自制约束带对颈椎后路手术预防胸肋部压力性损伤的研究

Application of Self-made Restraint Belt in Prevention of Pressure Injury of Sternum and Ribs in Posterior Cervical Spine Surgery

目的探讨自制上肢约束带在颈椎后路手术中预防胸肋部压力性损伤的应用。方法选取2019年2月—2020年5月医院收治的80例行颈椎后路手术患者,随机均分成对照组和试验组。对照组采用普通传统的约束方式,试验组采用自制的上肢约束带的约束方式。比较两组患者胸肋部皮肤压力性损伤情况、约束带引起的皮肤凹痕深度以及凹痕消退的时间。结果试验组患者术后胸肋部受压皮肤肤色正常的患者增长了23%,轻度发红的情况降低了35%,无青紫/硬结,水泡或破溃压力性损伤的患者。约束带凹痕的患者较对照组大幅度降低。30 min内约束带凹痕消退的患者数量下降了45%。试验组胸肋部皮肤压力性损伤程度低于对照组(P<0.05)。结论自制上肢约束带,平整、柔软、透气性强,避免了术中因约束带安置的不合理导致的约束带堆积、松脱等现象的发生。根据患者的手术方案和个人情况,既可安置于患者的前胸,避免与体位垫直接的接触,又可安置于患者的背部,增强了双上肢与躯干的压力避免了双上肢下垂、扭转、外翻等现象的发生,操作方式简便快捷,缩短了体位安置的时间。扩大了胸肋部皮肤与约束带之间的受力面积,减少了胸前压力,有助于降低颈椎后路手术中胸肋部皮肤的压力性损伤。

Objective To explore the application of self-made upper limb restraint belt in the posterior cervical spine surgery to prevent pressure injury of sternum and ribs.Methods A selection of 80 patients undergoing posterior cervical surgery admitted to our hospital from February 2019 to May 2020 were randomly divided into a control group and an experimental group.The control group was adopted the ordinary traditional restraint method,and the experimental group was adopted the restraint method of self-made upper limb restraint belt.The skin pressure injury of the sternum and ribs,the depth of the skin dent caused by the restraint band,and the time for the dent to disappear were compared between the two groups.Results In the experimental group,patients with normal skin color on the sternum and ribs after operation increased by 23%, mild redness decreased by 35%, and there was no cyanotic/induration, vesicle or burst pressure injury. The number of patients with constrained dents was significantly lower than the control group. The number of patients whose restraint belt dents subsided within 30 minutes decreased by 45%. The degree of skin pressure injury on the chest and ribs of the experimental group was lower than that of the control group (P < 0.05). Conclusion The self-made upper limb restraint belt is flat, soft, and has strong air permeability, which avoids the accumulation and loosening of restraint belts caused by the unreasonable placement of restraint belts during the operation. According to the patient’s surgical plan and personal situation, it can be placed on the patient’s front chest to avoid direct contact with the posture cushion, and can also be placed on the patient’s back, which increases the pressure on the upper limbs and the trunk and prevents the upper limbs from sagging and twisting, eversion and other phenomena occur, the operation method is simple and quick, which shortens the time of posture placement. It expands the force-bearing area between the skin of the sternum and the restraint belt, reduces the pressure on the chest, and helps to reduce the pressure damage of the skin of the sternum during posterior cervical surgery.