手术室强迫侧俯卧位患者压疮发生风险因素及预防效果研究

发布时间：2018-05-22 14:17

本文选题：强迫侧卧位 + 强迫俯卧位　；参考：《山东大学》2017年硕士论文

【摘要】：目的:通过对临床手术患者受压部位预防性使用赛肤润和减压贴,探讨赛肤润和减压贴联合使用在术中压疮预防中的效果;探讨手术中强迫侧卧位、俯卧位手术患者压疮发生高度危险因素,从而为预防和降低手术中压疮发生率提供依据。方法：本研究是随机对照试验,选取2016年4月1日至2017年1月31日在某三级大型甲等综合医院进行择期手术的800例患者进行调查,使用随机数字表法将患者分为试验组和对照组,两组各400例。参照Waterlow压疮危险因素评估表,制定手术患者压疮高危因素调查表,对患者进行调查。对照组受压部位使用减压贴,试验组涂抹赛肤润后贴减压贴,在手术结束后30分钟内、术后24小时进行评估受压部位皮肤状况,记录无压疮、Ⅰ期压疮、Ⅱ期压疮的转变或转归的例数,查找手术患者的压疮高危因素。调查对象的一般资料采用频数与百分比进行统计描述;将所有资料使用Excel2007进行数据录入,应用SPSS21.0软件进行统计分析,采用χ2检验比较对照组和试验组在压疮发生率的差异,采用Logistic多元回归分析探讨压疮发生的高度危险因素,显著性水平以P0.05表示有统计学意义。结果:1.本研究共收集800例侧卧位、俯卧位手术患者资料,其中对照组患者400例,侧卧位305(76%)例,俯卧位95(24%)例;16例患者术后发生了压疮,发生率为4%,其中Ⅰ期压疮11(69%)例,Ⅱ期患者5(31%)例,压疮好发部位为下颌部、颧骨隆突、髂前上棘和髂骨处,5(31%)例Ⅰ期压疮手术后24小时观察红斑消失,6(37.5%)例Ⅰ期压疮24小时出现水泡,转为Ⅱ期压疮。试验组患者400例,侧卧位309(77%)例,俯卧位91(23%)例;6例患者发生了压疮,发生率为1.5%,其中Ⅰ期压疮4(67%)例,Ⅱ期患者2(33%)例,压疮好发部位为下颌、颧骨隆突处,皮肤出现异常的时间在手术后30分钟,其中Ⅰ期压疮2例,术后24小时后皮肤恢复正常。2.通过单因素分析,试验组患者压疮发生率低于对照组,有显著差异(P0.05)。赛肤润和减压贴联合使用对术中压疮预防有效。3.通过Logistic多元回归分析进行非条件多因素分析,选出体重指数、术前血红蛋白、手术时间是手术中患者压疮发生的高度危险因素,体重指数16.0≤BMI≤17.5或27.0≤BMI≤30.0、BMI16.0或BMI30相对于18.5-23.9来说,对压疮发生有影响,OR分别为9.114和11.185,说明体重指数≤17.5或≥27是压疮发生的危险因素。术前血红蛋白60g/L、60-90g/L、90-110g/L相对于110g/L来说,对压疮发生均有影响,OR值分别为42.909、11.903和8.859,说明术前血红蛋白小于110g/L是压疮发生的危险因素,且术前血红蛋白越低,发生压疮的危险性越高。手术时间3-5h和5h相对于1-3h来说,对压疮发生有影响,OR值分别为32.418和40.314,说明手术时间大于3h是压疮发生的危险因素,且手术时间越长,压疮发生危险性越高。结论:1.体重指数≥27或≤17.5、术前血红蛋白小于110g/L、手术时间大于3h是压疮发生的危险因素,且术前血红蛋白越低,手术时间越长,压疮发生危险性越高。2.赛肤润和减压贴联合使用,能够降低侧卧位、俯卧位手术压疮的发生率,对手术压疮预防有效果。3.术前有效评估压疮发生高度危险因素,采取正确预防措施,可以有效降低术后患者压疮的发生率。
[Abstract]:Objective: To explore the effect of the combined use of skin moisturizing and decompression paste in the prevention of pressure sore in the operation, and to explore the high risk factors for pressure sore in patients with strong forced lateral position and prone position in operation, so as to provide a basis for preventing and reducing the incidence of pressure sore in the operation. Methods: This study was a randomized controlled trial. A total of 800 patients undergoing elective surgery in a three class large class a general hospital from April 1, 2016 to January 31, 2017 were investigated. The patients were divided into the experimental group and the control group, and the two groups of 400 cases were divided into two groups. The surgical patients were formulated with reference to the risk factors assessment of Waterlow pressure sore. The patients in the high risk factors of pressure sore were investigated. The compression sites in the control group were applied with decompression paste, and the experimental group was smeared with skin pressure post on the skin after 30 minutes after the operation, and 24 hours after the operation to assess the skin condition of the compression site, and record the number of non pressure sores, stage I pressure sore, stage II pressure sore change or outcome, and find surgical patients. The high risk factors of pressure sore. The general data of the subjects were described by frequency and percentage; all the data were recorded by Excel2007, and SPSS21.0 software was used for statistical analysis. The difference of the incidence of pressure ulcers in the control group and the test group was compared by the x 2 test, and the Logistic multivariate regression analysis was used to explore the pressure sore hair. A total of 800 cases of lateral position and prone position were collected in 1. studies, including 400 cases in the control group, 305 (76%) in the lateral position, 95 (24%) in the prone position, and 16 patients with pressure sore in 4%, of which stage I pressure sore 11 (69%), stage II suffering. In 5 (31%) cases, the good location of the pressure sore was the mandible, the zygomatic protuberance, the anterior superior iliac spine and the iliac bone, and the erythema disappeared in the 24 hour after the 5 (31%) stage I pressure sore operation. 6 (37.5%) stage I pressure sore appeared for 24 hours and turned to stage II pressure sore. In the experimental group, 400 cases, 309 (77%) cases in the lateral decubitus, 91 (23%) cases in the lateral decubitus, and the occurrence of pressure sore in the patients in the patients were occurred. The rate was 1.5%, including 4 (67%) cases of pressure sore in stage I, 2 (33%) patients in stage II. The good location of pressure sore was mandible, malar protuberance and abnormal skin time in 30 minutes after operation, of which 2 cases of pressure sore in stage I, after 24 hours after operation, the skin was restored to normal.2. through single factor analysis, the incidence of pressure sore in the test group was lower than that of the control group, there was significant difference (P 0.05). The combined use of skin moisturizing and decompression paste to prevent the effective.3. through the Logistic multivariate regression analysis for non conditional multifactor analysis, select body mass index, preoperative hemoglobin, operation time is a high risk factor for the occurrence of pressure sore in the operation, the weight index is 16 less than BMI less than 17.5 or 27 less than BMI < 30, BMI16.0 or BMI30 Relative to 18.5-23.9, the incidence of pressure sores was affected, OR was 9.114 and 11.185, respectively, which indicated that BMI < 17.5 or 27 was a risk factor for pressure ulcers. Preoperative hemoglobin 60g/L, 60-90g/L, 90-110g/L had an influence on the occurrence of pressure sore, OR value was 42.909,11.903 and 8.859, indicating that hemoglobin was less than 1 before operation. 10g/L is a risk factor for the occurrence of pressure sore, and the lower the hemoglobin before operation, the higher the risk of pressure sore. The operation time 3-5h and 5h have an influence on the pressure sore, OR value is 32.418 and 40.314 respectively, indicating that the operation time is greater than 3H is the risk factor of pressure sore, and the longer the operation time, the higher the risk of pressure sore. Conclusion: the 1. body mass index is more than 27 or less than 17.5, the preoperative hemoglobin is less than 110g/L, the operation time is more than 3H is the risk factor of pressure sore, and the lower the hemoglobin, the longer the operation time, the higher the risk of pressure sore, the more.2. skin moisturizing and the combined use, it can lower the lateral position, the incidence of pressure sore in the prone position, the operation pressure on the operation pressure. .3. is effective in evaluating the high risk factors of pressure ulcers. Proper preventive measures can effectively reduce the incidence of pressure ulcers.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472.3

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