俯卧位手术患者受压部位微环境动态监测及分析

Microclimate of Compressed Part of Surgical Patients in Prone Position:Dynamic Monitoring and Analysis

目的全程监测俯卧位手术患者受压部位微环境并分析其变化趋势。方法2018年3—10月,便利抽样法选取某院手术室俯卧位择期手术患者99例为研究对象,应用WTM-2000无线体温监测仪和菲斯凯尔皮肤水分测量仪动态监测,记录术中压力性损伤发生情况、术中受压部位微环境变化。结果俯卧位手术患者压力性损伤发生率为10.10%。颧骨、髂前上棘的皮肤温度存在时间上的差异(P<0.05)。未发生压力性损伤者,其颧骨处皮肤温度在手术2.5 h内、3.5〜4 h升速快(P<0.05),而髂前上棘处皮肤温度在手术4 h内升速快(P<0.05);发生压力性损伤者,其颧骨处皮肤温度在手术4.5 h内,升速平稳(P>0.05),而髂前上棘处皮肤温度在手术0.5〜1 h、2.5〜3 h、3.5〜4 h升速快(P<0.05)。发生与未发生压力性损伤者皮肤湿度变化规律一致,即颧骨处湿度在手术结束时升高(P<0.05);髂前上棘处湿度在手术结束时变化差异无统计学意义(P>0.05)。结论俯卧位手术患者术中皮肤温度和皮肤湿度均持续升高。不同的受压部位,微环境变化规律差异显著,颧骨较髂前上棘明显。

Objective To monitor the microclimate of the compressed part of patients undergoing prone position surgery and analyze its change trend.Methods From March to October 2018,99 patients with prone position surgery were selected by convenience sampling method.WTM-2000 wireless temperature monitor and Fisker skin moisture meter were used for dynamic monitoring,and the occurrence of intraoperative pressure injury,intraoperative microclimate changes and related factors were recorded.Results The incidence of compression injury in prone position surgical patients was 10.10%.There was differences in time in skin temperature at zygomatic bone and anterior superior iliac spine(P<0.05).The skin temperature at the zygomatic bone increased rapidly within 2.5 h,3.5-4 h of operation(P<0.05);while the skin temperature at the anterior superior iliac spine increased rapidly within 4 h of operation(P<0.05).The skin temperature at the zygomatic bone increased steadily within 4.5 h of operation(P>0.05);while the skin temperature at the anterior superior iliac spine increased rapidly within 0.5-1 h,2.5-3 h,3.5-4 h of operation(P<0.05).The changes of skin humidity in patients with and without pressure ulcer were the same,that is,the humidity at zygomatic bone increased at the end of operation(P<0.05).There was no significant difference in the humidity at anterior superior iliac spine at the end of operation(P>0.05).Conclusions The skin temperature and humidity of the patients in prone position increase continuously.The changes of microclimate in zygomatic bone are more obvious than those in anterior superior iliac spine.