曲线仰卧位对手术患者压力性损伤发生率及界面压力影响的研究

Study for the influence of curvilinear supine position on the incidence of pressure injury and interface pressure in patients undergoing surgery

目的探讨曲线仰卧位对患者围手术期压力性损伤发生率及界面压力的影响。方法前瞻性纳入2018年5月—2019年10月在我院行采用仰卧位开放性手术的101例患者。按照随机数字表法分为观察组50例和对照组51例。两组受试者仰卧在相同规格的手术床上。对照组采用常规仰卧位,观察组采用曲线式仰卧位(手术台的头、背、座板升高约10°,腿板降低约10°)。床边压力分布系统连续实时显示并记录各界面压力数据。观察术后0~2 d患者压力性损伤发生率、术中身体与手术台各界面压力分布情况、患者的舒适度和医护人员的满意度的组间差异。结果观察组连续3 d压力性损伤的发生率均为0;对照组连续3d压力性损伤的发生率分别为17.65%、7.84%和1.96%。其中第0天和第1天两组患者压力性损伤的发生率差异有统计学意义(P<0.05)。与对照组相比,观察组的骶骨和足跟区界面压力降低,差异有统计学意义(P<0.05)。观察组和对照组患者感觉舒适满意的比例分别为40(80%)和3(5.88%),差异有统计学意义(P<0.001)。而外科医生、护士、麻醉师的满意度组间比较差异无统计学意义(P>0.05)。结论曲线型仰卧体位相对于传统仰卧体位,能更大限度地实现压力再分配,显著降低压力性损伤的发生率。

Objective To investigate the preventive effect of curvilinear supine position on peri-operative stress injury(PIs).Methods 101 patients underwent open supine surgery in our hospital from May 2018 to October 2019 were prospectively included.According to the random number table method,they were divided into the intervention group(50 cases)and the control group(51 cases).Two groups of subjects were supine on the MAQUET bed.The control group was in the conventional supine position,and the intervention group was in the curvilinear supine position(the head,back and seat plate of the operating table were raised by about 10°,and the leg plate was lowered by about 10°).The bedside pressure distribution system continuously displays and records the pressure data of all areas in real time.The incidence of PIs,the distribution of intra-operative pressure between the body and the operating table,the comfort of patients and the satisfaction of medical staff were investigated.Results The incidence of PIs in the intervention group was 0 for 3 consecutive days.The incidence of PIs in the control group for 3 consecutive days was 17.65%,7.84%and 1.96%respectively.There was statistically significant difference in the incidence of PIs between the two groups on day 0 and day 1(P<0.05).Compared with the control group,the interface pressure in the sacrum and heel area of the experimental group was reduced.The difference was statistically significant(P<0.05).The proportion of patients in the intervention group and the control group who felt comfortable and satisfied was 40(80%)and 3(5.88%)respectively,There was statistically significant difference(P<0.001).However,there was no statistically significant difference in the satisfaction of surgeons,nurses and anesthesiologists among the groups(P>0.05).Conclusion Compared with the traditional supine position,the curvilinear supine position can achieve greater pressure redistribution and significantly reduce the incidence of PIs.