ṣ⎗傥⚈䦣㢵䈑㈿⭧ᷣ䕦 ㇧㕘䘤䓇ᷳ⡻≃⿏㎵ ䷥嗽㔠/ỷ昊䷥Ṣ
䕭(graft versus host disease, GVHD)℞䙖兂⬴㔜⿏ 㖍)x100%烬
炻⎴ᶨ嗽 ⎋䚠嶅 4 ℔↮ℏ⎰Ἕ妰䬿炻
⍿㎵炻劍≈ᶲ橼傥嘃⻙⡆≈再⸲㗪攻炻ὧ㚫忈ㆸ⍿ 庫 2013 ⸜ 0.17%㚱㖶栗ᶲ⋯嵐⊊炻ᶼ䚠庫㕤⎘䀋
⡻悐ỵ↢䎦埨㵚㿴㳩ᶵ嵛炻㍸⋯⡻≃⿏㎵ 䘤䓇桐 冐⸲ㆸ㓰㊯㧁(taiwan clinical performance indicator,
晒炻㓭⺽䘤⮰㟰㓡┬≽㨇ˤ䚤啱䓙⮰㟰↮㜸ᷣ天⍇ TCPI)ᶨ凔䕭㇧䘬⸛⛯ῤ 0.11%䁢檀ˤ䴻↮㜸⡻≃
⚈炻㒔⭂㓡┬㍒㕥炻ẍ旵Ỷ╖ỵ⡻≃⿏㎵ 䘤䓇⭮ ⿏㎵ ẍ ↮ 䳂 1 (Stage1, S1) 䘤 䓇 㭼 ἳ 㚨 檀 Ỽ
⹎炻忚侴㍸⋯埨㵚儓䗌䕭Ṣ䘬冐⸲嬟䎮䄏嬟⑩岒ˤ 53.9%ˣ℞㫉䁢↮䳂 2 (Stage2, S2)Ỽ 33.3%ˤ徸㟰

冢⣏慓昊 1 嬟䎮悐炻2 ℏ䥹悐炻3 ⑩岒䭉䎮ᷕ⽫

⍿㔯㖍㛇 2019 ⸜ 8 㚰 6 㖍 ㍍⍿㖍㛇 2019 ⸜ 10 㚰 18 㖍
忂妲ἄ侭倗䴉嗽烉嫅䥨䤅炻冢⣏慓昊嬟䎮悐炻冢⊿ⶪᷕⰙ⋿嶗 7 嘇ˤE-mail: tiffany@ntuh.gov.tw

324 Formosan J Med 2020 Vol.24 No.3

 旵Ỷ埨㵚儓䗌䕭㇧⡻≃⿏㎵ !

堐ᶨ烉2014 ⸜徸㟰↮㜸悐ỵ⍲䘤䓇⭮⹎
䘤䓇悐ỵ 全悐 俛㛝 啎㢶 滣⫸ ㇳ㊯ 嵛嶇 偑傃橐 ℏ嵛巅
2014 ⸜ẞ㔠 11 11 6 4 4 1 1 1
䘤䓇⭮⹎(%) 28.2 28.2 15.4 10.3 10.3 2.6 2.6 2.6

堐Ḵ烉嬟䎮ⷓ⮵⡻≃⿏㎵ 嬟䎮娵䞍㬋䡢䌯婧㞍(n=17)
⡻≃⿏㎵ 娵䞍㷔槿 㬋䡢Ṣ㔠 㬋䡢䌯(%)
1. NPUAP ⡻≃⿏㎵ ↮䳂? 2 11.8
2. ⡻≃⿏㎵ 娵䞍ᶳ↿ỽ侭㬋䡢烎 3 17.6
3. ᶳ↿ỽ媪⡻≃⿏㎵ 枸旚㕡㱽ᷳ椾怠烎 3 17.6
4. 忈ㆸ⡻≃⿏㎵ ⮶⚈䁢⡻≃⻟⹎ˣ㊩临㗪攻ˣ䳬䷼侸⍿⹎Ƀ烎 6 35.3
5. ᶳ↿㔀徘㚱斄⡻≃⿏㎵ 䘬⼙枧⚈䳈炻ỽ侭拗婌烎 8 47
6. 㟡㒂ˬ嬟䎮㧁㸾˭ᶳ↿㔀徘ỽ侭㬋䡢烎 8 47
7. ⣏⮷ὧ⣙䤩嬟䎮ỽ侭㬋䡢烎 9 52.9
8. ỽ媪伶⚳ NPUAP ⡻≃⿏㎵ ⭂佑烎 11 64.7
9. ˬSKIN Bundle ⬰嬟䲭喳㝄˭䘬⡻≃⿏㎵ 枸旚㓡┬妰䔓炻拗婌烎 11 64.7
10. 䕭Ṣ⍿⡻悐ỵ⏰䎦㛒䟜䙖㯜㲉炻NPUAP ⡻≃⿏㎵ ↮䳂? 12 70.6
11. 侣幓㈨ⶏᶳ↿㔀徘ỽ侭㬋䡢(墯怠)烎 14 82.4
12. 䔞⡻≃⿏㎵ ⎋䓊䓇炻ᶳ↿ ⎋嬟䎮㔀徘ỽ侭㬋䡢烎 16 94.1
13. ỽ侭㗗忈ㆸ⡻≃⿏㎵ 䘬⍇⚈烎 17 100
14. ỽ䁢⡻≃⿏㎵ 枸旚䘬嬟䎮㍒㕥烎 17 100
15. 䙖兂嬟䎮㕡㱽ỽ侭䁢拗婌烎 17 100
䷥⸛⛯ 60.4

㩊妶炻⤥䘤悐ỵẍ全悐⍲俛㛝䁢㚨⣂⎬Ỽ 28.2%炻 NPUAP)⡻≃⿏㎵ ↮䳂˭ˣˬ⡻≃⿏㎵ 娵䞍˭ˣ

ᷣ天⍿橼傥嘃⻙忈ㆸ攟㛇㗪攻再⸲⍲䦣㢵⼴ ˬ⡻≃⿏㎵ 枸旚㕡㱽ᷳ椾怠˭
ˣˬ忈ㆸ⡻≃⿏㎵
GVHD炻⮶农儡㾱ˣ䙖兂䔘ⷠ䲭䕡僓䙖⍵ㅱ⼙枧烊 䘬⮶⚈˭
ˣˬ⡻≃⿏㎵ 䘬⼙枧⚈䳈˭
ˣˬ嬟䎮㧁㸾˭
俛㛝⚈攟㗪攻惵㇜⎋休ˣ㯏㯋⮶䭉⡻従⮶农炻⤪堐 ⍲ˬ⣏⮷ὧ⣙䤩嬟䎮˭䫱炻⤪堐Ḵ㇨䣢ˤ
ᶨ㇨䣢ˤ
Ο/ġៈ౛ৣჹᓸΚ‫܄‬ཞ໾ϩભղ‫ૈۓ‬Κϐ҅ዴ౗!
Β/ġៈ౛ৣჹᓸΚ‫܄‬ཞ໾ៈ౛ϐᇡ‫҅ޕ‬ዴ౗! ⇑䓐㛔昊 ⎋忈⎋嬟䎮ⷓ㍸ὃ䘬ⷠ夳⡻≃⿏
ὅ昊ℏˬ2014 ⸜⹎忈⎋ ⎋嬟䎮䧖⫸妻䶜䎕˭ ㎵ ⚾䇯 20 ⻝炻᷎⬴ㆸ妶婾⡻≃⿏㎵ 㬋䡢↮䳂
ᷳ婚䦳ℏ⭡⍲ˬ嬟䎮㧁㸾˭䁢ὅ㒂炻姕妰ˬ嬟䎮ⷓ ⼴炻ℙ⇞妪 20 ᾳ柴䚖炻㕤 2015 ⸜ 3 㚰 16 㖍军 3
⮵⡻≃⿏㎵ 嬟䎮娵䞍㷔槿˭⓷⌟炻ᶼ䴻䓙 ⎋嬟 㚰 25 㖍炻ἧ䓐⼑刚⚾䇯徸ᶨ憅⮵╖ỵ 17 ỵ嬟䎮ⷓ
䎮ⷓ⍲嬟䎮攟⋼≑㟉䧧炻㕤 2015 ⸜ 3 㚰 16 㖍军 3 忚埴㷔槿炻㬋䡢䌯䁢 76.5%炻䴻↮㜸嬟䎮ⷓ⮵㕤⡻
㚰 25 㖍炻㌺昌ℑỵ㛒㺧 3 ᾳ㚰㕘忚Ṣ⒉⍲⮰㟰屈 ≃⿏㎵ ↮䳂⇌⭂傥≃ᶵ嵛炻℞ᷕ⇌嬨拗婌䌯䁢㶙
屔Ṣ炻憅⮵╖ỵ 17 ỵ嬟䎮ⷓ忚埴婧㞍炻⸛⛯⸜屯 Ⰼ䳬䷼㎵ (deep tissue injury, DTI )10.0%ˣ↮䳂 1
忼 6.1 ⸜炻傥≃忚昶ᶲ N2 ẍᶲ侭Ỽ 88.2%炻䴻婧 (Stage, S1) 7.5%ˣ↮䳂 2 (Stage, S2) 3.0%ˣ↮䳂 3
㞍䳸㝄栗䣢炻⸛⛯忼 60.4%㬋䡢娵䞍䌯炻℞ᷕỶ (Stage, S3) 2.0%ˣ↮䳂 4 (Stage, S4)1.0%ˤ
㕤⸛⛯㬋䡢䌯䘬ℙ 7 枭炻↮⇍䁢ˬ伶⚳⚳⭞⡻䗉媖
Ѥ/ġᓸΚ‫܄‬ཞ໾ྣៈ୺Չ౜‫ݩ‬ፓࢗ!
娊⥼⒉㚫(National Pressure Ulcer Advisory Panel,
㛔昊枸旚⡻≃⿏㎵ 嬟䎮夷䭬慵溆䁢烉暨⛐䕭

⎘䀋慓⬠ 2020 ⸜ 24 ⌟ 3 㛇 325

Reducing Pressure Injury in Hematology-Oncology Wards

堐ᶱ烉嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟埴䌯
枭䚖 ㅱ➟埴Ṣ㔠 ➟埴Ṣ㔠 㬋䡢➟埴䌯(%)
1. 怑䔞ἧ䓐旚⡻庼℟ 11 2 18.2
2. ὅ侣幓堐䡢⮎⋼≑㭷ℑ⮷㗪㬋䡢侣幓⍲䲨抬 11 2 18.2
3. 怑䔞姽Ộ⍲ᾅ嬟䭉嶗㍍妠䙖兂䘬⍿⡻嗽 11 3 27.3
4. ⬴ㆸ怑䔞䘬枸旚⡻≃⿏㎵ 嬟䎮㊯⮶⍲䲨抬 11 5 45.5
5. 㭷⣑句⮎➟埴䙖兂⬴㔜⿏姽Ộ⍲Ṍ䎕 11 6 54.5
6. 䕭ね㓡嬲 24 ⮷㗪ℏㅱℵ姽Ộᶼℏ⭡㬋䡢 11 7 63.6
7. 怑䔞ἧ䓐⍂Ṣⶍ䙖ㆾ㲉㡱ᾅ嬟橐䨩嗽䙖兂 11 7 63.6
8. ⣙䤩⿏䙖兂䀶䕭Ṣ⯨悐怑䔞㶭㻼⍲ᾅ嬟(n烌3) 3 2 66.7
9. “ˣ⸛幢㚫⛐暁⮷儧攻ˣᶳ㓦伖㜽柕ㆾ㡱塓㌚ 11 8 72.7
10. Braden 姽Ộʀ18 ↮侭炻24 ⮷㗪ℏ↿嬟䎮⓷柴 11 9 81.8
11. 㭷⣑㚫廒㎃滣偫䭉⚢⭂悐ỵ(n烌2) 2 2 100
⸛⛯ 55.6

კ΋ǺൂՏᓸΚ‫܄‬ཞ໾วғஏࡋୃଯϐाӢϩ‫݋‬კ!

Ṣℍ昊 24 ⮷㗪ℏἧ䓐 Braden ⡻≃⿏㎵ ⌙晒⿏姽 ℑ⮷㗪㬋䡢侣幓⍲䲨抬忼 18.2%烊怑䔞姽Ộ⍲ᾅ

Ộ[4]炻ᶼ⛐䕭Ṣ䕭ね㓡嬲⼴暨 24 ⮷㗪ℏ䴎Ḱℵ㫉 嬟䭉嶗㍍妠䙖兂䘬⍿⡻嗽Ỽ 27.3%烊⬴ㆸ怑䔞䘬枸
姽Ộ炻劍↮㔠⮷㕤䫱㕤 18 ↮ㆾ䕭Ṣ⶚䴻㚱⡻≃⿏ 旚⡻≃⿏㎵ 嬟䎮㊯⮶⍲䲨抬Ỽ 45.5%烊㭷⣑句⮎
㎵ 暨↿↢嬟䎮⓷柴炻᷎㭷⣑姽Ộ橐䨩嗽⍲⍿⡻悐 ➟埴䙖兂⬴㔜⿏姽Ộ⍲Ṍ䎕Ỽ 54.5%炻⤪堐ᶱ㇨
ỵᶨ㫉ˤ⍫侫昊ℏˬ2014 ⸜⹎忈⎋ ⎋嬟䎮䧖⫸ 䣢ˤ⎎╖ỵ旚⡻䚠斄庼℟⎒㚱 2 ⻝㯋⠲⸲炻ᶼ⚈⸜
妻䶜䎕˭ᷳ婚䦳ℏ⭡ˣ
ˬ⡻≃⿏㎵ 嬟䎮㧁㸾ἄ㤕˭ ᷭ⮶农≇傥㫈Ἓ炻庫栗ᶵ嵛ˤ
⍲㔯䌣屯㕁炻⎴㗪侫慷╖ỵ䕭Ṣ⡻≃⿏㎵ 桐晒⚈ ⮰㟰⮷䳬㕤 2015 ⸜ 3 㚰 26 㖍军 31 㖍㛇攻炻
⫸炻⇞⭂ˬ嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟埴䌯㞍㟠堐˭
炻 啱䓙嬟䎮ⷓ⮵⡻≃⿏㎵ 嬟䎮ᷳ娵䞍ˣ↮䳂⇌⭂傥
㕤 2015 ⸜ 3 㚰 16 㖍军 25 㖍䓙 5 ỵ⮰㟰ㆸ⒉炻憅 ≃ˣ⡻≃⿏㎵ 䄏嬟➟埴䌯烊旚⡻庼℟⍲䕭Ṣ⚈䳈
⮵ 3 䎕ℙ 17 ỵ嬟䎮ⷓ忚埴㞍㟠炻䘤䎦⡻≃⿏㎵ 䫱Ⰼ朊ᷳ䎦㱩㞍㟠䳸㝄炻㬠䲵↢忈ㆸ╖ỵ⡻≃⿏㎵
䄏嬟⸛⛯➟埴䌯忼 55.6%炻Ỷ㕤⸛⛯➟埴䌯枭䚖 䘤䓇⭮⹎檀ᷳ䈡⿏天⚈⚾炻⤪⚾ᶨ㇨䣢炻⎴㗪㌺
㚱 5 枭烉怑䔞ἧ䓐旚⡻庼℟⍲ὅ侣幓堐䡢⮎⋼≑㭷 昌ᶵ⎗㍏⇞䘬䕭Ṣ⚈䳈ˤ

326 Formosan J Med 2020 Vol.24 No.3

 旵Ỷ埨㵚儓䗌䕭㇧⡻≃⿏㎵ !

ୢᚒϷᏤӢዴҥ! 䙖央味炻⮶农䃉㱽姽Ộˤ㍉䓐℟檀ᾉ㓰⹎ᷳ Braden

㮷慷堐(Braden scale)姽Ộ妋䕭Ṣ㗗⏎䁢⡻≃⿏㎵
啱䓙䎦㱩↮㜸婧㞍䳸㝄㬠䲵⡻≃⿏㎵ 䘤䓇 檀⌙晒佌炻ℏ⭡ᷣ天㗗姽Ộ䕭Ṣ䘬䦣≽≃ˣ㳣≽
⭮⹎檀忼 0.30%䘬天⚈䁢烉(ᶨ)嬟䎮ⷓ⮵⡻≃⿏㎵ ≃ˣ䢐㒎≃/−≃ˣ⣙䤩/㴠㼌ˣ䆇梲冯シ嬀䉨ンℕ
嬟䎮娵䞍ᶵ嵛烊(Ḵ)嬟䎮ⷓ⡻≃⿏㎵ ↮䳂⇌⭂ 枭㊯㧁炻䷥↮䓴㕤 6-23 ↮炻䔞↮㔠グỶ炻ẋ堐䕭
傥≃ᶵ嵛烊(ᶱ)嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟埴ᶵ嵛烉 Ṣ䘤䓇⡻≃⿏㎵ 䘬⌙晒⿏グ檀炻ㅱ⍲㖑⺢䩳䚠斄
(1)㛒ὅ侣幓堐䡢⮎⋼≑㭷ℑ⮷㗪㬋䡢侣幓⍲䲨 旚嬟㍒㕥[1,7,8]ˤ
抬烊(2)㛒怑䔞姽Ộ⍲ᾅ嬟䭉嶗㍍妠䙖兂䘬⍿⡻
嗽烊(3)㛒⬴ㆸ怑䔞䘬枸旚⡻≃⿏㎵ 嬟䎮㊯⮶⍲ Ο/ġၮҔᓸΚ‫܄‬ཞ໾ៈ౛ࡰЇ‫ܭ‬फ़եᓸΚ‫܄‬ཞ໾
䲨抬烊(4)㛒句⮎㭷⣑➟埴䙖兂⬴㔜⿏姽Ộ⍲Ṍ วғஏࡋ!
䎕烊(⚃)㛔╖ỵ旚⡻庼℟姕⁁ᶵ嵛ˤ 䔞⡻≃⿏㎵ 䘤䓇㗪㚫⡆≈䕤䖃侴旵Ỷ䓇㳣
⑩岒炻♜慵侭⮶农デ㝻᷎⺞攟ỷ昊⣑㔠炻⤪傥≈⻟
஑ਢҞ‫!ޑ‬ ⮵⡻≃⿏㎵ 嬟䎮ˣ㍸㖑䮑怠↢檀⌙晒佌ˣ怑䔞㷃
⡻ᾅ嬟⍿⡻嗽炻⯙傥㚱㓰旚㬊⡻≃⿏㎵ 䓊䓇
ẍ昊ℏ 2014 ⸜ TCPI ᶨ凔䕭㇧⡻≃⿏㎵ ⸛
[9]ˤ⡻≃⿏㎵ 枸旚㚱岜㕤炻(ᶨ)㍸⋯嬟䎮ⷓ⮵⡻
⛯䘤䓇⭮⹎䚋㷔䳸㝄 0.11%䁢㧁䪧⬠佺㊯㧁炻Ữ侫
≃⿏㎵ 䘬娵䞍烉䔞嬟䎮ⷓ⮵㕤⮶农⡻≃⿏㎵ ⚈
慷╖ỵ⮰䥹䈡⿏⍲傥≃炻᷎⍫侫忶⍣ 3 ⸜⸛⛯ῤ
䳈⍲⡻≃⿏㎵ 娵䞍庫Ỷ㗪炻䕭Ṣ㖻嗽⛐⡻≃⿏㎵
0.15%炻⮯䚖㧁⇞妪䁢 2015 ⸜ 10-12 㚰╖ỵ⡻≃⿏
檀桐晒ᷳᶳ炻䁢㍸⋯嬟䎮⑩岒炻⺢嬘冱彎⡻≃⿏
㎵ 䘤䓇⭮⹎炻䴻⮰㟰㓡┬⼴⸛⛯⎗ᶳ旵军⮷㕤
㎵ ⛐借两临㔁做婚䦳炻怠↢╖ỵ嬟䎮ⷓ㑼ả䧖⫸
0.15%(㓡┬⇵ 0.30%)炻㓡┬ㆸ㓰㛇㛃忼 50%ˤ
ㆸ⒉炻⋼≑䚋㷔䕭Ṣ⡻≃⿏㎵ 䫱䳂䘬彐娵⹎烊
(Ḵ)⤈⭂㇨㚱䕭Ṣ⬀⛐⡻≃⿏㎵ 䘬⌙晒烊(ᶱ)䙖
Ў᝘ࢗ᛾!
兂姽Ộ烉㭷⣑㩊㞍⽆柕⇘儛橐䨩嗽䙖兂炻⊭⏓䙖兂
΋/ġՈనဍዦੰΓϐᓸΚ‫܄‬ཞ໾॥ᓀ! 䘬⬴㔜⿏ˣ柷刚䘬㓡嬲⍲梥⎰⹎烊(⚃)䙖兂ᾅ嬟㍒
埨㵚儓䗌㱣䗪㕡⺷ẍ檀∹慷⊾⬠㱣䗪䁢ᷣ炻悐 㕥烉橐䨩嗽ㅱἧ䓐ᾅ嬟⠲炻性⃵ᷕ䨢䑘埴ᾅ嬟⠲忈
↮⎰Ἕ㓦⮬䶂㱣䗪炻⽭天㗪忚埴橐橻ㆾ␐怲忈埨⸡ ㆸ⽒䑘⍿旣炻憅⮵⡻≃⿏㎵ 檀⌙䕭Ṣ炻ἧ䓐℟㚱
䳘傆䦣㢵ㆾ䓇䈑墥∹䗪㱽炻䕭Ṣ㍍⍿⊾䗪⼴橐橻⍿ 㷃⡻㓰㝄䘬㓗㊩⸲朊炻朄ン⤪䈡㬲㲉㡱⸲炻≽ン⤪
㈹⇞炻忈ㆸℐ埨䎫Ỷᶳ⺽䘤橼傥嘃⻙ˣデ㝻ˣ儡㾱 攻㫯⺷㯋⠲⸲炻ἧ䓐㷃⡻⸲⠲䕭Ṣ军⮹㭷 6 ⮷㗪㓡
⍲㓿埨䕯桐晒炻⚈㬌⺞攟℞再⸲㗪攻炻侴⊾䗪⼴䘬 嬲⦧⊊炻ᶨ凔⸲⠲军⮹㭷 2 ⮷㗪侣幓ᶨ㫉烊䁢㷃⮹
◩⽫▼⎸ˣ⎋僼㼘䖵ˣ␛奢㓡嬲⮶农䆇梲㓅⍾ᶵ −≃炻⎗⸛幢㎾檀⸲柕⊧崭忶 30 ⹎炻᷎㉔檀ᶳ偊烊
嵛炻Ṏ㚫⼙枧䙖兂‍⹟䦳⹎⍲ ⎋ᾖ⽑傥≃烊䦣㢵 “幢㗪側悐冯⸲朊䘬⣦奺⊧崭忶 30 ⹎炻᷎㕤Ḵ儧
⼴䘬GVHD⎗傥⮶农儡㾱ˣ⣙䤩⿏䙖兂䀶ˣ䙖兂䲭 充味冯儛巅攻⣦㜽柕烊㍉⛸⦧㗪㭷昼 15 ↮揀䦣≽
䕡ˣ嬲唬炻侴䔞䕭Ṣ䕭ね忚⯽⬀⛐ẍᶲ⚈䳈㗪炻⇯ ⍿⡻嗽炻ㆾ㭷⮷㗪㉔檀全悐嬲㎃⦧⊊烊⣙䤩⿏䙖兂
⡆≈⡻≃⿏㎵ 檀⌙晒⿏[2,5,6]ˤ 䀶䁢慵天⇵⮶⚈䳈炻ㅱᾅ㊩偃攨⍲㚫昘悐䙖兂㶭㻼
Ḧ䆍[8-11]烊(Ḽ)⡆≈䆇梲㓅⍾烉䗴䕯䕭Ṣ䘤䓇⡻
Β/ġᓸΚ‫܄‬ཞ໾ϐ‫ۓ‬ကǵϩભϷᖏ‫׉‬ຑ՗π‫!ڀ‬
≃⿏㎵ 䘬埨ᷕ䷥䘥噳䘥慷栗叿Ỷ㕤㛒䘤䓇侭炻ㅱ
憅⮵⡻≃⿏㎵ ⭂佑ˬ㊯⚈⡻≃ㆾ⎰Ἕ−≃炻
㚫姢䆇梲ⷓ㍸ὃ䆇梲⮰㤕媖娊炻ẍ⡆≈梚梇㓅⍾慷
侴⮶农䙖兂ㆾ䙖兂ᶳ䘬䳬䷼⯨悐㎵ 炻⤥䘤橐䨩
ㆾ㷃⮹㳩⣙[6]烊(ℕ)怠㑯怑䔞喍儷⍲㔟㕁烉㲉㡱㔟
嗽˭
烊NPUAP ⮯⍇㚱䘬⡻≃⿏㎵ ⚃䳂↮栆炻ℵ慵
㕁(⤪烉Border)℟㚱⣂Ⰼ㲉㡱⍲㝼庇䞥先䘬湷層
㕘⭂佑⎎⢾ℑᾳ䫱䳂⤪ᶳ烉DTI 㗗⚈慵⡻ㆾ−≃⮶
朊炻⣂Ⰼ㲉㡱⎗ẍ⡆≈⻰⿏⍲⏠㓞濘炻⛐⡻濘㍍妠
农⃭埨䘬㯜㲉ㆾ䙖兂↢䎦䳓墸刚䘬䙖ᶳ䳬䷼㎵
䙖兂⇵忚灖䶑堅⡻従ㆾ㗗−濘炻侴㝼庇䞥先䘬湷層
烊䃉㱽↮䳂(unstageable)䁢 ⎋⸽悐塓僸倱ㆾ䕪
朊⎗㚱㓰⡆≈湷旬⍲⏠旬−濘炻䓐⛐枸旚⡻≃⿏㎵

⎘䀋慓⬠ 2020 ⸜ 24 ⌟ 3 㛇 327

Reducing Pressure Injury in Hematology-Oncology Wards

堐⚃烉旵Ỷ╖ỵ⡻≃⿏㎵ 䘤䓇⭮⹎ᷳ㰢䫾䞑昋↮㜸堐(n=5)
ᷣ天天⚈ ⮵䫾㕡㟰 ⮵䫾姽₡
⎗ 慵 ㆸ ䷥ ㍉
埴 天
⿏ ⿏ 㛔 ↮ 埴
1. ⡻≃⿏㎵ 嬟䎮娵䞍ᶵ嵛 1-1 冱彎⡻≃⿏㎵ 娵䞍⛐借㔁做 13 14 11 38 点
2. ⡻≃⿏㎵ ↮䳂⇌⭂傥≃ᶵ 2-1 冱彎⡻≃⿏㎵ ↮䳂⛐借㔁做 13 14 11 38 点
嵛 2-2 ➡妻⡻≃⿏㎵ 䄏嬟䧖⫸Ṣ⒉ 13 15 13 41 点
3. ⡻≃⿏㎵ 3-1 ⬴ㆸ枸旚⡻ 3-1-1 㒔妪┇≽ˬSKIN Bundle ⬰嬟䲭喳 12 15 14 41 点
䄏嬟➟ ≃⿏㎵ 㝄˭㨇⇞
埴ᶵ嵛 ㊯⮶ 3-1-2 ⇞⭂枸旚⡻≃⿏㎵ 䄏嬟夷䭬 15 15 13 43
3-2 姽Ộ⍲ᾅ嬟 3-2-1 ⭋⮶惵㇜⎋休ˣ㯏㯋⮶䭉ἧ䓐㡱 12 14 11 37 点
⍿⡻嗽 䶂⚢⭂炻↮㔋俛㛝⍿⡻嗽ᷳ⡻≃
3-2-2 ⭋⮶橐䨩ㆾ⍿⡻嗽ἧ䓐㲉㡱㔟㕁 11 15 9 35 点
㷃⡻
3-3 句⮎䙖兂⬴ 3-3-1 丒墥ˬṢ⼊⚾(㧁䣢悐ỵˣ ⎋嬟 12 12 12 36 点
㔜姽Ộ⍲ 䎮)˭Ṍ䎕╖
Ṍ䎕 3-3-2 ⇞⭂ˬ嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟ 13 14 12 39 点
埴㞍㟠堐˭
3-4 ὅ侣幓堐䡢 3-4-1 墥ἄˬ㬋䡢侣幓㒢ỵ⦧⊊⍫教堐˭ 13 14 10 37 点
⮎侣幓⍲ 3-4-2 ㍸ὃ侣幓ⶍ℟炻⤪烉㜽柕ˣ㡱塓 12 15 12 39
䲨抬 ㌚ 点
4. 旚⡻庼℟姕⁁ᶵ嵛 4-1 䓛婳岤屟㷃⡻⸲⠲ 10 14 10 34 点
4-2 㩊夾㯋⡻⸲⠲䘬≇傥 14 15 13 42 点

嗽⎗性⃵潒≽[12]ˤ ⿏㎵ 嬟䎮㧁㸾ἄ㤕˭炻⺢䩳⡻≃⿏㎵ 䕭Ṣ䄏栏

夷䭬炻㕤嬟䎮䲨抬⏰䎦䚠斄嗽伖炻᷎ᶼ┇≽ˬSKIN
ှ،ᒤ‫ݤ‬Ϸ୺Չၸำ! Bundle ⬰嬟䲭喳㝄˭(S烉䙖兂㩊㞍ˣK烉㭷ℑ⮷㗪
侣幓ᶨ㫉炻⎴ᶨ⛸⦧⊧崭忶 15 ↮揀ˣI烉ᾅ㊩䙖兂
ὅ䎦㱩婧㞍↮㜸䳸㝄炻憅⮵╖ỵ⡻≃⿏㎵ 䘤
䘬㶭㻼冯Ḧ䇥ˣN烉㓅⍾嵛⣈䘬梲↮⍲㯜↮)夷䭬⍲
䓇⭮⹎ῷ檀ᷳ慵天天⚈炻䴻忶㔯䌣㞍嫱⍲ 5 ỵ⮰㟰
≈⻟ˬ侣幓䲨抬堐˭㬋䡢ἧ䓐䌯ˤ
⮷䳬ㆸ⒉炻ὅ➟埴㕡㟰䘬⎗埴⿏ˣ慵天⿏⍲ㆸ㛔䫱
(Ḵ) 婳柀⹓⁁㡱䶂
ᶱᾳ➢㸾忚埴㰢䫾䞑昋↮㜸(堐⚃)炻妰↮㕡⺷䁢 3
䕭㇧㚠姀⎹慓㛸ᾱ⹓婳柀㡱䶂䓐慷炻Ḱ攟㗪攻
↮堐䣢⎗埴⿏檀ˣ慵天⿏檀ˣㆸ㛔Ỷ烊1 ↮堐䣢⎗
惵㇜⎋休ˣ㯏㯋⮶䭉䕭Ṣ炻ἧ䓐㡱䶂⚢⭂炻↮㔋俛
埴⿏Ỷˣ慵天⿏Ỷˣㆸ㛔檀炻㚨檀↮䁢 45 ↮炻㚨
㛝⍿⡻嗽ᷳ⡻≃ˤ
Ỷ↮䁢 15 ↮炻䴻䳬⒉姽↮堐㰢炻䷥↮ 30 ↮ẍᶲ怠
(ᶱ) 丒墥ˬṢ⼊⚾(⏓悐ỵ⍲ ⎋嬟䎮㕡⺷)˭
䓐䁢⮰㟰ᷣ天㍉埴㕡㟰烪3(姽₡枭䚖)×2(姽↮ᷕ
姕妰丒墥ˬṢ⼊⚾˭炻⬴㔜㬋䡢㧁姀⡻≃⿏㎵
溆)×5(Ṣ㔠)烬
ˤ
悐ỵˣ㎃喍㕡⺷⍲㚜㎃㔟㕁䧖栆ˣ柣䌯炻忼⇘Ṍ
⮰㟰➟埴㛇攻冒 2015 ⸜ 4 㚰 1 㖍军 12 㚰 31
䎕䘬ᶨ农⍲忋临⿏ˤ
㖍炻ὅ妰∫㛇ˣ➟埴㛇⍲姽ῤ㛇忚埴⤪ᶳ烉
(⚃) ⇞⭂枸旚⡻≃⿏㎵ 䄏嬟夷䭬
΋. ीჄය(2015 ԃ 4 Д 1 ВԿ 5 Д 31 В) 惵⎰ᷕ⣖嬟䎮㧁㸾-⡻≃⿏㎵ 枸旚⍲嗽䎮炻
(ᶨ) 㒔妪ˬSKIN Bundle ⬰嬟䲭喳㝄˭㍸愺㨇⇞ ⍲䚠斄㔯䌣炻⇞⭂ㆸ╖ỵ⡻≃⿏㎵ 䄏嬟夷䭬ὃ嬟
㟡㒂冐⸲➟埴䎦㱩↮㜸炻ὅ㔯䌣⍲㛔昊ˬ⡻≃ 䎮ⷓ⍫侫ˤ⊭㊔烉(1)橐䨩ㆾ⍿⡻嗽䴻䕭Ṣ⎴シㅱ

328 Formosan J Med 2020 Vol.24 No.3

 旵Ỷ埨㵚儓䗌䕭㇧⡻≃⿏㎵ !

ἧ䓐 Border ㆾ Mepilex 䫱㲉㡱㔟㕁㷃⡻炻⤪⚾Ḵ㇨

䣢烊(2) 24 ⮷㗪ẍᶲ㛒ᷕ㕟惵㇜⎋休ˣ㯏㯋⮶䭉䕭
Ṣ炻Ḱἧ䓐㡱䶂⮯暁俛ᶲ⮶䭉⼨ᶲ㍸炻䴹䴩⚢⭂㕤
柕枪ẍ↮㔋⯨悐⡻≃烊(3)㭷⣑忚埴ℐ幓䙖兂⬴㔜
⿏㩊㞍烊(4)儡㾱䕭Ṣ炻ᾅ㊩偃攨⎋⍲㚫昘䘬㶭㻼ˣ
Ḧ帩烊(5)⇑䓐ˬ㬋䡢侣幓㒢ỵ⦧⊊⍫教堐˭⍲ˬ侣
幓姀抬堐˭㬋䡢侣幓烊(6)⸛幢㎾檀⸲柕⊧崭忶 30
⹎᷎ᶼᶳ偊㉔檀炻㷃⮹−≃烊(7)“幢㗪側悐冯⸲
朊䘬⣦奺⊧崭忶 30 ⹎炻᷎㕤ℑ儧充味冯儛巅攻⣦
㜽柕烊(8)ἧ䓐㡱塓㌚ㆾ㜽柕⠲檀⮷儧ᶳ⋲悐炻ẍ
㉔檀嵛嶇⍲儛巅ˤ
კΒǺBorder ᔈҔ‫ ܭ‬Bi PAP
(Ḽ) ⇞⭂➡妻⡻≃⿏㎵ 䄏嬟䧖⫸Ṣ⒉
䓙⑩䭉䳬ㆸ⒉ 2 ỵ㑼ả╖ỵ䧖⫸Ṣ⒉炻⍫冯嬟
䎮悐ᷕ⣖ᷳ⡻≃⿏㎵ 姽㟠⍲䚠斄婚䦳炻᷎⎹╖ỵ
嬟䎮ⷓ⭋⮶炻⍲⋼≑䚋㷔䕭Ṣ䫱䳂䘬彐娵⹎ˤ
(ℕ) 墥ἄˬ㬋䡢侣幓㒢ỵ⦧⊊⍫教堐˭
㟡㒂㔯䌣墥ἄˬ㬋䡢侣幓㒢ỵ⦧⊊⍫教堐˭堃
㔁屯㕁炻⋼≑᷎㔁⮶㬋䡢侣幓㒢ỵˤ
(ᶫ) 夷∫⛐借㔁做婚䦳
⮰㟰ㆸ⒉冯╖ỵ⛐借㔁做⮷䳬ˣ䆇梲ⷓˣ忈⎋
嬟䎮ⷓℙ⎴㒔⭂婚䦳炻↮⇍㕤 3 䎕ᶵ⎴㗪㭝㌰婚炻
ℙ冱彎 4 ⟜⛐借㔁做炻㭷⟜䲬 60 ↮揀ˤ
(ℓ) 㩊夾㯋⡻⸲⠲䘬≇傥炻⡆岤㷃⡻⸲⠲ კΟǺ੝ਸጤ஥ග܎਼਻း࿼!

㞍㩊䎦⬀㯋⡻⸲⠲≇傥炻⤪㚱㎵㭨ᾖ䷽ㆾ⟙
⺊烊德忶䣦ⶍ悐倗专⍿㋸ 13 ⻝㷃⡻⸲⠲炻忳䓐⛐ 䲭喳㝄㧁䣢≈⻟㍸愺炻句⮎➟埴旚嬟㍒㕥烊⺋㲃⇑
冐⸲ᶲ檀桐晒ㆾ䎦⬀⡻≃⿏㎵ ⍲攟㛇再⸲䕭Ṣˤ 䓐╖ỵ⺢䩳ᷳˬṢ⼊⚾˭忼⇘Ṍ䎕䘬ᶨ农⿏ˤ
(ᶱ) ⭋⮶枸旚⡻≃⿏㎵ 䄏嬟夷
Β. ୺Չය(2015 ԃ 6 Д 1 ВԿ 9 Д 30 В)
⇑䓐 2015 ⸜ 6 㚰 29 㖍⛐借㔁做炻⮰㟰ㆸ⒉⎹
(ᶨ) ㆸ䩳⡻≃⿏㎵ 䄏嬟䧖⫸Ṣ⒉
嬟䎮ⷓ⭋⮶⇞⭂䘬⡻≃⿏㎵ 㔜⎰⺷䄏嬟䫾䔍ℙ
➡妻 2 ỵ⑩䭉䳬ㆸ⒉⍫冯ˬ2015 ⸜⹎忈⎋
8 枭⍲⮰㟰㓡┬➟埴㬍樇炻䓙⮰㟰ㆸ⒉屈屔䚋䜋➟
⎋嬟䎮䧖⫸妻䶜䎕˭ᷳ婚䦳炻⁛忼㬋䡢䘬⡻≃⿏㎵
埴ㆸ㓰ˤ㑵ἄ忶䦳ᷕ䘤䎦炻悐↮䕭Ṣ⚈柕檖忈ㆸ㡱
奨⾝⍲䫱䳂↮彐炻᷎ᶼ⋼≑忚埴╖ỵ㔁做妻䶜⍲
䶂ᶵ㖻⚢⭂炻㯏㯋墅伖㖻㹹僓炻⚈㬌ᾖ㓡㍒㕥⮯㡱
䚋㷔冐⸲ᶲ䕭Ṣ䘬䙖兂姽Ộᷳ㬋䡢⍲ᶨ农⿏炻ㆾ㗗
䶂婧㔜䁢℟㚱⺞⯽⿏ᷳ䈡㬲先ⷞ炻Ḱẍ⎹ᶲ㍸㉱炻
䄏㚫 ⎋嬟䎮ⷓ䴎Ḱ ⎋䘬䫱䳂彐⇍⍲㎃喍㕡⺷
忼⇘↮㔋⯨悐⡻≃ᷳㆸ㓰炻⤪⚾ᶱ㇨䣢ˤ
䘬⺢嬘ˤ
(⚃) 冱彎⛐借㔁做妻䶜婚䦳
(Ḵ) ⮎㕥ˬSKIN Bundle ⬰嬟䲭喳㝄˭㍸愺㨇⇞
䓙╖ỵ⡻≃⿏㎵ 䄏嬟䧖⫸Ṣ⒉⍲䆇梲ⷓ⋼
2015 ⸜ 6-9 㚰䓙⮰㟰ㆸ⒉㕤㭷㚰䕭㇧㚫嬘ᷕ
≑炻↮⇍㕤 2015 ⸜ 6ˣ7ˣ8ˣ9 㚰⇑䓐䕭㇧㚫嬘冱
⭋⮶⸜⹎⮰㟰炻⤪旵Ỷ埨㵚儓䗌䕭㇧⡻≃⿏㎵ 䘤
彎㔁做妻䶜婚䦳炻↢ⷕ䌯↮⇍䁢烉90%ˣ70%ˣ75%ˣ
䓇⭮⹎ᷳ䚖䘬ˣ慵天⿏冯➟埴㕡㱽炻ἧ㭷ỵ嬟䎮ⷓ
95%炻⬴ㆸ(1)⡻≃⿏㎵ 娵䞍烉啱䓙⼑刚冐⸲⡻≃
傥䝕妋ˬSKIN Bundle ⬰嬟䲭喳㝄˭暨惵⎰ᷳ㍒㕥
⿏㎵ ⚾䇯炻㍉ˬ⓷冯䫼˭Ḻ≽㕡⺷炻⡆忚嬟䎮ⷓ
᷎句⮎➟埴炻檀⌙ㆾ䎦⬀⡻≃⿏㎵ 䕭Ṣ㕤⸲柕ẍ
娵䞍烊(2)㬋䡢侣幓㒢ỵ烉㍉䛇Ṣ㺼䶜⍲⚆央䣢㔁

⎘䀋慓⬠ 2020 ⸜ 24 ⌟ 3 㛇 329

Reducing Pressure Injury in Hematology-Oncology Wards

!
კѤǺ஑ਢ‫ׯ‬๓߻ࡕෳ࣬ᜢԋਏКၨკ!

㕡⺷炻忼⮎晃㑵ἄ㶙⇣⌘尉炻᷎㔁⮶䚋䜋ᷣ天䄏栏 䓙⇵㷔ᶨ㧋䘬 5 ỵ⮰㟰ㆸ⒉⮎⛘婧㞍炻惵⎰㞍

侭⋼≑侣幓㒢ỵ⦧⊊炻⍲侣幓姀抬堐䘬ἧ䓐䌯烊(3) 㩊堐炻奨⮇嬟䎮ⷓ⮵㕤⡻≃⿏㎵ 䘬䄏嬟忶䦳烊姕
䆇梲䵕嬟烉怨婳䆇梲ⷓ嫃徘ˬ䗴䕯䕭Ṣ䆇梲姽Ộ⍲ 妰ˬ㷃⡻⸲⠲㺧シ⹎˭⓷⌟炻⮎⛘㞍㩊㓡┬ㆸ㓰炻
䄏栏˭炻᷎⇑䓐㭷忙Ḵ䆇梲ⷓ梚梇姒㞍㗪炻妶婾䕭 忚埴䚠斄屯㕁䴙妰⍲↮㜸ˤ
Ṣ䆇梲暨㯪䴎Ḱ㊯⮶⍲䚋㷔炻冯慓ⷓ⍲冐⸲喍ⷓ妶 (ᶱ) ⡻≃⿏㎵ 䘤䓇⭮⹎䴙妰
婾ℐ朄傰䆇梲(total parenteral nutrition, TPN)ἧ䓐 ᶲ䵚㞍娊慓昊℔⏲╖ỵ㭷㚰㕘䘤䓇⡻≃⿏㎵
㗪㨇烊(4)䙖兂ᾅ嬟㔟㕁䘬怠㑯⍲㬋䡢㑵ἄ烉怨婳 Ṣ㫉ˣ䷥䘤䓇⭮⹎⍲ℐ昊⎬╖ỵ䘤䓇⭮⹎ˤ
忈⎋ⷓ冯䓊⑩堃㔁ⷓ嫃徘ˬ⎰怑䘬䙖兂ᾅ嬟䓐䈑ṳ
䳡⍲㔟㕁䘬怠㑯ˣ㬋䡢ἧ䓐㈨ⶏ˭炻㛒⍫冯ᷳ嬟䎮 ่݀ຑॶ!
ⷓ炻㍸ὃ㚠朊屯㕁教嬨᷎㍍⍿媖娊炻㕤⡻≃⿏㎵
΋/ġៈ ౛ৣჹᓸΚ‫܄‬ཞ໾ៈ౛ᇡ‫ޕ‬Ϸϩભղ‫ૈۓ‬
娵䞍⼴㷔㗪㍉姀⎵㷔槿㕡⺷炻䡢娵嬟䎮ⷓ⶚教嬨⍲
Κፓࢗ!
Ḯ妋婚䦳ℏ⭡炻ẍὧ徥希庼⮶炻᷎䓙⮰㟰屈屔Ṣ㕤
⮰㟰ㆸ⒉㕤 2015 ⸜ 10 㚰 10 㖍-20 㖍炻ẍˬ嬟
冐⸲ㅱ䓐忶䦳⋼≑䣢䭬⍲䚋㷔ἧ䓐㗪㨇ˣ㬋䡢⿏ˤ
䎮ⷓ⮵⡻≃⿏㎵ 嬟䎮娵䞍㷔槿˭⓷⌟炻⚈ 6-8 㚰
(Ḽ) ㍐⺋忳䓐㷃⡻⸲⠲
Ṣ⒉䔘≽憅⮵ 14 ỵ嬟䎮ⷓ忚埴⼴㷔炻㔜橼娵䞍䓙
忳 䓐 ⛐ 冐 ⸲ ᶲ 檀 ⌙ 桐 晒 (Braden 姽 Ộ ʀ 18
60.4%忚㬍⇘ 96.1%炻⡻≃⿏㎵ ↮䳂⇌⭂傥≃ḇ
↮)ˣ䎦⬀⡻≃⿏㎵ ㆾ攟㛇再⸲䕭Ṣ炻᷎㕤⸲柕
⽆ 76.5%忚㬍⇘ 92.8%炻嬟䎮ⷓ⡻≃⿏㎵ 娵䞍⍲
≈ẍ㧁姀炻㕡ὧ暨天䕭Ṣᷳ⌛㗪廱䓐ˤ
↮䳂⇌⭂㬋䡢䌯㚱栗叿㍸⋯炻侴憅⮵䫼拗柴䚖Ḱ䕭
(ℕ) ἧ䓐嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟埴㞍㟠堐
㇧㚫嬘ᶲ忚埴ℵ㔁做炻⤪⚾⚃㇨䣢ˤ
⮰㟰ㆸ⒉㭷⣑ᶵ⭂㛇⮎⛘㞍㟠嬟䎮ⷓ㗗⏎⬴
ㆸ㞍㟠堐ℏ䘬枭䚖(㞍㟠ℏ⭡⤪堐ᶱ)炻⤪㛒⬴ㆸ炻 Β/ġᓸΚ‫܄‬ཞ໾ྣៈ୺Չ౗!
⇯ᾳ⇍㊯⮶嬟䎮ⷓ⌛㗪㬋䡢⬴ㆸˤ ⡻≃⿏㎵ 䄏 嬟 ➟ 埴 䌯 䓙 55.6% ᶲ ⋯ 军
89.7%炻⤪堐Ḽ㇨䣢炻⎗夳嬟䎮ⷓ傥句⮎⡻≃⿏㎵
Ο. ຑॶය(2015 ԃ 10 Д 1 ВԿ 12 Д 31 В)
䄏嬟㕤䕭Ṣ幓ᶲˤ䴻冐⸲⮎⛘㞍㟠䳸㝄 92%䕭Ṣ
(ᶨ) 嬟䎮ⷓ⮵⡻≃⿏㎵ 嬟䎮娵䞍⍲↮䳂⇌⭂傥
㍍⍿䆇梲ⷓᷣ≽梚梇姒夾炻冯䕭Ṣ妶婾䆇梲㓅⍾䉨
≃婧㞍(⼴㷔)ἧ䓐冯⇵㷔ℏ⭡ᶨ农ᷳˬ嬟䎮ⷓ
㱩炻嬟䎮ⷓ傥怑㗪冯慓ⷓ⍲冐⸲喍ⷓ妶婾 TPN 䘬
⮵⡻≃⿏㎵ 嬟䎮娵䞍㷔槿˭⍲ 20 ⻝⚾䇯忚
ṳℍ㗪㨇烊䔞 ⎋䓊䓇㗪䄏㚫 ⎋嬟䎮ⷓ⋼≑㍸ὃ
埴⼴㷔炻ℙ䘤㓦 14 ấ⚆㓞 14 ấˤ
㎃喍㕡⺷⍲廱⸲㗪ᷳ ⎋䫱䳂㼬㶭炻⎗忼 95%➟埴
(Ḵ) ⡻≃⿏㎵ 䄏嬟➟埴䌯婧㞍
䌯炻忼⇘列⤥嶐柀➇⛀昲⎰ἄ㨇⇞ˤ2015 ⸜ 10 㚰

330 Formosan J Med 2020 Vol.24 No.3

 旵Ỷ埨㵚儓䗌䕭㇧⡻≃⿏㎵ !

堐Ḽ烉嬟䎮ⷓ⡻≃⿏㎵ 䄏嬟➟埴䌯(n=14)
枭䚖 ⇵㷔㬋䡢➟埴(%) ⼴㷔㬋䡢➟埴䌯(%)
1. ὅ侣幓堐䡢⮎⋼≑㭷ℑ⮷㗪㬋䡢侣幓⍲䲨抬 18.2 72.7
2. ⬴ㆸ怑䔞䘬枸旚⡻≃⿏㎵ 嬟䎮㊯⮶⍲䲨抬 45.5 81.8
3. 䕭ね㓡嬲 24 ⮷㗪ℏㅱℵ姽Ộᶼℏ⭡㬋䡢 63.6 81.8
4. 㭷⣑句⮎➟埴䙖兂⬴㔜⿏姽Ộ⍲Ṍ䎕 54.5 86.5
5. 怑䔞ἧ䓐旚⡻庼℟ 18.2 90.9
6. 怑䔞姽Ộ⍲ᾅ嬟䭉嶗㍍妠䙖兂䘬⍿⡻嗽 27.3 90.9
7. “ˣ⸛幢㚫⛐暁⮷儧攻ˣᶳ㓦伖㜽柕ㆾ㡱塓㌚ 72.7 90.9
8. Braden 姽Ộʀ18 ↮侭炻24 ⮷㗪ℏ㚱↿䙖兂嬟䎮⓷柴 81.8 90.9
9. 怑䔞ἧ䓐⍂Ṣⶍ䙖ㆾ㲉㡱ᾅ嬟橐䨩嗽䙖兂 63.6 100
10. ⣙䤩⿏䙖兂䀶䕭Ṣ⯨悐怑䔞㶭㻼⍲ᾅ嬟 66.7 100
11. 㭷⣑㚫廒㎃滣偫䭉⚢⭂悐ỵ 100 100
⸛⛯ 55.6 89.7

კϖǺ‫ׯ‬๓߻ࡕൂՏᓸΚ‫܄‬ཞ໾วғஏࡋᖿ༈კ

1 㖍军 7 㖍憅⮵㷃⡻⸲⠲ἧ䓐 2 忙ẍᶲℙ 13 ỵ䕭 忼䚖㧁ῤ炻Ữ 2015 ⸜ 8ˣ9ˣ11ˣ12 娚㚰╖ỵ䘤䓇

Ṣ炻忚埴ˬ㷃⡻⸲⠲㺧シ⹎˭⓷⌟婧㞍炻ℏ⭡⊭㊔
⸲⠲ᷳ庇䠔ˣ㵤䇥ˣ冺⡻ˣ冯冲⸲⠲䚠㭼庫⍲㔜橼
㺧シ⹎炻䕭Ṣ㺧シ⍲朆ⷠ㺧シ侭⸛⛯⎗忼 84.6%烊
嬟䎮ⷓ⮵㕤䙖兂‍⹟䉨㱩⤪㼖㽽䦳⹎ˣ㹓⹎ˣ㐑㒎
≃⍲䙖兂㗗⏎䓊䓇䲭儓忶㓷䫱䔘䉨䕯䉨炻悐↮⍲栗
叿㓡┬ㆸ㓰⎗忼 92.3%烊ᶼ姒婯䕭Ṣ 84.6%⍵ㅱ㷃
⡻⸲⠲⡆≈再⸲冺怑デ炻⮵㕤䜉䛈⑩岒㚱列⤥㓡
┬炻䓊䓇䎮゛䘬旬ⷞ㓡┬ㆸ㓰ˤ
Ο/ġᓸΚ‫܄‬ཞ໾วғஏࡋ಍ी!!
䴻 TCPI 䴙妰↮㜸屯㕁栗䣢炻2015 ⸜ 10-12 㚰
㓡┬⼴ᷳ⡻≃⿏㎵ 䘤䓇⭮⹎⸛⛯䁢 0.12 %炻晾⎗
⭮⹎ṵ↢䎦檀㕤䚖㧁ῤ 0.15%炻䴻徸㟰㩊妶↮㜸炻
䘤䓇㕤 4 ỵ䕭Ṣℙ 5 ẞ炻↮Ự㕤全悐ˣ啎㢶ˣ⢾俛炻
℞ᷕ 1 ỵ㛓㛇䕭Ṣ㊩临再⸲忼 5 ᾳ㚰炻⡻≃⿏㎵
旚嬟ㆸ㓰Ἓ炻Ữ⚈冐䳪⇵橾橐儓䗌廱䦣⿏⻟䁰䕤䖃
㉺䳽㭷 2 ⮷㗪侣幓炻⎰Ἕ偅堘䪕 Lactulose 㱣䗪忈
ㆸ儡㾱烊1 ỵℐ幓忶㓷⿏䲭䕡僓䙖忈ㆸ廱⸲㗪⢾俛
⡻≃⿏㎵ 姽Ộ⚘㒦炻䴻≈嬟䕭㇧忂⟙烊1 ỵ䕭Ṣ
㕤⭞ᷕ⶚↢䎦 1 ⹎⡻≃⿏㎵ 炻ℍ昊 3 ⣑ℏ㛒⍲㗪
忂⟙烊1 ỵ䕭ね⾓忇ら⊾⎰Ἕ儡㾱忈ㆸ炻憅⮵⍇⚈
㕤㭷㚰䕭㇧㚫嬘ᷕ≈⻟䚠斄㓡┬㍒㕥ᷳ⭋⮶⍲句
⮎䚋㷔炻㊩临徥希 2016-2018 ⸜㓰㝄䵕㊩ㆸ㓰⸛⛯
忼 0.05%(⸛⛯Ỽ⸲䌯忼 97.9%)炻⤪⚾Ḽ㇨䣢ˤ

⎘䀋慓⬠ 2020 ⸜ 24 ⌟ 3 㛇 331

Reducing Pressure Injury in Hematology-Oncology Wards

૸ፕᆶ่ፕ! ठ!ᖴ!
埨㵚儓䗌䥹䕭Ṣ⚈⃵䕓Ỷᶳ⍲橼傥嘃⻙再⸲ 㛔㓡┬⮰㟰デ嫅冢⣏慓昊埨㵚儓䗌䥹㇨㚱慓
㗪攻庫攟炻䁢⡻≃⿏㎵ 檀䘤䓇桐晒㕷佌炻䴻䓙⮎ 嬟⎴ṩ䘬㓗㊩冯惵⎰炻嫡㬌农ᶲ㚨㶙嫅⾙ˤ
⛘㞍㟠⍲⓷⌟䘤䎦╖ỵ䘤䓇⭮⹎檀䘬⍇⚈䁢烉(1)
嬟䎮ⷓ⮵⡻≃⿏㎵ 嬟䎮娵䞍ᶵ嵛烊(2)嬟䎮ⷓ⡻ ᖂ!ܴ!
≃⿏㎵ ↮䳂⇌⭂傥≃ᶵ嵛烊(3)嬟䎮ⷓ⡻≃⿏㎵
㛔䞼䨞ᷳ⇑䙲堅䨩烉䃉ˤ䞍ね⎴シ烉䃉ˤ⍿
䄏嬟➟埴ᶵ嵛烊(4)㛔╖ỵ旚⡻庼℟姕⁁ᶵ嵛ˤ
娎侭㪲䙲烉䃉Ṣ橼ㆾ≽䈑⮎槿ˤ
德忶≈⻟⛐借㔁做⍲➡做䧖⫸Ṣ⒉炻㍸⋯嬟䎮ⷓ⡻
≃⿏㎵ 枸旚䚠斄娵䞍⍲㑵ἄ傥≃炻⺢䩳䄏嬟㞍㟠 ୖԵЎ᝘!
㨇⇞炻⌛㗪ṳℍ怑䔞䘬旚⡻庼℟⍲㔟㕁炻⇑䓐侣幓
㒢ỵ⚾䇯╖⻝ㆾ⼙䇯炻㍸⋯㊯⮶ㆸ㓰炻᷎┬䓐嶐柀 1. National pressure ulcer advisory panel: NPUAP
➇⛀昲⎰ἄ屯㸸䫱㍒㕥炻⎗㚱㓰旵Ỷ╖ỵ⡻≃⿏㎵ Pressure Ulcer Stages/Categories 2014. http://
䘤䓇⭮⹎炻ᶼ㓰㝄䵕㊩ㆸ㓰列⤥ˤ www.npuap.org/resources/educational-and-clini
憅⮵ㆸ㛔庫檀䘬㷃⡻⸲⠲䃉㱽 37 ⸲⎴㗪ℐ朊 cal-resources/npuap-pressure-ulcer-stagescatego
岤ℍ炻⚈㬌⽭枰晐㗪䚋㷔㭼庫䕭Ṣ䘬暨㯪炻᷎⋼≑ ries./ Accessed March 31, 2014
廱䓐炻㚱㗪⮯⍿旸㕤廱䓐㗪㨇ᶼ⸲⠲庫慵炻⡆≈嬟 2. Taylor AG, Snyder AE, Anderson JG, et al.
䎮ⷓㅱ䓐ᶲᷳ⚘㒦䁢䚠斄旣≃炻德忶㛔⮰㟰䕭Ṣ⚆ Gentle massage improves disease- and
棳㺧シ⹎⍲⡻䗉㓡┬ㆸ㓰炻㕤 2016 ⸜䯥妪ℐ昊⿏ treatment-related symptoms in patients with
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⎘䀋慓⬠ 2020 ⸜ 24 ⌟ 3 㛇 333

Reducing Pressure Injury in Hematology-Oncology Wards

Reducing the Incident Density of Pressure Injury

in Hematology-Oncology Wards
Hsing-Yi Chou1, Shiouh-Chu Shieh1, Wan-Jing Lu1, Jui-Yi Chen1, Jih-Shuin Jerng2,3,
Hsiu-O Kao1

Abstract: Patients at the hematology-oncology wards are prone to develop pressure injury because of frailty due
to prolonged bed-ridden status, which was a result of immunosuppression by chemotherapy or bone marrow
transplantation. In out unit, the density of pressure injury increased from 0.17% in 2013 to 0.30% in 2014;
therefore, we thus expected this project could effectively reduce the occurrence of stress injury. Causes of this
situation included: (1) A lack of awareness and knowledge regarding pressure injury. (2) Insufficient skills for
assessing and staging pressure injury. (3) Poor execution of necessary procedures for preventing pressure injury.
(4) Inadequate injury-preventing devices. Strategies of improvement included intensification of on-job training
for staff members and trainers, enhancement of knowledge and skills related to injury prevention, auditing of
injury-preventing practices, timely intervention with pressure-preventing devices, improvement of education
efficacy by applying relevant diagrams, pictures and videos, and employment of multidisciplinary team resource
management. These strategies reduced the density of pressure injury from 0.30% to 0.12%, which reached the
goal and was well sustained. We concluded that our program provides evidence and useful guidance to enhance
the quality of nursing care for the prevention of pressure injury.
Key Words: hematology-oncology, pressure injury
(Full text in Chinese: Formosan J Med 2020;24:324-34) DOI:10.6320/FJM.202005_24(3).0012

Department of 1Nursing, 2Internal Medicine, 3Center for Quality Management, National Taiwan University Hospital, Taipei,
Taiwan
Received: August 9, 2019 Accepted: October 18, 2019
Address correspondence to: Shiouh-Chu Shieh, Department of Nursing, No.7, Chung Shan South Rd., Taipei, Taiwan.
E-mail: tiffany@ntuh.gov.tw

334 Formosan J Med 2020 Vol.24 No.3