骶尾受压部位血氧、压力变化与妇科恶性肿瘤截石位患者术中压力性损伤相关性研究

Correlation between blood oxygen and pressure change in sacral compression site and intraoperative pressure injury in patients with gynecological malignant tumor at lithotomy position

目的观察妇科恶性肿瘤截石位手术患者骶尾受压部位血氧、压力变化,并分析两者与术中压力性损伤的相关性。方法前瞻性选取2020年10月—2022年10月于本院接受截石位手术的216例妇科恶性肿瘤患者,所有患者入院时、手术结束时均检测骶尾受压部位血氧、压力,观察其变化情况。统计妇科恶性肿瘤截石位患者术后3 d内压力性损伤发生状况,将其分为损伤组与未损伤组,对比两组临床资料,并分析骶尾受压部位血氧、压力与术中压力性损伤的相关性。结果手术结束时,妇科恶性肿瘤截石位手术患者骶尾受压部位血氧低于入院时,压力高于入院时(t=17.475、15.690,均P<0.05);216例妇科恶性肿瘤截石位手术患者中发生术中压力性损伤21例,占9.72%;入院时,损伤组骶尾受压部位血氧低于未损伤组,压力高于未损伤组(t=3.930、5.227,P<0.05);经点二列相关性分析,结果显示,妇科恶性肿瘤截石位手术患者骶尾受压部位血氧与术中压力性损伤呈负相关(r=0.252,P<0.05),骶尾受压部位压力与术中压力性损伤呈正相关(r=0.336,P<0.05);经Logistic回归分析,结果显示,骶尾受压部位血氧是妇科恶性肿瘤截石位手术患者发生术中压力性损伤的保护因素(OR=0.458,P<0.05);骶尾受压部位压力是的危险因素(OR=1.412,P<0.05);绘制ROC曲线,结果显示,骶尾受压部位血氧、压力预测妇科恶性肿瘤截石位手术患者发生术中压力性损伤的AUC=0.753、0.805,具有一定预测价值,两者联合预测价值更高(AUC=0.862)。结论妇科恶性肿瘤截石位手术患者术后骶尾受压部位血氧降低、压力升高,两者与术中压力性损伤密切相关,血氧是术中压力性损伤的保护因素,压力是危险因素。

Objective To observe the changes of blood oxygen and pressure in sacral compression part of patients with gynecological malignant tumor undergoing lithotomy position,and analyze the correlation between the two and intraoperative pressure injury.Methods A total of 216 patients with gynecological malignant tumor who underwent lithotomy from October 2020 to October 2022 in our hospital were prospectively selected.Blood oxygen and pressure in the sacrococcygeal compression part were measured at the time of admission and at the end of the operation,and the changes were observed.The incidence of pressure injury in patients with gynecological malignant tumor at lithotomy position within 3d after operation was counted and divided into injury group and non-injury group.The clinical data of the two groups were compared,and the correlation between blood oxygen and pressure at sacral compression part and pressure injury during operation was analyzed.Results At the end of the surgery,the blood oxygen in the sacral compression part of patients undergoing lithotomy position for gynecological malignant tumor was lower than that at the time of admission,and the pressure was higher than that at the time of admission(t=17.475 and 15.690,P<0.05).Among 216 cases of gynecological malignant tumor treated with lithotomy position,21 cases(9.72%)suffered from intraoperative pressure injury.On admission,the blood oxygen level in sacral compression part of the injured group was lower than that of the intact group,and the pressure was higher than that of the intact group(t=3.930 and 5.227,P<0.05).The results of the two-point correlation analysis showed that blood oxygen in the sacral compression part of patients with gynecological malignant tumor undergoing lithotomy had a negative correlation with intraoperative pressure injury(r=0.252,P<0.05),and the pressure in the sacral compression part had a positive correlation with intraoperative pressure injury(r=0.336,P<0.05).Logistic regression analysis showed that blood oxygen in the sacral compression part was a protective factor for intraoperative pressure injury in patients undergoing lithotomy position for gynecological malignant tumors(OR=0.458,P<0.05).Pressure at sacral compression site was a risk factor(OR=1.412,P<0.05);The ROC curve was drawn,and the results showed that oxygen and pressure in the sacral compression site had certain predictive value in predicting AUC=0.753 and 0.805 of intraoperative pressure injury in patients undergoing lithotomy position for gynecological malignant tumor,and the combination of the two had higher predictive value(AUC=0.862).Conclusion Blood oxygen in sacral compression decreased and pressure increased in patients with gynecological malignant tumor undergoing lithotomy position after operation,which are closely related to intraoperative pressure injury.Blood oxygen is a protective factor for intraoperative pressure injury,while pressure is a risk factor.