肝移植患儿术中压力性损伤发生特征及影响因素分析

Characteristics and influencing factors of intraoperative Pressure Injury among children undergoing liver transplantation surgery

目的:调查肝移植患儿术中压力性损伤发生的特征,并分析其影响因素,为进一步完善肝移植术中压力性损伤预防策略提供依据。方法:调查2007年1月至2018年12月我院接受肝移植手术治疗的101例患儿相关资料,收集人口学资料、术中压力性损伤相关信息,采用Logistic回归分析研究患儿术中压力性损伤发生的影响因素。结果:101例肝移植患儿中20例发生术中压力性损伤,发生率为19.8%;术中压力性损伤好发于头面部(67.8%),压力性损伤分期以1期(85.7%)为主;Logistic回归分析显示Braden Q评分、血清白蛋白、无肝期低体温是肝移植患儿术中压力性损伤发生的影响因素。结论:肝移植患儿是术中压力性损伤发生的高危人群,术前应关注患儿Braden Q评分以及血清白蛋白值是否低于正常,初步判断患儿压力性损伤的风险是否较高;在术中应结合肝移植手术特点,重点关注无肝期体温的变化,以及术中低血压情况,做好应对措施,提高护士认知与压力性损伤预防管理水平,防止术中压力性损伤发生。

Objective: To investigate the characteristics of intraoperative Pressure Injury among children undergoing liver transplantation and to analyze its influencing factors, so as to provide basis for preventing intraoperative Pressure Injury in liver transplantation. Methods: The relevant data of children undergoing liver transplantation were collected in one children's hospital in Chongqing from 2007 to 2018. Demographic data, intraoperative Pressure Injury information and possible influencing factors were collected and analyzed. Results: A total of 101 children undergoing liver transplantation were recruited, and 20 children developed intraoperative Pressure Injury with an incidence of 19.8%. Intraoperative Pressure Injury was mostly occurred in the head and face (67.8%), and the stage of pressure ulcer was mainly stage 1 (85.7%). Logistic regression analysis indicated that Braden Q score, albumin, hypothermia in non-hepatic stage were the influencing factors of Pressure Injury among children undergoing liver transplantation. Conclusion: Children undergoing liver transplantation were at high risk of intraoperative Pressure Injury. We should pay attention to the Braden Q score and albumin before surgery, and supervise the vital signs of children to find out whether hypotension or hypothermia occurred in an hepatic phase or reperfusion phase,so as to effectively prevent intraoperative Pressure Injury and enhance the quality of nursing.