A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery

Aims and objectives. In this experimental study, a 4‐cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. Background. Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29·5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure‐reducing devices on the operating room (OR)‐table should reduce the patients’ interface pressure and thus the hazard of skin breakdown. Methods. A randomized controlled trial was performed to test the effect of a 4‐cm thermoactive viscoelastic foam overlay with a water‐filled warming mattress on the OR‐table (test OR‐table) compared with the standard OR‐table (a water‐filled warming mattress, no pressure‐reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. Instruments. The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. Results. The results show that patients lying on the 4‐cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17·6%) than patients on the standard OR‐table without the foam overlay (11·1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. Conclusions. The combination of a 4‐cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. Relevance to clinical practice. Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.     

泡沫敷料加聚氨酯凝胶垫预防手术患者压疮的效果评价

目的 观察泡沫敷料和聚氨酯凝胶垫预防手术压疮的效果.方法 将140例神经外科需放置俯卧位和侧卧位的手术患者随机分为对照组和实验组各70例,对照组术中采用常规处理加海绵垫;实验组术中常规压疮处理运用泡沫敷料加聚氨酯凝胶垫.术后即刻和术后30 min共2次,记录皮肤压疮情况,测量红斑最大直径(cm),并进行分期.术后24h对2组患者进行术后回访,记录压疮情况. 比较2组患者的一般状况及皮肤压疮情况和红斑最大直径.结果 实验组术后即刻、术后30 min、术后24h这3个时间点出现Ⅰ期压疮、Ⅱ期压疮的例数均低于对照组,红斑最大径在3个时间点也显著小于对照组.结论 泡沫敷料加聚氨酯凝胶垫的方法能够有效预防或缓解手术压疮,值得临床推广.     

品管圈对降低手术压疮发生率的效果

目的：探讨应用品管圈降低手术相关压疮发生率的实践效果。方法成立品管圈小组,确定降低手术相关压疮发生率为活动主题,选择2013年5—7月手术患者260例(品管圈活动前组),对手术相关压疮的发生情况进行现状调查。通过设定目标、查找导致手术相关压疮发生的原因,采取有针对性的措施进行持续质量改进。随即对2013年10—12月手术患者282例(品管圈活动后组)手术相关压疮发生情况进行统计。评价实施品管圈活动前后手术相关压疮发生率、手术室护士压疮相关知识掌握情况及手术体位摆放操作规范率等指标。结果品管圈活动后,手术相关压疮发生率由9.3%下降到1.4%,手术室护士压疮知识掌握情况及体位摆放规范度均较品管圈活动前有了明显的改善,差异有统计学意义(P<0.05)。结论品管圈活动对降低手术相关压疮发生率,提高手术室护士理论知识水平和体位摆放规范度均有显著效果,并有助于发挥护士主观能动性,提高科室团队凝聚力和解决问题的能力。     

开胸术围手术期发生压疮的调查分析

目的 通过对胸外科围手术期压疮危险因素的评估,准确及时采取护理措施,预防压疮发生,提高护理质量及患者的生存质量.方法 应用压疮危险因素评估量表对100例开胸术后患者发生压疮的情况及危险因素进行调查,比较相关因素对压疮发生率的影响.结果 单因素分析显示,术前吸烟、白蛋白含量、术后翻身时间延长对压疮发生有显著影响.结论 开胸手术患者是院内压疮发生的高危人群,手术当天至手术后第3天为术后压疮预防的关键时期.     

压疮管理小组在压疮护理中的作用

目的探讨压疮管理小组在压疮护理中的作用。方法成立压疮管理小组,确立管理目标,实施专项理论培训,制订压疮危险评估表和压疮情况报告表,建立管理流程。结果压疮管理小组成立2年内,共收治院外带入压疮患者134例,治愈104例,好转19例,治愈及好转率为91.79%,实现了院内压疮零发生。结论压疮管理小组的建立对压疮护理管理具有积极的督促作用,能为临床护士提供新的理论和方法,有效降低压疮的发生。     

两种防压疮垫在高危压疮患者中应用效果比较

目的:了解两种防压疮垫在高危压疮患者中应用效果,为优选及开发新防压疮设施提供依据。方法:将76例住院卧床患者采用掷硬币法随机分为对照组37例和观察组39例,对照组采用鱼跃YUYUE喷气式防压疮垫,观察组采用雅博9P-046520电动防压疮垫。观察两组头枕部、肩胛部、背部、骶尾部、肘部及足跟平均压强值及肤温。结果:观察组受压部位平均压强值低于对照组(P0.01),受压部位皮肤温度低于对照组(P0.01),压疮发生率低于对照组(P0.05)。结论:使用雅博防压疮垫可更有效地降低受压部位的压强及高危压疮患者压疮发生率,效果优于鱼跃防压疮垫,值得临床推广。     

硅胶凝胶垫预防老年患者手术中压疮的效果

目的探讨硅胶凝胶垫对老年患者手术中压疮的预防效果。方法选取2010年8月-2011年5月在复旦大学附属华东医院行择期手术的老年患者182例,随机分为实验组和对照组各91例。实验组患者在压疮好发部位使用硅胶凝胶垫,对照组患者常规护理,两组手术时间均超过2．5h,观察两组患者压疮的发生情况以及不同手术时间段内压疮的发生情况。结果实验组患者压疮发生率明显低于对照组,尤其对手术时间在3～4h的患者效果显著,两组比较差异有统计学意义。结论手术过程中使用硅胶凝胶垫能有效降低老年患者因体位等因素造成的压疮发生,有利于手术患者的康复。     

An audit of pressure ulcer incidence in a palliative care setting

This article reports a continuous audit of pressure ulcer incidence within a specialist palliative care unit over 2 years. Details of every patient admission were considered (542 patients). Of these, 26.1% were admitted with pressure ulcers while 12.0% developed pressure damage during their stay. The retrospective audit looked at the ulcers developing in the unit and found these patients were older, stayed 12 days longer and more of them died than the average for all patients admitted to the unit. In total, 95.3% were accurately assessed at 'high' or 'very high' risk using the Waterlow (1985) Pressure Sore Risk Assessment Tool and 89.2% of ulcers were Grade 1 or 2 measured using the Stirling Pressure Sore Severity Scale (Reid and Morrison, 1994). Of all developing ulcers, 78.4% were sacral and the position of the tumour, as well as comfort and positioning difficulties were considered most often responsible. Despite this knowledge and many 'improvements' introduced, the incidence did not improve with superficial ulcers often developing in the last days of life.     

两种评估表对脊柱后路手术患者压疮预测效果的比较研究

目的:研究脊柱外科脊柱后路手术患者的压疮发生率,比较Braden和Norton两种评估表对脊柱后路手术患者压疮的预测效果。方法:选取脊柱外科后路手术患者100例,运用两种评估表对其进行测评,在术后的0h、24h和72h分别观察和记录压疮的发生情况,计算各个量表的灵敏度和特异度。结果:压疮发生率为7%,该研究中的患者Braden评估表具有良好的灵敏度和特异性。结论:脊柱后路手术患者压疮的发生率较高,应用Braden评估表可以较好地预测压疮的发生。     

脊柱外科手术后静脉血栓栓塞症自然发生率的临床研究

目的 分析脊柱手术后静脉血栓栓塞症（VTE）的自然发生率,探讨采取干预措施抗凝以预防VTE的必要性;结合文献,分析VTE的发生与手术方式、体位、时间等关系,指导临床改进相关环节.方法 2011年1月至2012年1月收治的接受脊柱手术患者168例,术前进行血常规、凝血指标及双下肢静脉彩超检查.术后复查双下肢静脉彩超.随访时间3个月.如果彩超怀疑深静脉血栓（DVT）,行下肢静脉造影确诊;如果高度怀疑肺栓塞（PE）形成,行肺血管造影确诊.统计患者资料及VTE例数.通过SPSS 11.0软件,利用x2检验、Mann-Whitney检验分析.结果 168例患者中确诊VTE1例,无PE病例.脊柱手术后VTE自然发生率为0.60％.尝试分析VTE阳性组与阴性组在性别、年龄、体重、手术时间、部位、入路、失血量、卧床时间等方面是否存在统计学差异.但由于VTE阳性例数少,随机性大,未能进行分析.结论 本次研究结果与文献报道类似,显示脊柱手术围手术期不采用抗凝措施下,VTE自然发生率较低;脊柱手术后对于无VTE症状以及不存在VTE危险因素的患者不需要行双下肢静脉彩超检查、血管造影检查以及常规抗凝处理.     

交替性减压体位垫对脊柱手术患者受压皮肤的影响

目的 探讨交替性减压体位垫预防术中压疮的作用.方法 采用随机抽样的方法,收集病例100例,将其分为实验组和对照组各50例.实验组采用自行设计的交替性减压体位垫摆放体位,对照组采用普通体位垫摆放体位.观察主要受压部位皮肤压红、压伤情况,以及应用DZX29型软体压力数字测量仪测量出主要受压部位额部、胸部、髂前上棘的平均压强.比较实验组与对照组的主要受压部位的压红、压伤情况和平均压强.结果 2组主要受压部位压红、压伤情况和平均压强比较,差异明显.结论 交替性减压体位垫能有效减小手术患者主要受压部位的垂直压力,对预防术中压疮有积极作用,但预防压疮仍需采取综合性的措施.     

Silica gel pad nursing intervention for the prevention of pressure ulcers in elderly patients in operation research 陆建平,阎倩,袁洁萍,徐超,蒋芝萍,王岑

目的 探讨硅胶凝胶垫对老年手术患者手术过程中压疮的预防情况。方法 将182例年龄≥80岁、手术时间≥2.5h的患者分层随机分为2组：实验组和对照组,对试验组的患者在压疮好发部位使用硅胶凝胶垫进行干预,对照组进行常规护理。结果 试验组患者压疮发生率明显低于对照组患者。结论 手术过程中使用硅胶凝胶垫进行护理干预能减少老年手术患者压疮的发生,有利于手术患者的康复。     

Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions

AIM: This paper reports a study investigating whether repositioning patients lying on a pressure-reducing mattress alternately for 2 hours in a lateral position and 4 hours in a supine position reduces the incidence of pressure ulcers in comparison with repositioning every 4 hours. BACKGROUND: Repositioning is commonly recognized as an effective preventive measure. Almost no research has been carried out so far on the necessary turning frequencies to prevent pressure ulcer lesions. The pressure is higher in a lateral than in a supine position. METHOD: A two-arm randomized controlled trial was conducted in 16 Belgian elder care nursing homes. Patients with non-blanchable erythema were randomly assigned to either an experimental or a control group. In the experimental group (n = 122), patients were repositioned alternately 2 hours in a lateral position and 4 hours in a supine position. In the control group (n = 113), patients were repositioned every 4 hours. The sitting protocol was identical in both groups. Pressure areas were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. RESULTS: In the experimental group, 16.4% patients developed a pressure ulcer lesion (grade 2-4), while 21.2% did so in the control group. The incidence was not statistically significantly different between the two groups (P = 0.40). The severity (P = 0.65) and location (P = 0.19) of pressure ulcer lesions, and the time to developing them (P = 0.29) were also similar in both groups. No patient developed a pressure ulcer at the hips. A considerable number of patients changed from a lateral to a supine position between the turning intervals. CONCLUSION: More frequent repositioning on a pressure-reducing mattress does not necessarily lead to fewer pressure ulcer lesions and consequently cannot be considered as a more effective preventive measure.     

两种压疮评估表在外科长期卧床患者中的应用效果比较

目的:比较我院自行研制的压疮危险评估量表(SPURAS)与Braden评估量表在外科长期卧床住院患者压疮评估中的应用效果。方法:将我院457例外科住院、丧失下肢行动能力患者随机分为A,B两组,A组(228例)采用外科住院患者SPURAS量表进行评估,B组(229例)采用Braden量表评估,根据评估结果分别给予相应的护理措施。结果:A组实际发生压疮7例,发生率为3.10%;B组实际发生压疮17例,发生率为7.42%,两组比较有统计学意义(P0.05)。结论:SPURAS量表预测外科长期卧床住院患者压疮的效果与Braden压疮评估表比较,SPURAS量表更加直观,易于操作,节省时间,提高效率。     

营养风险对老年住院患者压疮发生的影响

目的 探讨营养风险对老年住院患者压疮发生的影响,为制订针对性营养支持方案提供依据.方法 应用营养风险筛查表(nutritional risk screening 2002,NRS-2002)及相关营养指标对150例神经内科老年住院患者进行营养风险筛查与评估,分析营养风险对老年人压疮发生的影响.结果 有营养风险者86例,压疮发生率为16.67％.无营养风险者64例,压疮发生率为42.67％.营养指标显示血红蛋白(HGB)、血清白蛋白(ALB)、前清白蛋白(PAB)、总淋巴细胞计数(TLC)在有营养风险组较营养正常组有差异.Logistic回归分析有营养风险老年患者压疮的发生率是营养正常者的6.99倍.结论 对老年住院患者进行营养风险筛查,采取积极、合理的营养支持计划与护理干预,可有效降低老年住院患者压疮的发生.     

Elevated preoperative blood pressure predicts the intraoperative loss of SSEP neuromonitoring signals during spinal surgery

Intraoperative neuromonitoring of somatosensory evoked potentials (SSEPs) can allow identification of evolving neurologic deficit. However, SSEP deterioration is not always associated with postoperative deficit. Transient physiologic changes, including a decrease in blood pressure (BP), can result in signal deterioration, defined as a decrease in waveform amplitude of >50 % seen without neurologic deficit. This study examines the relationship between intraoperative BP decrease and SSEP neuromonitoring to determine whether hypertensive patients are more prone to decreases in BP and if such BP declines are associated with signal loss. We conducted a retrospective review of 43 lumbar laminectomy patients at Mount Sinai. Patients were categorized based on whether they had a previous hypertension diagnosis and if they presented with a first systolic BP of greater than 140 mmHg in the admission area on the morning of surgery, two groups that were not mutually exclusive. We measured BP drop by calculating fractional mean arterial pressure (fMAP, lowest MAP/baseline MAP) and change in BP. We identified patients’ SSEP tracings in which signal amplitude decreased >50 %. After dividing patients’ recording times into 5-min epochs, we calculated median MAP and whether SSEPs deteriorated in each epoch. We compared the likelihood of signal loss in hypertensives to patients presenting with elevated BP, calculating the odds ratio. Elevated BP prior to surgery is associated with lower fMAP (p = 0.007) and a larger intraoperative decrease in BP (p < 0.001). A diagnosis of hypertension is not associated with lower fMAP or BP drop. Lower epoch fMAP is associated with signal loss (p = 0.0026). While the presence of preoperative elevated BP predicts SSEP abnormality (p = 0.0039), a diagnosis of hypertension does not. Elevated BP, not a hypertension diagnosis, is associated with intraoperative loss of SSEP signals. This effect of elevated BP on SSEPs may be due to the larger associated intraoperative BP decline.     

Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients

OBJECTIVE: To describe the short-term and long-term effects of a hospital-wide pressure ulcer prevention and treatment guideline on both the incidence and the time to the onset of pressure ulcers in critically ill patients. DESIGN: Prospective cohort study. SETTING: Adult intensive care department of a university medical center. PATIENTS: Critically ill patients (n = 399). INTERVENTIONS: A guideline for pressure ulcer care was implemented on all intensive care units. The attention of nurses for timely transfer to a specific pressure-reducing device was an important part of this guideline. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, demographics, pressure ulcer risk profile at admission, daily pressure ulcer grading, and type of mattress were determined to describe the short-term and long-term effects 3 and 12 months after the implementation. The incidence density of pressure ulcers grade II-IV decreased from 54 per 1000 patient days at baseline to 32 per 1000 days (p = .001) 12 months after the implementation. The median pressure ulcer-free time increased from 12 days to 19 days (hazard rate ratio, 0.58; p = .02). After adjustment for differences in risk factors in a Cox proportional hazard model, the number of preventive transfers to special mattresses was the strongest indicator for the decreased risk of pressure ulcers (hazard rate ratio, 0.22; p < .001). The number needed to treat to prevent one pressure ulcer during the first 9 days was six. CONCLUSIONS: The implementation of a guideline for pressure ulcer care resulted in a significant and sustained decrease in the development of grade II-IV pressure ulcers in critically ill patients. Timely transfer to a specific mattress (i.e., transfer before the occurrence of a pressure ulcer) was the main indicator for a decrease in pressure ulcer development.     

Effects of foam pad balance exercises on cancer patients undergoing chemotherapy: A randomized control trial

BackgroundThis study sought to investigate the effects of foam pad balance exercises on balance, physical performance, peripheral neuropathy symptoms, and quality of life in cancer patients undergoing taxane-based chemotherapy.MethodsThirty cancer patients receiving chemotherapy were randomly divided into 2 groups (n = 15/group): control group (CG) and balance exercise group (BG). The BG were asked to perform foam pad balance exercises 60 min/day, twice/week for 6 weeks, along with conventional therapy. The CG only received conventional therapy. The Fullerton Advanced Balance (FAB) Score, Short Physical Performance Battery (SPPB), Michigan Diabetic Neuropathy Score (MDNS), and Functional Assessment of Cancer Therapy-Taxane (FACT-Taxane) were used to assess balance, physical performance, peripheral neuropathy symptoms, and quality of life, respectively, at baseline and after 4 and 6 weeks of treatment.ResultsAt 4 and/or 6 weeks, the CG showed a decline in FAB and SPPB Scores, while the BG maintained their baseline levels. There were significant differences in the FAB Scores between the groups at the 4th and 6th week (p = 0.04 and p < 0.01, respectively) and significant differences in SPPB Scores at only the 6th week (p = 0.03). MDNS showed no significant changes between or within groups. For FACT-Taxane between groups, the CG and BG showed significant decreases (p < 0.01) and increases (p < 0.01), respectively, at 6th week.ConclusionsFoam pad balance exercises during chemotherapy can be used to alleviate declining balance and enhance physical performance and quality of life of cancer patients.     

Risk factors of pelvic pressure ulcer recurrence after primary skin flap surgery in people with spinal cord injury

Background

Flap surgery for deep pelvic pressure ulcers (PPUs) has been found effective, but the recurrence rate remains high and few risk factors have been identified.

信息-动机-行为技巧模式结合爱立敷泡沫敷料对下肢手术后患者压力性损伤发生率及健康行为的影响

目的 探讨信息-动机-行为技巧模式结合爱立敷泡沫敷料对下肢手术后患者压力性损伤发生率及健康行为的影响。方法 选取2018年12月至2020年12月收治的66例下肢手术患者为研究对象,以抽签法将其随机分为对照组和观察组,各33例。对照组采取常规护理干预,观察组在常规护理基础上同时展开信息-动机-行为技巧模式结合爱立敷泡沫敷料干预。比较两组的干预效果。结果 观察组的压力性损伤、感染发生率均低于对照组,差异具有统计学意义（P<0.05）;两组的下肢深静脉血栓发生率比较,差异无统计学意义（P>0.05）。干预前,两组的身体活动、营养、用药、SER、ESCA评分比较,差异无统计学意义（P>0.05）;干预后,两组的身体活动、营养、用药、SER、ESCA评分均较干预前升高,且观察组高于对照组,差异具有统计学意义（P<0.05）。结论 信息-动机-行为技巧模式结合爱立敷泡沫敷料干预应用于下肢手术后患者中,有助于降低压力性损伤、感染发生率,促进其健康行为养成,提高其自我效能感和自我护理能力。