肝移植患者急性压疮发生的危险因素分析

目的 分析肝移植手术后患者发生急性压疮的危险因素,寻找护理切入点.方法 收集2005年1月-2013年9月95例肝移植患者的基本资料,记录术前、术中、术后可能与压疮发生有关的指标,对肝移植患者压疮危险因素进行分析,并评价医护因素对肝移植患者急性压疮发生情况的影响.结果 30例患者于手术当天至术后3d出现皮肤异常,其中手术当天出现皮肤异常患者14例（46.67％）,术后1～3 d分别为9例（30.00％）,5例（16.67％）,2例（6.66％）.30例压疮患者中,发生于骶尾部19例（63.33％）、足跟部9例（30.00％）.不同Braden评分、血清总蛋白、手术时间、失血量、首次下床时间及遵医行为患者压疮发生率差异有统计学意义（x2 /Z值分别为6.338,7.787,4.005,12.960,4.163,6.257;P＜0.05）.医护人员对压疮缺乏认知引起者最多为12例（40.00％）,其次为观察评估频次较少引起者7例（23.33％）.结论 肝移植患者发生急性压疮与Braden评分、血清总蛋白、手术时间、失血量、首次下床时间及遵医行为密切相关,针对上述高危因素制定护理措施,可以降低术后压疮的发生危险.

Analysis on the risk factors of acute pressure ulcer in liver transplantation patients

Objective To analyze the risk factors of acute pressure ulcer in liver transplantation patients after operation to look for the nursing method.Methods Ninety-five liver transplantation patients from January 2005 to September 2013 were chosen,and their basic information were collected,and the indicator associated with the occurrence of pressure ulcer before,during and after the operation were recorded and the risk factors were analyzed,and the effect of medical factors on the incidence of pressure ulcer in patients with liver transplantation were evaluated.Results Thirty patients had the pressure ulcers within three days after operation,and the fourteen cases（46.67%） occurred on the day of operation,and nine （30.00%）,five （16.67%）,two （6.66%） respectively occurred on the first,second and third day of operation.The cases of pressure ulcers occurred in the sacral and heel area were respectively nineteen （63.33%） and nine cases （30.00%）.The differences were found in the incidence rate of pressure ulcers in patients with different the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior （x2/Z =6.338,7.787,4.005,12.960,4.163,6.257,respectively; P 〈 0.05）.The maximum cases of pressure ulcers caused by the lack of cognition were twelve cases （40.00%）,followed by seven cases （23.33%） which caused by the less frequency evaluation.Conclusions The occurrence of acute pressure ulcer is closely related to the score of Braden,the level of serum total protein,the operative time,the blood loss,the first time to get out of bed and compliance behavior,and nursing measures should be taken according to the risk factors to reduce the incidence of pressure ulcer after operation.