基于倾向性评分匹配评价泡沫敷料对术中获得性压力性损伤的保护作用

Evaluation of the protective effect of foam dressings on intraoperative acquired pressure injuries based on propensity score matching

目的评估泡沫敷料预防术中获得性压力性损伤(IAPI)的保护作用,为临床术中IAPI防治提供参考依据。方法回顾性分析2020年10月至2021年1月上海交通大学医学院附属新华医院收治的455例外科手术患者的临床资料,按照是否术中受压部位使用泡沫敷料分为敷料组101例和对照组354例。以年龄、BMI、术前Braden评分、合并脑血管疾病为协变量对2组进行倾向性评分匹配,最终分为敷料组患者89例及对照组患者162例。应用Logistic回归分析与分层分析全面评估手术人群中泡沫敷料对IAPI发生的实际效果。结果251例手术患者中,敷料组共计14例占15.7%发生IAPI,对照组共计13例占8.0%发生IAPI,2组IAPI发生率比较差异无统计学意义(χ^(2)=3.41,P>0.05)。分层分析显示,在俯卧位手术患者中,相较于对照组,敷料组能够有效降低手术患者77%的IAPI发生风险(OR=0.23,95%CI 0.05~0.98,P<0.05)。泡沫敷料与各术中手术特征间不存在交互作用(P>0.05)。结论在俯卧位手术患者中,术中受压部位泡沫敷料的使用在预防IAPI的发生起保护作用。其余手术特征患者中术中泡沫敷料的使用并无显著的保护效果。

Objective To evaluate the protective effect of foam dressing in preventing intraoperative acquired pressure injury(IAPI),and to provide reference basis for prevention and treatment of IAPI during clinical operation.Methods The clinical data of 455 surgical patients admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University from October 2020 to January 2021 were retrospectively collected.According to whether foam dressing was used at the compression site during operation,the patients were divided into dressing group(101 cases)and control group(354 cases).The two groups were matched with age,body mass index,preoperative Braden and cerebrovascular disease as covariates,and were finally divided into 89 patients in the dressing group and 162 patients in the control group.Logistic regression analysis and stratified analysis were used to comprehensively evaluate the actual effect of foam dressing on the occurrence of IAPI in the surgical patients.Results Among the 251 patients,there were 14(15.7%)cases with IAPI in the dressing group and 13(8.0%)cases in the control group,and the difference was not statistically significant(χ^(2)=3.41,P>0.05).Among the patients in the prone position,compared to the control group,the dressing group can effectively reduce the risk of IAPI in surgical patients by 77%(OR=0.23,95%CI 0.05-0.98,P<0.05).There was no interaction between foam dressing and intraoperative surgical characteristics(P>0.05).Conclusions Foam dressing plays a protective role in preventing the occurrence of IAPI in patients undergoing surgery in the prone position.There was no significant protective effect of intraoperative foam dressing in patients with other surgical characteristics.