本文關(guān)鍵詞： 凝膠減壓墊 壓瘡 困于輪椅的老年人 經(jīng)皮血氧分壓　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過使用更加客觀的指標(biāo),探討凝膠減壓墊在預(yù)防困于輪椅的老年人坐骨結(jié)節(jié)壓瘡中的作用及這一人群更換體位的較好時間。方法:采用自身前后對照試驗設(shè)計,以32名需要使用輪椅且無法自主更換體位的老年人為研究對象。首先協(xié)助研究對象側(cè)臥位,評估其骶尾部皮膚完整情況,然后采用激光多普勒儀Peri Flux5000測試其未受壓側(cè)坐骨結(jié)節(jié)處經(jīng)皮血氧分壓(Transcutaneous Oxygen Pressure,Tc PO2)、激光多普勒血流灌注(Laser Doppler Perfusion,LDP)情況獲得基線值;使用紅外測溫儀測試相同部位皮膚表面溫度獲得皮溫基線值。其次,協(xié)助研究對象坐于放置有凝膠減壓墊的標(biāo)準(zhǔn)輪椅上,30分鐘后再次側(cè)臥位(同基線值測量時的體位),采用相同儀器及方法,評估其坐骨結(jié)節(jié)受壓后局部皮膚變化情況、測量受壓后同一部位經(jīng)皮血氧分壓、激光多普勒血流灌注和皮溫,獲得測量值。第三,讓研究對象充分休息24小時后,在同一時間段和環(huán)境下,重復(fù)測試基線值的步驟,獲得第二次基線值;然后協(xié)助研究對象坐于標(biāo)準(zhǔn)醫(yī)用輪椅上,30分鐘后重復(fù)測量值步驟,獲得標(biāo)準(zhǔn)輪椅使用后的測量值。所有數(shù)據(jù)錄入SPSS21.0進行統(tǒng)計分析。結(jié)果:(1)32例研究對象平均年齡為82.09±8.77歲,其中男性13例,占40.6%;女性19例,占59.4%。伴隨高血壓、冠心病、糖尿病的研究對象分別占56.3%,37.5%和34.3%;(2)32名研究對象使用放置有凝膠減壓墊的標(biāo)準(zhǔn)輪椅后Tc PO2值為40.75±16.40mm Hg,使用標(biāo)準(zhǔn)輪椅后Tc PO2值35.06±16.67mm Hg,前后比較差異具有統(tǒng)計學(xué)意義(P=0.005);使用放置有凝膠減壓墊的醫(yī)用輪椅后LDP值為5.50(3.25,9.00)PU,使用標(biāo)準(zhǔn)輪椅后LDP值為6.00(4.25,8.75)PU,差異無統(tǒng)計學(xué)意義(P=0.621);(3)研究對象在使用放置有凝膠減壓墊的標(biāo)準(zhǔn)輪椅后其坐骨結(jié)節(jié)處皮膚表面溫度(31.16±1.70)℃低于使用未放置減壓墊的標(biāo)準(zhǔn)輪椅后相同部位皮膚表面溫度(32.06±1.87)℃,差異有統(tǒng)計學(xué)意義(P=0.01);(4)參與本研究的32個研究對象中,有6人在使用放置有凝膠減壓墊的標(biāo)準(zhǔn)輪椅和未放置凝膠減壓墊的標(biāo)準(zhǔn)輪椅30min后,骶尾部均出現(xiàn)了非蒼白性紅斑;有12人在使用標(biāo)準(zhǔn)輪椅后出現(xiàn)了非蒼白性紅斑,但其使用放置有凝膠減壓墊的輪椅后未出現(xiàn)皮膚異常,差異有統(tǒng)計學(xué)意義(P=0.024);(5)32名研究對象中,有8人在使用凝膠減壓墊和標(biāo)準(zhǔn)輪椅30min后,Tc PO2均未恢復(fù)至基線值;有17人在使用標(biāo)準(zhǔn)輪椅后Tc PO2未恢復(fù)至基線值,但其使用放置有凝膠墊的輪椅后Tc PO2恢復(fù)至基線值,有5人在使用凝膠減壓墊和醫(yī)用標(biāo)準(zhǔn)輪椅后Tc PO2均恢復(fù)至基線值,以上結(jié)果對比,差異無統(tǒng)計學(xué)意義(P=1.000)。結(jié)論:凝膠減壓墊能降低困于輪椅的老年人受壓部位皮膚表面溫度,同時能在一定程度上改善受壓組織微循環(huán),但是不能使組織的微循環(huán)在解壓后得到完全恢復(fù)。因此,在照顧受困于輪椅的老年人時,不能過分依賴凝膠減壓墊來預(yù)防壓瘡的發(fā)生。在凝膠減壓墊使用后30分鐘內(nèi),仍然存在研究對象出現(xiàn)壓之不褪色的非蒼白性白斑(I期壓瘡)、Tc PO2降低且未恢復(fù)的情況,因此在照顧受困于輪椅的老年人時,應(yīng)盡量減少其坐位的時間。使用凝膠減壓墊來預(yù)防這一人群的壓瘡發(fā)生時,至少應(yīng)每30分鐘更換體位一次。
[Abstract]:Objective: through the use of a more objective index of good gel pad in the prevention of decompression time trapped in the wheelchair elderly ischial tuberosity of pressure ulcers in this population and change posture. Methods: using the self control study, 32 need to use the wheelchair and cannot change posture of elderly people as the research object first. To assist the research object of lateral position, evaluate the sacrococcygeal skin condition, then by using the laser Doppler instrument Peri Flux5000 test the compression side sciatic nodules by percutaneous oxygen partial pressure (Transcutaneous Oxygen Pressure, Tc PO2), laser Doppler perfusion (Laser Doppler, Perfusion, LDP) to get the baseline value; infrared thermometer test the same skin surface temperature to obtain baseline temperature. Secondly, the research object is placed to assist to sit in the wheelchair cushion on the standard gel, again after 30 minutes Lateral position (with the baseline measurement of the body), using the same instrument and method of evaluating the changes of local skin the ischial tuberosity after compression, compression of measuring the same part of percutaneous oxygen partial pressure, laser Doppler perfusion and skin temperature, the value obtained. Third, make the research object fully after 24 hours of rest, at the same time and environment, the test of baseline steps repeat second times the baseline value; then assist the research object sitting in standard medical wheelchair, 30 minutes after repeated measurement steps, measurement standard wheelchair after use value. All the data into SPSS21.0 for statistical analysis. Results: (1) 32 subjects with an average age of 82.09 + 8.77 years, among which 13 cases were male, accounting for 40.6%; 19 cases of female, accounting for 59.4%. with hypertension, coronary heart disease, study diabetes accounted for 56.3%, 37.5% and 34.3%; (2) the 32 subjects are placed using coagulation Standard rubber pad Tc after decompression wheelchair PO2 = 40.75 + 16.40mm Hg, Tc PO2 35.06 + 16.67mm Hg value using a standard wheelchair, with statistical significance difference (P=0.005); the use of medical wheelchair placed gel pad after decompression LDP value was 5.50 (3.25,9.00) PU, using the standard LDP value for wheelchair 6 (4.25,8.75) PU, the difference was not statistically significant (P=0.621); (3) the research object put standard wheelchair with gel pad in the decompression after using the ischial tuberosity skin surface temperature (31.16 + 1.70) degrees lower than the standard wheelchair use not placed after the same skin decompression pad surface temperature (32.06 + 1.87) C, the difference was statistically significant (P=0.01); (4) of 32 subjects participated in this study, there are 6 people in the use of 30min standard wheelchair wheelchair put standard gel pad and decompression without placing a gel pad after decompression, sacrococcygeal showed non pale erythema; There are 12 people in the use of standard wheelchair after the emergence of non pale erythema, but its use is placed in a wheelchair cushion gel without skin abnormalities, the difference was statistically significant (P=0.024); (5) the 32 subjects, there were 8 people in the use of gel pad and decompression standard wheelchair after 30min, Tc PO2 were not restored to the baseline value; there are 17 people in the use of standard wheelchair after Tc PO2 not return to baseline values, but its use is placed in a wheelchair gel pad Tc PO2 returned to the baseline level, there are 5 people in the use of gel pad and medical standard after decompression Tc PO2 wheelchair recovered to baseline values, the above results contrast, the difference was not statistically significant (P=1.000). Conclusion: the gel cushion can reduce compression skin surface temperature of elderly people trapped in a wheelchair, and can improve the compression of microcirculation in a certain extent, but not so in the microcirculation after decompression to fully recover. Therefore, In the care of elderly people trapped in a wheelchair, can not rely too much on the gel cushion to prevent pressure ulcer. In the gel cushion use after 30 minutes, there are still research object of the pressure does not fade non pale white spots (Tc PO2, stage I) and did not reduce the recovery, so take care of the old man trapped in a wheelchair, should minimize its seat time. The use of gel cushion to prevent this population pressure, at least every 30 minutes to replace the position again.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R472

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本文編號：1538599