Application of Improved Position Pad in Reducing the Incidence of Pressure Injury in Prone Position
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摘要:
目的 研究应用改良式体位垫降低神经外科俯卧位手术压力性损伤发生的效果。 方法 将2017年9月至2019年3月于昆明医科大学第一附属医院神经外一科就诊，并确诊为后颅窝肿瘤需要手术切除肿瘤的58例患者为研究对象，根据排除标准排除14例不符合该研究原则的患者，纳入44名患者作为该项研究对象，将2017年9月至2018年6月的21例实施后颅窝肿瘤切除而采用俯卧位手术患者设为对照组，采用传统俯卧位方式，运用弓背架进行，头部用三钉头架固定。将2018年6月至2019年3月的23例实施后颅窝肿瘤切除而采用俯卧位手术患者设为实验组，在对照组方法的基础上，实验组摒弃弓背架，采用改良的体位垫进行俯卧位翻身。比较2组患者压力性损伤发生例数、发生率、发生部位数量、程度。 结果 实验组患者PI的发生例数为2 例，发生率为8.69%，发生部位数为11，> NPUAP Ⅰ期例数为0例，与对照组相比压力性损伤发生率明显减低，差异有统计学意义（P < 0.05）。 结论 改良式体位垫运用一种仿绸合成织物技术（silk-like synthetic fabric technology）显著降低了压力性损伤的发生率，值得在临床推广使用。 Abstract:Objective To study the effect of modified position pad on reducing the occurrence of stress injury in prone position of neurosurgery. Methods From September 2017 to March 2019, 58 patients diagnosed as posterior fossa tumor in the first Department of Neurosurgery, the First Affiliated Hospital of Kunming Medical University were selected as the research objects. According to the exclusion criteria, 14 patients who did not meet the research principles were excluded, and 44 patients were included as the research objects. From September 2017 to June 2018, 21 patients with posterior fossa tumor resection in prone position were selected as the control group. They were treated in traditional prone position, and their heads were fixed with three nails. From June 2018 to March 2019, 23 patients with posterior fossa tumor resection who were operated in prone position were selected as the experimental group. On the basis of the control group, the experimental group used the improved body position pad to turn over in prone position. The number of cases, the incidence, the number of parts （the number of patients with PI） and the degree of stress injury were compared between the two groups. Results In the observation group, there were 9 cases of PI, the incidence rate was 42.85%, and the number of occurrence parts was 54, of which 18 cases were concentrated in the anterior chest wall area, and 1 case was > NPUAP stage I; in the experimental group, there were 2 cases of PI, the incidence rate was 8.69%, the occurrence site was 11, and 0 case was > NPUAP stage Ⅰ. Conclusion The improved body position pad uses a silk like synthetic fabric technology to significantly reduce the incidence of pressure injury, which is worthy of clinical application. -
表 1 2组手术患者一般资料比较（ $\bar x \pm s$）
Table 1. Comparison of general data of surgery patients in the two groups （ $\bar x \pm s$）
组别 男（n） 女（n） n 年龄（岁） 体重（kg） 肿瘤大小（mm） 手术时长（h） 对照组 11 10 21 49.27 ± 17.01 55.53 ± 10.69 3.53 ± 1.09 4.23 ± 0.67 实验组 11 12 23 48.65 ± 16.89 56.38 ± 10.47 3.09 ± 1.02 4.16 ± 0.89 t 1.271 2.201 0.587 3.285 P 0.125 0.227 0.754 0.522 
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表 2 2组手术患者发生PI情况比较（n）
Table 2. Comparison of the incidence of PI in the two groups （n）
组别 n PI发生例数 PI发生率（%） > NPUAPI期例数 对照组 21 9 42.85% 1 实验组 23 2 8.69% 0 t 6.235 3.782 −2.104 P 0.004* 0.012* 0.031* *P < 0.05。
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表 3 男性患者PI发生部位数及 > NPUAP I程度（n）
Table 3. The number of sites of PI and > NPUAP I degree in male patients （n）
级别 锁骨 前胸壁 髂骨 会阴区 生殖器 小腿胫前 踝关节 上肢前臂 对照组 2 6 4 1 2 4 3 5 对照组 > NPUAP I 0 1 0 0 0 0 0 0 实验组 0 3 0 0 0 2 1 0 实验组 > NPUAP I 0 0 0 0 0 0 0 0
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表 4 女性患者PI发生部位数及 > NPUAP I程度（n）
Table 4. The number of sites of PI and > NPUAP I degree in female patients （n）
部位 锁骨 前胸壁（乳房） 髂骨 会阴区 小腿胫前 踝关节 上肢前臂 对照组 1 12 7 2 2 2 4 对照组 > NPUAP I 0 0 0 0 0 0 0 实验组 0 3 0 0 1 1 0 实验组 > NPUAP I 0 0 0 0 0 0 0
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