成人骨科俯卧位手术患者术中压力性损伤发生的影响因素

Influencing factors of intraoperative stress injury in adult orthopaedic prone surgery patients

目的分析成人骨科俯卧位手术患者术中发生压力性损伤的影响因素。方法回顾性分析2021年1月至2022年1月在南京医科大学附属泰州人民医院接受骨科俯卧位手术治疗的100例患者,记录患者性别、年龄等一般资料及手术时间等手术相关资料。根据术中是否发生压力性损伤分为发生组和未发生组,以问卷调查方式收集患者临床资料,并对两组患者临床资料进行分析。结果患者年龄、体重指数、术前活动力、手术时间、合并慢性疾病、使用骨科医疗器械是导致患者术中发生压力性损伤的影响因素(P<0.05)。年龄≥60岁、肥胖、术前活动力受限、合并慢性疾病、手术时间≥3 h、骨科医疗器械的使用均为患者发生术中压力性损伤的独立危险因素(P<0.05)。ROC曲线分析结果显示,年龄≥60岁、肥胖、术前活动力受限、合并慢性疾病、手术时间≥3 h、使用骨科医疗器械曲线下面积分别为0.727、0.613、0.638、0.620、0.741、0.660,其中术前活动力最佳截断值>1。结论影响成人骨科俯卧位手术患者术中发生压力性损伤的危险因素众多,其中年龄≥60岁、肥胖、术前活动力重度受限、合并慢性疾病、手术时间≥3 h、使用骨科医疗器械易诱发术中压力性损伤。

Objective To study the risk factors of intraoperative stress injury in prone position patients undergoing orthopedic surgery.Methods The clinical data of 100 patients who received orthopedic prone surgery in this hospital from January 2021 to January 2022 were retrospectively analyzed.The general data of patients,such as gender and age,as well as surgical data such as operation time,were recorded.According to the occurrence of intraoperative stress injury,the patients were divided into the occurrence group and the non-occurrence group.Clinical data of the patients were collected by questionnaire survey,and the clinical data of the two groups were analyzed.Results Age,body mass index,preoperative activity,operation time,chronic diseases,and use of orthopedic medical instruments were the factors that caused intraoperative stress injury(P<0.05).Age≥60 years old,obesity,preoperative activity limitation,chronic diseases,operation time≥3 hours,and the use of orthopedic medical instruments were all independent risk factors for intraoperative stress injury(P<0.05).ROC curve analysis results showed that age≥60 years old,obesity,preoperative activity limitation,chronic disease,operation time≥3 hours,area under the curve using orthopedic medical instruments were 0.727,0.613,0.638,0.620,0.741,0.660,among which the optimal cut-off value of preoperative activity was>1.Conclusions There are many risk factors affecting intraoperative stress injury in prone orthopedic surgery patients,including age≥60 years old,obesity,severe restriction of preoperative activity,chronic diseases,operation time≥3 hours,and use of orthopedic medical instruments.