清醒气管插管患者自主摆放俯卧位在预防术中压疮的应用研究

Study on the application of self-positioning in the prevention of pressure ulcer in patients with conscious tracheal intubation

目的研究清醒气管插管患者自主摆放体位预防术中压疮形成的效果及其在临床中的可行性。方法将60例均需在全麻俯卧位下手术患者,随机分为两组,即实验组(自主摆放体位组)和对照组(被动摆放体位组),每组30例。实验组患者采用环甲膜穿刺气管内表面麻醉后,纤支镜引导清醒气管插管成功后,根据自身的舒适度配合医务人员摆放俯卧位,然后行诱导麻醉;对照组患者采用全麻气管插管后,由医务人员根据手术需要为患者摆放俯卧位。手术结束后,及时将患者改变为仰卧位,观察两组患者皮肤受压情况手术后即刻、术后30分、术后3天进行比较。结果术毕对照组皮肤反应发生率为63.3%,而实验组的皮肤反应发生率为6.7%,实验组压疮危险评分明显低于对照组,差异有统计学意义。结论全麻下俯卧位手术的患者,在纤支镜引导下清醒气管插管后患者自行摆放俯卧位的方法,可以降低术中压疮发生的风险。

Objective To study the effect and clinical feasibility of self placed prone position in the prevention of surgery-related pressure ulcer in patients with conscious tracheal intubation. Methods 60 patients undergoing general anaesthesia in prone position were randomly divided into two groups（ 30 patients in each group）. In experimental group,cricothyroid injection of topical anaethesia was followed by awake fiberoptic bronchoscope intubation. The patient then turned himself/herself to the prone position comfortably. After surgery,the patient was placed in the supine position. The skin compression conditions of the two groups were compared immediately after operation,30 points after operation,and 3 days after the operation. Results In the control group,the skin reaction rate was 63.3%,while the skin reaction rate in the experimental group was 6. 7%. The risk score of pressure ulcer in the experimental group was significantly lower than that in the control group,the difference was statistically significant.Conclusions For patients undergoing prone position surgery under general anesthesia,it is possible to reduce the risk of pressure ulcers in patients undergoing self guided placement of prone position under fiberoptic bronchoscopy.