重症监护室内神经外科气管切开患者颈部皮肤压伤现状及不同方案防治效果

目的 研究神经外科气道切口重症监护室(ICU)患者颈部皮肤压伤现状及不同方案防治效果。方法 选择本院2018年1月-2020年9月诊治的121例神经外科气道切口ICU患者,随机数表法分为A组(40例)、B组(40例)和C组(41例),其中A组患者切口给予衬垫纱布固定,B组患者切口给予粘贴水胶体敷料,C组患者切口给予衬垫泡沫敷料。比较三组患者颈部皮肤损伤发生率,并分析其损伤原因；评估三组患者皮肤损伤严重程度、瘢痕评分、颈部运动度以及颈部皮肤感觉功能。结果 C组患者皮损发生率明显低于A、B组(P＜0.05),且发生原因主要为衬垫与皮肤的摩擦力和剪切力、切口敷料吸收能力差、敷料更换不频繁、切口渗液、患者营养差、水肿以及患者对敷料过敏；C组患者皮肤损伤严重程度明显低于A、B组,差异有统计学意义(P＜0.05)；C组患者瘢痕色泽、厚度、血管分布以及柔软度评分均显著低于A、B组(P＜0.05)；三组患者颈部前屈、向健侧侧屈、向患侧侧屈和向患侧旋转活动度比较无显著差异(P＞0.05),但C组患者颈部后仰、向健侧旋转活动度显著高于A、B组(P＜0.05)；三组患者疼痛评分以及感觉丧失发生率比较无显著差异(P＞0.05)。结论 神经外科气管切开术在一定程度上会造成患者颈部皮肤损伤,但通过泡沫敷料、水胶体敷料以及纱布均具有一定的预防效果,其中以泡沫敷料预防效果最好,可减少颈部皮损发生率,减轻皮肤损伤程度,同时促进瘢痕以及颈部运动功能恢复。

Current status of cervical skin pressure ulcer in ICU patients undergoing neurosurgical tracheotomy and the control effect of different treatments

Objective To study the current status of cervical skin pressure ulcer in patients undergoing neurosurgical tracheotomy in intensive care unit (ICU) and the control effect of different programs. Methods A total of 121 patients undergoing neurosurgical tracheotomy in ICU of the hospital between January 2018 and September 2020 were enrolled. They were divided into group A (40 cases), group B (40 cases) and group C (41 cases) by random number table method. Incisions of the three groups were fixed with padded gauze, hydrocolloid dressings, and padded foam dressings, respectively. The incidence of cervical skin pressure ulcer was compared among the three groups, and the causes of ulcer were analyzed. The severity of skin injury, scar scores, cervical motion and sensory function of cervical skin in the three groups were assessed. Results The incidence of skin lesions in group C was significantly lower than that in group A and group B (P<0.05). The main causes included the friction and shear force between pad and skin, poor uptake ability of incision dressings, infrequent dressing change, incision exudate, poor nutrition, edema, and allergies to dressings. Skin injury in group C was significantly milder than that in group A and group B (P<0.05). The scores for scar color, thickness, blood vessel distribution and softness in group C were significantly lower than those in group A and group B (P<0.05). No significant differences were found among the three groups in terms of neck flexion, lateral flexion to the uninvolved side, flexion to the affected side, and rotation to the affected side (P>0.05), but the ranges of neck extension and rotation to the healthy side in group C were significantly greater than those in group A and group B (P<0.05). There were no significant differences in the pain score and sensory loss among the three groups (P>0.05). Conclusion Neurosurgical tracheotomy can cause cervical skin injury to a certain extent. Foam dressing, hydrocolloid dressing and gauze have certain preventive effects, and foam dressing has the best preventive effect, which can reduce the incidence and severity of cervical skin injury while promoting the recovery of scars and cervical motor function.