本文關(guān)鍵詞： 脊柱手術(shù) 俯臥位 頭面部 壓瘡　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：壓瘡又稱壓力性潰瘍(PU),是臨床常見并發(fā)癥之一[1]。歐洲壓瘡顧問小組(EPUAP)提示[2]，高達(dá)18%的住院患者會(huì)發(fā)生壓瘡，國內(nèi)住院患者壓瘡發(fā)生率為2.5%～15%，其中俯臥位頭面部壓瘡發(fā)生率為2.5%～8.8％，甚至高達(dá)11.6％。頭面部壓瘡的發(fā)生，不僅給患者帶來痛苦，而且會(huì)降低其生活質(zhì)量，壓瘡經(jīng)久不愈，導(dǎo)致嚴(yán)重感染、全身衰竭甚至危及生命［3］。俯臥位是脊柱后路手術(shù)最常用體位[4]。脊柱手術(shù)由于手術(shù)創(chuàng)面大,手術(shù)時(shí)間長,如果手術(shù)體位擺放不當(dāng)或保護(hù)措施不恰當(dāng),會(huì)在長時(shí)間的手術(shù)過程中對患者造成傷害[5]。因此，使用合適的頭面部保護(hù)具是預(yù)防俯臥位手術(shù)患者頭面部壓瘡發(fā)生的主要手段。而現(xiàn)有頭面部保護(hù)具規(guī)格比較局限，不能夠很好的根據(jù)個(gè)體面部的差異做出靈活吻合的調(diào)整以更好的保護(hù)患者頭面部皮膚。因此，我們在對傳統(tǒng)頭面部保護(hù)具充分深入研究的基礎(chǔ)上對其進(jìn)行改良后并進(jìn)行循證試驗(yàn)性研究。通過對比顯示：俯臥位脊柱后路手術(shù)時(shí)應(yīng)用改良式頭托，可以降低頭面部壓瘡發(fā)生率；能夠促進(jìn)臨床保護(hù)架的發(fā)展；同時(shí)也能為臨床實(shí)踐中壓瘡的預(yù)防提供更多的參考價(jià)值。 研究目的：通過對兩組手術(shù)患者頭面部壓瘡發(fā)生率的比較，探討改良式頭面部保護(hù)支架在俯臥位脊柱后路手術(shù)中的應(yīng)用效果,及對患者術(shù)后頭面部并發(fā)癥發(fā)生率的影響。 研究方法：采用隨機(jī)對照分組的方法，選取2012年8月—2013年12月在中日聯(lián)誼醫(yī)院脊柱外科住院行脊柱后路手術(shù)的患者,共160例。按照納入與排除標(biāo)準(zhǔn)將被選入的160例手術(shù)患者隨機(jī)分為實(shí)驗(yàn)組和對照組。實(shí)驗(yàn)組80例，麻醉成功且頭、面部、眼瞼采取保護(hù)措施后，使用經(jīng)過改良的俯臥位頭面部保護(hù)支架；對照組80例，麻醉成功且頭、面部、眼瞼采取常規(guī)護(hù)理保護(hù)措施后，使用手術(shù)室傳統(tǒng)沿用的“馬蹄形”頭面部支托。兩組患者分別均于術(shù)前采用《手術(shù)壓瘡風(fēng)險(xiǎn)評估表（Braden）》，術(shù)后采用《頭面部皮膚損傷程度評估表》對兩組手術(shù)患者頭面部皮膚狀況進(jìn)行評估，并于術(shù)后清醒后進(jìn)行患者滿意度調(diào)查。 研究結(jié)果：實(shí)驗(yàn)組與對照組兩組患者術(shù)前應(yīng)用《手術(shù)壓瘡風(fēng)險(xiǎn)評估表（Braden）》對術(shù)前手術(shù)患者皮膚狀況進(jìn)行評估，實(shí)驗(yàn)組容易出現(xiàn)壓瘡的手術(shù)患者17人；對照組容易出現(xiàn)壓瘡的手術(shù)患者19人。實(shí)驗(yàn)組患者皮膚壓瘡風(fēng)險(xiǎn)度與對照組無較大差異，，差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后應(yīng)用《頭面部皮膚損傷程度評估表》對手術(shù)患者皮膚狀況進(jìn)行評估，實(shí)驗(yàn)組頭面部皮膚損傷患者12例，并發(fā)癥患者3例；對照組頭面部皮膚損傷患者27例，并發(fā)癥患者13例；兩組患者面部壓瘡發(fā)生率比較顯示：實(shí)驗(yàn)組患者使用改良頭面部保護(hù)架,發(fā)生壓瘡機(jī)率明顯低于對照組患者使用“馬蹄形”頭面部保護(hù)架的壓瘡發(fā)生率，差異有統(tǒng)計(jì)學(xué)意義（P㩳0.05）。兩組患者術(shù)后滿意度調(diào)查：根據(jù)選擇標(biāo)準(zhǔn)，實(shí)驗(yàn)組共78人，對照組共66人，使用X2檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析，實(shí)驗(yàn)組患者滿意度明顯高于對照組，顯著性差異有統(tǒng)計(jì)學(xué)意義（P㩳0.05）。 研究結(jié)論：通過對兩組手術(shù)患者發(fā)生壓瘡的比較，研究表明：應(yīng)用經(jīng)過改良的俯臥位頭架在降低俯臥位脊柱后路手術(shù)患者頭面部壓瘡發(fā)生率方面較手術(shù)室現(xiàn)有“馬蹄形”頭架效果明顯；改良頭架組成部分可根據(jù)手術(shù)患者五官靈活調(diào)節(jié)，符合人體頭面部生理結(jié)構(gòu)，增加了患者手術(shù)過程中的舒適度；縮短了患者的住院天數(shù)，同時(shí)減輕了患者的經(jīng)濟(jì)負(fù)擔(dān)；較好的提高了患者的滿意度；但沒有從根本上解決患者頭面部壓瘡問題。改良的俯臥位頭架是一種臨床應(yīng)用效果較好的頭部保護(hù)方式。
[Abstract]:Pressure ulcers also called pressure ulcer (PU) is one of the common complications, clinical [1]. European Pressure Ulcer Advisory Panel (EPUAP) [2], up to 18% of patients hospitalized for bedsore, the domestic rate of pressure ulcer was 2.5% ~ 15%, the position of head and face pressure ulcer incidence rate is 2.5% ~ 8.8%, even up to 11.6%. the head and face of pressure ulcers, not only bring pain to patients, and reduce their quality of life, pressure ulcer prolonged does not heal, causing serious infections, even life-threatening systemic failure 3. Posterior spinal surgery in prone position is the most commonly used position [4]. spinal surgery due to surgical wounds, long operation time, if improper operation position or protective measures are not appropriate, in the operation process in the long time of patient harm [5]. therefore, use head face protection right out is the main means to prevent the prone position surgery in patients with head and face pressure ulcer occurred. The head and face protection gauge is limited, can not be well according to the individual differences in facial make flexible adjustment agreement to protect patients with facial skin better. Therefore, we make in-depth research on the basis of traditional facial protection out on the modified and through experimental research by card. Comparison shows that: the application of modified head posterior spinal surgery, can reduce the incidence of facial pressure sores; can promote the development of clinical protection frame; at the same time also can provide more valuable reference for the prevention of pressure ulcers in clinical practice.
Research purposes: through comparing the incidence of head and face pressure sores in two groups of surgical patients, we discussed the application effect of modified head and face protector in prone position posterior spinal surgery, and the impact on postoperative incidence of head and face complications.
Research methods: randomized grouping, from August 2012 - December 2013 in patients who underwent posterior spinal surgery in spinal surgery in Japan Union Hospital, a total of 160 cases. According to the inclusion and exclusion criteria will be selected 160 patients were randomly divided into experimental group and control group. 80 cases in the experimental group, and the success of anesthesia head, face, eyelid to take protective measures, the use of the improved prone position of head and face protection bracket; the control group of 80 cases, the success of anesthesia and head, face, eyelid to adopt the conventional nursing protective measures, the use of traditional operation room followed the "horseshoe" head and face support. Two groups of patients were all used preoperatively "the operation of pressure ulcer risk assessment table (Braden) >, < the postoperative facial skin damage assessment table > to evaluate two groups of surgical patients with facial skin condition, satisfaction survey and patients awake from the postoperative.
Results: the experimental group and the control group patients in two groups before the application of < operation pressure ulcer risk assessment table (Braden) > to evaluate the preoperative patients with skin conditions, the experimental group prone to pressure ulcer patients 17; control group prone to pressure ulcer patients. 19 patients in the experimental group and the skin pressure ulcer risk the control group had no significant difference, the difference was not statistically significant (P0.05). The evaluation table to evaluate the status of patients with skin > < surgery of facial skin injury after operation, the experimental group of 12 patients with facial skin lesions, 3 cases of complications of patients; the control group of 27 patients with facial skin lesions, 13 cases of complications of patients; two groups of patients with facial pressure ulcer incidence comparison shows that the experimental group of patients with improved head and face protection frame, pressure ulcer rate was significantly lower than the control group patients with pressure sores horseshoe shaped head and face protection frame occurs The rate, the difference was statistically significant (P? 0.05). The survey of patient satisfaction in two groups after operation: according to the selection criteria, the experimental group 78, control group 66, X2 test was used for statistical analysis, the degree of satisfaction of experimental group was significantly higher than the control group, there were statistically significant differences (P? 0.05).
Conclusion: by comparison, the two groups of patients with pressure ulcer surgery research shows that using the improved prone position headrest after reduction in posterior spinal surgery in patients with head and face pressure ulcer incidence than the existing operation room "horseshoe" head effect is obvious; head part can be improved according to the features of patients with flexible regulation, consistent with physiological structure the face of human head, increase patient comfort during surgery; shorten the hospitalization days, at the same time, reduce the economic burden of the patients; improve patient satisfaction; patients with facial pressure sores but did not solve the problem fundamentally. The improved prone position headrest is a good clinical effect for head protection the way.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473

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