妇科腹腔镜截石位手术患者发生压力性损伤影响因素与防护

Influencing factors and protection of pressure injury in patients undergoing gynecological laparoscopic lithotomy position

目的探讨妇科腹腔镜截石位手术患者压力性损伤发生的相关因素及护理对策。方法选取2017年10月至2018年10月我院进行妇科腹腔镜截石位手术治疗的116例患者作为研究对象,建立数据库,总结分析研究对象的以往病史、年龄、手术床骶骨的压迫、举宫器使用情况、消毒情况、截石位摆放时机、漏尿次数及压力性损伤史等,讨论影响压力性损伤的相关因素。结果116例患者中,发生压力性损伤的有32例,发生率为27.59%。单因素分析显示,手术床骶骨的压迫、举宫器使用不当、消毒情况、手术截石位摆放时机不恰当、漏尿次数是影响妇科腹腔镜截石位手术患者发生压力性损伤的相关因素(P<0.05)。多因素logistic回归分析显示,手术床骶骨的压迫、举宫器使用不当、消毒情况、手术截石位摆放时机不恰当、漏尿次数为影响妇科腹腔镜截石位手术患者发生压力性损伤的独立危险因素。结论妇科腹腔截石位手术患者压力性损伤的主要因素为手术床骶骨的压迫、举宫器使用不当、消毒情况、手术截石位摆放时机不恰当、漏尿次数,针对其影响因素采取相应护理措施,帮助患者尽快康复。

Objective To explore the related factors and nursing strategies for the occurrence of pressure injury in patients undergoing gynecological laparoscopic lithotomy position.Methods We selected 116 cases of patients who underwent the treatment of gynecologic laparoscopic lithotomy from October 2017 to October 2018 as a study object.A database was established to summarize and analyze the previous medical history,age,and compression of the sacrum because of the operating table,the use of the uterine manipulator,the disinfection situation,the timing of the lithotomy position,the time of leaking urine and the history of pressure injury,etc.As a purpose,the above factors were discussed to determine the related factors affecting the pressure injury.Results In the 116 cases of patients,32 cases had pressure injury with an incidence of 27.59%.Univariate analysis showed that the compression of the sacrum because of the operating table,the improper use of the uterine manipulator,the disinfection situation,the improper timing of the placement of the lithotomy position,and the times of leaking urine were the related factors that affected the pressure injury in patients undergoing gynecologic laparoscopic lithotomy(P<0.05).Multivariate logistic regression analysis showed that the compression of the sacrum because of the operating table,the improper use of the uterine manipulator,the disinfection situation,the improper timing of the placement of the lithotomy position,and the times of leaking urine were the independent risk factors that affected the pressure injury in patients undergoing gynecologic laparoscopic lithotomy.Conclusion The main factors of pressure injury in patients undergoing gynecological abdominal lithotomy were the compression of the sacrum because of the operating table,improper use of the uterine manipulator,the disinfection situation,improper timing of the placement of the lithotomy position,and time of leaking urine.Corresponding nursing measures should be adopted to help patients recover as soon as possible.