俯卧位脊柱后路手术患者头面部皮肤保护方法的研究

发布时间：2018-01-20 23:52

本文关键词： 脊柱手术俯卧位头面部压疮　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：压疮又称压力性溃疡(PU),是临床常见并发症之一[1]。欧洲压疮顾问小组(EPUAP)提示[2]，高达18%的住院患者会发生压疮，国内住院患者压疮发生率为2.5%～15%，其中俯卧位头面部压疮发生率为2.5%～8.8％，甚至高达11.6％。头面部压疮的发生，不仅给患者带来痛苦，而且会降低其生活质量，压疮经久不愈，导致严重感染、全身衰竭甚至危及生命［3］。俯卧位是脊柱后路手术最常用体位[4]。脊柱手术由于手术创面大,手术时间长,如果手术体位摆放不当或保护措施不恰当,会在长时间的手术过程中对患者造成伤害[5]。因此，使用合适的头面部保护具是预防俯卧位手术患者头面部压疮发生的主要手段。而现有头面部保护具规格比较局限，不能够很好的根据个体面部的差异做出灵活吻合的调整以更好的保护患者头面部皮肤。因此，我们在对传统头面部保护具充分深入研究的基础上对其进行改良后并进行循证试验性研究。通过对比显示：俯卧位脊柱后路手术时应用改良式头托，可以降低头面部压疮发生率；能够促进临床保护架的发展；同时也能为临床实践中压疮的预防提供更多的参考价值。研究目的：通过对两组手术患者头面部压疮发生率的比较，探讨改良式头面部保护支架在俯卧位脊柱后路手术中的应用效果,及对患者术后头面部并发症发生率的影响。研究方法：采用随机对照分组的方法，选取2012年8月—2013年12月在中日联谊医院脊柱外科住院行脊柱后路手术的患者,共160例。按照纳入与排除标准将被选入的160例手术患者随机分为实验组和对照组。实验组80例，麻醉成功且头、面部、眼睑采取保护措施后，使用经过改良的俯卧位头面部保护支架；对照组80例，麻醉成功且头、面部、眼睑采取常规护理保护措施后，使用手术室传统沿用的“马蹄形”头面部支托。两组患者分别均于术前采用《手术压疮风险评估表（Braden）》，术后采用《头面部皮肤损伤程度评估表》对两组手术患者头面部皮肤状况进行评估，并于术后清醒后进行患者满意度调查。研究结果：实验组与对照组两组患者术前应用《手术压疮风险评估表（Braden）》对术前手术患者皮肤状况进行评估，实验组容易出现压疮的手术患者17人；对照组容易出现压疮的手术患者19人。实验组患者皮肤压疮风险度与对照组无较大差异，，差异无统计学意义(P0.05)。术后应用《头面部皮肤损伤程度评估表》对手术患者皮肤状况进行评估，实验组头面部皮肤损伤患者12例，并发症患者3例；对照组头面部皮肤损伤患者27例，并发症患者13例；两组患者面部压疮发生率比较显示：实验组患者使用改良头面部保护架,发生压疮机率明显低于对照组患者使用“马蹄形”头面部保护架的压疮发生率，差异有统计学意义（P㩳0.05）。两组患者术后满意度调查：根据选择标准，实验组共78人，对照组共66人，使用X2检验进行统计学分析，实验组患者满意度明显高于对照组，显著性差异有统计学意义（P㩳0.05）。研究结论：通过对两组手术患者发生压疮的比较，研究表明：应用经过改良的俯卧位头架在降低俯卧位脊柱后路手术患者头面部压疮发生率方面较手术室现有“马蹄形”头架效果明显；改良头架组成部分可根据手术患者五官灵活调节，符合人体头面部生理结构，增加了患者手术过程中的舒适度；缩短了患者的住院天数，同时减轻了患者的经济负担；较好的提高了患者的满意度；但没有从根本上解决患者头面部压疮问题。改良的俯卧位头架是一种临床应用效果较好的头部保护方式。
[Abstract]:Pressure ulcers also called pressure ulcer (PU) is one of the common complications, clinical [1]. European Pressure Ulcer Advisory Panel (EPUAP) [2], up to 18% of patients hospitalized for bedsore, the domestic rate of pressure ulcer was 2.5% ~ 15%, the position of head and face pressure ulcer incidence rate is 2.5% ~ 8.8%, even up to 11.6%. the head and face of pressure ulcers, not only bring pain to patients, and reduce their quality of life, pressure ulcer prolonged does not heal, causing serious infections, even life-threatening systemic failure 3. Posterior spinal surgery in prone position is the most commonly used position [4]. spinal surgery due to surgical wounds, long operation time, if improper operation position or protective measures are not appropriate, in the operation process in the long time of patient harm [5]. therefore, use head face protection right out is the main means to prevent the prone position surgery in patients with head and face pressure ulcer occurred. The head and face protection gauge is limited, can not be well according to the individual differences in facial make flexible adjustment agreement to protect patients with facial skin better. Therefore, we make in-depth research on the basis of traditional facial protection out on the modified and through experimental research by card. Comparison shows that: the application of modified head posterior spinal surgery, can reduce the incidence of facial pressure sores; can promote the development of clinical protection frame; at the same time also can provide more valuable reference for the prevention of pressure ulcers in clinical practice.
Research purposes: through comparing the incidence of head and face pressure sores in two groups of surgical patients, we discussed the application effect of modified head and face protector in prone position posterior spinal surgery, and the impact on postoperative incidence of head and face complications.
Research methods: randomized grouping, from August 2012 - December 2013 in patients who underwent posterior spinal surgery in spinal surgery in Japan Union Hospital, a total of 160 cases. According to the inclusion and exclusion criteria will be selected 160 patients were randomly divided into experimental group and control group. 80 cases in the experimental group, and the success of anesthesia head, face, eyelid to take protective measures, the use of the improved prone position of head and face protection bracket; the control group of 80 cases, the success of anesthesia and head, face, eyelid to adopt the conventional nursing protective measures, the use of traditional operation room followed the "horseshoe" head and face support. Two groups of patients were all used preoperatively "the operation of pressure ulcer risk assessment table (Braden) >, < the postoperative facial skin damage assessment table > to evaluate two groups of surgical patients with facial skin condition, satisfaction survey and patients awake from the postoperative.
Results: the experimental group and the control group patients in two groups before the application of < operation pressure ulcer risk assessment table (Braden) > to evaluate the preoperative patients with skin conditions, the experimental group prone to pressure ulcer patients 17; control group prone to pressure ulcer patients. 19 patients in the experimental group and the skin pressure ulcer risk the control group had no significant difference, the difference was not statistically significant (P0.05). The evaluation table to evaluate the status of patients with skin > < surgery of facial skin injury after operation, the experimental group of 12 patients with facial skin lesions, 3 cases of complications of patients; the control group of 27 patients with facial skin lesions, 13 cases of complications of patients; two groups of patients with facial pressure ulcer incidence comparison shows that the experimental group of patients with improved head and face protection frame, pressure ulcer rate was significantly lower than the control group patients with pressure sores horseshoe shaped head and face protection frame occurs The rate, the difference was statistically significant (P? 0.05). The survey of patient satisfaction in two groups after operation: according to the selection criteria, the experimental group 78, control group 66, X2 test was used for statistical analysis, the degree of satisfaction of experimental group was significantly higher than the control group, there were statistically significant differences (P? 0.05).
Conclusion: by comparison, the two groups of patients with pressure ulcer surgery research shows that using the improved prone position headrest after reduction in posterior spinal surgery in patients with head and face pressure ulcer incidence than the existing operation room "horseshoe" head effect is obvious; head part can be improved according to the features of patients with flexible regulation, consistent with physiological structure the face of human head, increase patient comfort during surgery; shorten the hospitalization days, at the same time, reduce the economic burden of the patients; improve patient satisfaction; patients with facial pressure sores but did not solve the problem fundamentally. The improved prone position headrest is a good clinical effect for head protection the way.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473

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