凝胶减压垫预防困于轮椅的老年人坐骨结节压疮的研究

发布时间：2018-02-26 15:29

本文关键词： 凝胶减压垫压疮困于轮椅的老年人经皮血氧分压　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过使用更加客观的指标,探讨凝胶减压垫在预防困于轮椅的老年人坐骨结节压疮中的作用及这一人群更换体位的较好时间。方法:采用自身前后对照试验设计,以32名需要使用轮椅且无法自主更换体位的老年人为研究对象。首先协助研究对象侧卧位,评估其骶尾部皮肤完整情况,然后采用激光多普勒仪Peri Flux5000测试其未受压侧坐骨结节处经皮血氧分压(Transcutaneous Oxygen Pressure,Tc PO2)、激光多普勒血流灌注(Laser Doppler Perfusion,LDP)情况获得基线值;使用红外测温仪测试相同部位皮肤表面温度获得皮温基线值。其次,协助研究对象坐于放置有凝胶减压垫的标准轮椅上,30分钟后再次侧卧位(同基线值测量时的体位),采用相同仪器及方法,评估其坐骨结节受压后局部皮肤变化情况、测量受压后同一部位经皮血氧分压、激光多普勒血流灌注和皮温,获得测量值。第三,让研究对象充分休息24小时后,在同一时间段和环境下,重复测试基线值的步骤,获得第二次基线值;然后协助研究对象坐于标准医用轮椅上,30分钟后重复测量值步骤,获得标准轮椅使用后的测量值。所有数据录入SPSS21.0进行统计分析。结果:(1)32例研究对象平均年龄为82.09±8.77岁,其中男性13例,占40.6%;女性19例,占59.4%。伴随高血压、冠心病、糖尿病的研究对象分别占56.3%,37.5%和34.3%;(2)32名研究对象使用放置有凝胶减压垫的标准轮椅后Tc PO2值为40.75±16.40mm Hg,使用标准轮椅后Tc PO2值35.06±16.67mm Hg,前后比较差异具有统计学意义(P=0.005);使用放置有凝胶减压垫的医用轮椅后LDP值为5.50(3.25,9.00)PU,使用标准轮椅后LDP值为6.00(4.25,8.75)PU,差异无统计学意义(P=0.621);(3)研究对象在使用放置有凝胶减压垫的标准轮椅后其坐骨结节处皮肤表面温度(31.16±1.70)℃低于使用未放置减压垫的标准轮椅后相同部位皮肤表面温度(32.06±1.87)℃,差异有统计学意义(P=0.01);(4)参与本研究的32个研究对象中,有6人在使用放置有凝胶减压垫的标准轮椅和未放置凝胶减压垫的标准轮椅30min后,骶尾部均出现了非苍白性红斑;有12人在使用标准轮椅后出现了非苍白性红斑,但其使用放置有凝胶减压垫的轮椅后未出现皮肤异常,差异有统计学意义(P=0.024);(5)32名研究对象中,有8人在使用凝胶减压垫和标准轮椅30min后,Tc PO2均未恢复至基线值;有17人在使用标准轮椅后Tc PO2未恢复至基线值,但其使用放置有凝胶垫的轮椅后Tc PO2恢复至基线值,有5人在使用凝胶减压垫和医用标准轮椅后Tc PO2均恢复至基线值,以上结果对比,差异无统计学意义(P=1.000)。结论:凝胶减压垫能降低困于轮椅的老年人受压部位皮肤表面温度,同时能在一定程度上改善受压组织微循环,但是不能使组织的微循环在解压后得到完全恢复。因此,在照顾受困于轮椅的老年人时,不能过分依赖凝胶减压垫来预防压疮的发生。在凝胶减压垫使用后30分钟内,仍然存在研究对象出现压之不褪色的非苍白性白斑(I期压疮)、Tc PO2降低且未恢复的情况,因此在照顾受困于轮椅的老年人时,应尽量减少其坐位的时间。使用凝胶减压垫来预防这一人群的压疮发生时,至少应每30分钟更换体位一次。
[Abstract]:Objective: through the use of a more objective index of good gel pad in the prevention of decompression time trapped in the wheelchair elderly ischial tuberosity of pressure ulcers in this population and change posture. Methods: using the self control study, 32 need to use the wheelchair and cannot change posture of elderly people as the research object first. To assist the research object of lateral position, evaluate the sacrococcygeal skin condition, then by using the laser Doppler instrument Peri Flux5000 test the compression side sciatic nodules by percutaneous oxygen partial pressure (Transcutaneous Oxygen Pressure, Tc PO2), laser Doppler perfusion (Laser Doppler, Perfusion, LDP) to get the baseline value; infrared thermometer test the same skin surface temperature to obtain baseline temperature. Secondly, the research object is placed to assist to sit in the wheelchair cushion on the standard gel, again after 30 minutes Lateral position (with the baseline measurement of the body), using the same instrument and method of evaluating the changes of local skin the ischial tuberosity after compression, compression of measuring the same part of percutaneous oxygen partial pressure, laser Doppler perfusion and skin temperature, the value obtained. Third, make the research object fully after 24 hours of rest, at the same time and environment, the test of baseline steps repeat second times the baseline value; then assist the research object sitting in standard medical wheelchair, 30 minutes after repeated measurement steps, measurement standard wheelchair after use value. All the data into SPSS21.0 for statistical analysis. Results: (1) 32 subjects with an average age of 82.09 + 8.77 years, among which 13 cases were male, accounting for 40.6%; 19 cases of female, accounting for 59.4%. with hypertension, coronary heart disease, study diabetes accounted for 56.3%, 37.5% and 34.3%; (2) the 32 subjects are placed using coagulation Standard rubber pad Tc after decompression wheelchair PO2 = 40.75 + 16.40mm Hg, Tc PO2 35.06 + 16.67mm Hg value using a standard wheelchair, with statistical significance difference (P=0.005); the use of medical wheelchair placed gel pad after decompression LDP value was 5.50 (3.25,9.00) PU, using the standard LDP value for wheelchair 6 (4.25,8.75) PU, the difference was not statistically significant (P=0.621); (3) the research object put standard wheelchair with gel pad in the decompression after using the ischial tuberosity skin surface temperature (31.16 + 1.70) degrees lower than the standard wheelchair use not placed after the same skin decompression pad surface temperature (32.06 + 1.87) C, the difference was statistically significant (P=0.01); (4) of 32 subjects participated in this study, there are 6 people in the use of 30min standard wheelchair wheelchair put standard gel pad and decompression without placing a gel pad after decompression, sacrococcygeal showed non pale erythema; There are 12 people in the use of standard wheelchair after the emergence of non pale erythema, but its use is placed in a wheelchair cushion gel without skin abnormalities, the difference was statistically significant (P=0.024); (5) the 32 subjects, there were 8 people in the use of gel pad and decompression standard wheelchair after 30min, Tc PO2 were not restored to the baseline value; there are 17 people in the use of standard wheelchair after Tc PO2 not return to baseline values, but its use is placed in a wheelchair gel pad Tc PO2 returned to the baseline level, there are 5 people in the use of gel pad and medical standard after decompression Tc PO2 wheelchair recovered to baseline values, the above results contrast, the difference was not statistically significant (P=1.000). Conclusion: the gel cushion can reduce compression skin surface temperature of elderly people trapped in a wheelchair, and can improve the compression of microcirculation in a certain extent, but not so in the microcirculation after decompression to fully recover. Therefore, In the care of elderly people trapped in a wheelchair, can not rely too much on the gel cushion to prevent pressure ulcer. In the gel cushion use after 30 minutes, there are still research object of the pressure does not fade non pale white spots (Tc PO2, stage I) and did not reduce the recovery, so take care of the old man trapped in a wheelchair, should minimize its seat time. The use of gel cushion to prevent this population pressure, at least every 30 minutes to replace the position again.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

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