成人开颅手术压疮的风险因素研究  

Risk Factors for Pressure Ulcers in Adult Patients Undergoing Craniotomy

作　　者：宋文静[1] 管晓萍[2] 李蓉[2] 张利岩[2] 

机构地区：[1]辽宁医学院,辽宁省锦州市121001 [2]北京武警总医院

出　　处：《中国全科医学》2015年第11期1270-1273,1279,共5页Chinese General Practice

摘　　要：目的探讨成人开颅手术压疮的风险因素,为临床护理工作者科学筛选手术压疮的高危人群,制定预防手术压疮的有效措施提供依据。方法选取2014-03-10至2014-05-10在北京武警总医院神经科学研究所住院并接受开颅手术的成人患者124例。采用临床病例资料回顾性分析的方法,收集研究对象的年龄、性别、体质指数、糖尿病史、术前血红蛋白水平、术前意识状况及肢体活动力、手术时间、术中体位、美国麻醉医师协会(ASA)身体状况分级、术中皮肤护理措施、是否急诊手术、术后皮肤状况等资料。根据患者出手术室时皮肤是否出现压红或压疮分为压疮组和对照组,对两组上述指标进行单因素及多因素Logistic回归分析,得出手术压疮的风险因素。结果压疮组56例,对照组68例。两组患者年龄、体质指数、术前血红蛋白、性别、术中体位比较,差异均无统计学意义(P>0.05);两组手术时间、糖尿病史、意识状况、肢体活动力、ASA分级、术中皮肤护理措施和急诊手术比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,手术时间≥4.0 h、有糖尿病史是成人开颅手术压疮的危险因素(P<0.05)。结论临床护理工作中应注重科学筛选手术压疮的高危人群,手术时间≥4.0 h、有糖尿病史是成人开颅手术压疮的危险因素,应采取针对性干预措施,预防为主,防治结合,以提高手术压疮防控的护理质量。Objective To investigate the risk factors for pressure ulcers in adult patients undergoing craniotomy and to provide a reference for effective precaution. Methods This study enrolled 124 adult patients who were admitted into Neuroscience Institute of General Hospital of Armed Police Force and received craniotomy from March 10 to May 10 in 2014. The clinical data of the 124 patients were retrospectively analyzed, including age, gender, BMI, diabetes history, preoperative hemoglobin level, preoperative consciousness and body mobility, length of operation, intraoperative decubitus, grading of physical state by standard of ASA,intraoperative skin care,being emergency operation or not and postoperative skin status. This study allocated patients into PU group and control group based on whether pressed red or pressure ulcers appear when craniotomy finished. Univariate and multivariate Logistic regression analyses were conducted to compare the indicators mentioned above between the two groups to find out the risk factors. Results PU group had 56 patients,and control group 68 patients. Age,BMI,preoperative hemoglobin level,gender,intraoperative decubitus were not significantly different between the two groups（ P〈0. 05）; length of operation,diabetes history,consciousness,body mobility,ASA grading,skin care,and being emergency operation or not were significantly different between the two groups（ P〈0. 05）. The multivariate Logistic regression analysis showed that operation length ≥4. 0 h and diabetes history were risk factors（ P〈0. 05）. Conclusion Patients with operation length ≥4. 0 h and diabetes history are at high risk of pressure ulcers due to craniotomy. In clinical nursing, these patients should be identified and receive precaution in order to curb pressure ulcers from happening.

关 键 词：成人患者 开颅手术 手术压疮 皮肤护理 

分 类 号：R619[医药卫生—外科学]