本文選題：強迫側(cè)臥位 + 強迫俯臥位�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:通過對臨床手術(shù)患者受壓部位預(yù)防性使用賽膚潤和減壓貼,探討賽膚潤和減壓貼聯(lián)合使用在術(shù)中壓瘡預(yù)防中的效果;探討手術(shù)中強迫側(cè)臥位、俯臥位手術(shù)患者壓瘡發(fā)生高度危險因素,從而為預(yù)防和降低手術(shù)中壓瘡發(fā)生率提供依據(jù)。方法：本研究是隨機對照試驗,選取2016年4月1日至2017年1月31日在某三級大型甲等綜合醫(yī)院進行擇期手術(shù)的800例患者進行調(diào)查,使用隨機數(shù)字表法將患者分為試驗組和對照組,兩組各400例。參照Waterlow壓瘡危險因素評估表,制定手術(shù)患者壓瘡高危因素調(diào)查表,對患者進行調(diào)查。對照組受壓部位使用減壓貼,試驗組涂抹賽膚潤后貼減壓貼,在手術(shù)結(jié)束后30分鐘內(nèi)、術(shù)后24小時進行評估受壓部位皮膚狀況,記錄無壓瘡、Ⅰ期壓瘡、Ⅱ期壓瘡的轉(zhuǎn)變或轉(zhuǎn)歸的例數(shù),查找手術(shù)患者的壓瘡高危因素。調(diào)查對象的一般資料采用頻數(shù)與百分比進行統(tǒng)計描述;將所有資料使用Excel2007進行數(shù)據(jù)錄入,應(yīng)用SPSS21.0軟件進行統(tǒng)計分析,采用χ2檢驗比較對照組和試驗組在壓瘡發(fā)生率的差異,采用Logistic多元回歸分析探討壓瘡發(fā)生的高度危險因素,顯著性水平以P0.05表示有統(tǒng)計學(xué)意義。結(jié)果:1.本研究共收集800例側(cè)臥位、俯臥位手術(shù)患者資料,其中對照組患者400例,側(cè)臥位305(76%)例,俯臥位95(24%)例;16例患者術(shù)后發(fā)生了壓瘡,發(fā)生率為4%,其中Ⅰ期壓瘡11(69%)例,Ⅱ期患者5(31%)例,壓瘡好發(fā)部位為下頜部、顴骨隆突、髂前上棘和髂骨處,5(31%)例Ⅰ期壓瘡手術(shù)后24小時觀察紅斑消失,6(37.5%)例Ⅰ期壓瘡24小時出現(xiàn)水泡,轉(zhuǎn)為Ⅱ期壓瘡。試驗組患者400例,側(cè)臥位309(77%)例,俯臥位91(23%)例;6例患者發(fā)生了壓瘡,發(fā)生率為1.5%,其中Ⅰ期壓瘡4(67%)例,Ⅱ期患者2(33%)例,壓瘡好發(fā)部位為下頜、顴骨隆突處,皮膚出現(xiàn)異常的時間在手術(shù)后30分鐘,其中Ⅰ期壓瘡2例,術(shù)后24小時后皮膚恢復(fù)正常。2.通過單因素分析,試驗組患者壓瘡發(fā)生率低于對照組,有顯著差異(P0.05)。賽膚潤和減壓貼聯(lián)合使用對術(shù)中壓瘡預(yù)防有效。3.通過Logistic多元回歸分析進行非條件多因素分析,選出體重指數(shù)、術(shù)前血紅蛋白、手術(shù)時間是手術(shù)中患者壓瘡發(fā)生的高度危險因素,體重指數(shù)16.0≤BMI≤17.5或27.0≤BMI≤30.0、BMI16.0或BMI30相對于18.5-23.9來說,對壓瘡發(fā)生有影響,OR分別為9.114和11.185,說明體重指數(shù)≤17.5或≥27是壓瘡發(fā)生的危險因素。術(shù)前血紅蛋白60g/L、60-90g/L、90-110g/L相對于110g/L來說,對壓瘡發(fā)生均有影響,OR值分別為42.909、11.903和8.859,說明術(shù)前血紅蛋白小于110g/L是壓瘡發(fā)生的危險因素,且術(shù)前血紅蛋白越低,發(fā)生壓瘡的危險性越高。手術(shù)時間3-5h和5h相對于1-3h來說,對壓瘡發(fā)生有影響,OR值分別為32.418和40.314,說明手術(shù)時間大于3h是壓瘡發(fā)生的危險因素,且手術(shù)時間越長,壓瘡發(fā)生危險性越高。結(jié)論:1.體重指數(shù)≥27或≤17.5、術(shù)前血紅蛋白小于110g/L、手術(shù)時間大于3h是壓瘡發(fā)生的危險因素,且術(shù)前血紅蛋白越低,手術(shù)時間越長,壓瘡發(fā)生危險性越高。2.賽膚潤和減壓貼聯(lián)合使用,能夠降低側(cè)臥位、俯臥位手術(shù)壓瘡的發(fā)生率,對手術(shù)壓瘡預(yù)防有效果。3.術(shù)前有效評估壓瘡發(fā)生高度危險因素,采取正確預(yù)防措施,可以有效降低術(shù)后患者壓瘡的發(fā)生率。
[Abstract]:Objective: To explore the effect of the combined use of skin moisturizing and decompression paste in the prevention of pressure sore in the operation, and to explore the high risk factors for pressure sore in patients with strong forced lateral position and prone position in operation, so as to provide a basis for preventing and reducing the incidence of pressure sore in the operation. Methods: This study was a randomized controlled trial. A total of 800 patients undergoing elective surgery in a three class large class a general hospital from April 1, 2016 to January 31, 2017 were investigated. The patients were divided into the experimental group and the control group, and the two groups of 400 cases were divided into two groups. The surgical patients were formulated with reference to the risk factors assessment of Waterlow pressure sore. The patients in the high risk factors of pressure sore were investigated. The compression sites in the control group were applied with decompression paste, and the experimental group was smeared with skin pressure post on the skin after 30 minutes after the operation, and 24 hours after the operation to assess the skin condition of the compression site, and record the number of non pressure sores, stage I pressure sore, stage II pressure sore change or outcome, and find surgical patients. The high risk factors of pressure sore. The general data of the subjects were described by frequency and percentage; all the data were recorded by Excel2007, and SPSS21.0 software was used for statistical analysis. The difference of the incidence of pressure ulcers in the control group and the test group was compared by the x 2 test, and the Logistic multivariate regression analysis was used to explore the pressure sore hair. A total of 800 cases of lateral position and prone position were collected in 1. studies, including 400 cases in the control group, 305 (76%) in the lateral position, 95 (24%) in the prone position, and 16 patients with pressure sore in 4%, of which stage I pressure sore 11 (69%), stage II suffering. In 5 (31%) cases, the good location of the pressure sore was the mandible, the zygomatic protuberance, the anterior superior iliac spine and the iliac bone, and the erythema disappeared in the 24 hour after the 5 (31%) stage I pressure sore operation. 6 (37.5%) stage I pressure sore appeared for 24 hours and turned to stage II pressure sore. In the experimental group, 400 cases, 309 (77%) cases in the lateral decubitus, 91 (23%) cases in the lateral decubitus, and the occurrence of pressure sore in the patients in the patients were occurred. The rate was 1.5%, including 4 (67%) cases of pressure sore in stage I, 2 (33%) patients in stage II. The good location of pressure sore was mandible, malar protuberance and abnormal skin time in 30 minutes after operation, of which 2 cases of pressure sore in stage I, after 24 hours after operation, the skin was restored to normal.2. through single factor analysis, the incidence of pressure sore in the test group was lower than that of the control group, there was significant difference (P 0.05). The combined use of skin moisturizing and decompression paste to prevent the effective.3. through the Logistic multivariate regression analysis for non conditional multifactor analysis, select body mass index, preoperative hemoglobin, operation time is a high risk factor for the occurrence of pressure sore in the operation, the weight index is 16 less than BMI less than 17.5 or 27 less than BMI < 30, BMI16.0 or BMI30 Relative to 18.5-23.9, the incidence of pressure sores was affected, OR was 9.114 and 11.185, respectively, which indicated that BMI < 17.5 or 27 was a risk factor for pressure ulcers. Preoperative hemoglobin 60g/L, 60-90g/L, 90-110g/L had an influence on the occurrence of pressure sore, OR value was 42.909,11.903 and 8.859, indicating that hemoglobin was less than 1 before operation. 10g/L is a risk factor for the occurrence of pressure sore, and the lower the hemoglobin before operation, the higher the risk of pressure sore. The operation time 3-5h and 5h have an influence on the pressure sore, OR value is 32.418 and 40.314 respectively, indicating that the operation time is greater than 3H is the risk factor of pressure sore, and the longer the operation time, the higher the risk of pressure sore. Conclusion: the 1. body mass index is more than 27 or less than 17.5, the preoperative hemoglobin is less than 110g/L, the operation time is more than 3H is the risk factor of pressure sore, and the lower the hemoglobin, the longer the operation time, the higher the risk of pressure sore, the more.2. skin moisturizing and the combined use, it can lower the lateral position, the incidence of pressure sore in the prone position, the operation pressure on the operation pressure. .3. is effective in evaluating the high risk factors of pressure ulcers. Proper preventive measures can effectively reduce the incidence of pressure ulcers.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R472.3

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