加用泡沫敷料预防脊柱术中急性获得性压疮

目的比较压疮垫和术中预防性应用泡沫敷料联合压疮垫在预防脊柱术中急性获得性压疮方面的效果。方法全身情况良好、初次手术治疗的腰椎间盘突出症428例患者随机分为处理组(术中进行常规压疮预防处理并预防性应用泡沫敷料,214例)和对照组(术中仅进行常规压疮预防处理,214例)。出室时,记录髂前上嵴皮肤压疮情况,测量红斑最大直径(cm),并进行分期。术后24h时对两组患者进行术后回访,记录髂前上嵴压疮情况。结果出室时,处理组总体、Ⅰ期和Ⅱ压疮发生率分别为5.1%、3.7%和1.4%,与对照组(16.8%、10.7%和6.1%)比较,差异均有统计学意义(P<0.05);术后24h回访时,处理组总体、Ⅰ期和Ⅱ压疮发生率分别为5.6%、4.2%和1.4%,与对照组(20.1%、12.1%和7.9%)比较,差异均有统计学意义(P<0.01)。出室时及术后24h,两组患者红斑最大直径间差异均有统计学意义(P<0.01)。结论术中联合应用压疮垫和泡沫敷料可有效地降低术中急性获得性压疮的发生率以及严重程度,明显缩小压疮损伤范围,控制术后24h内的进展。

Intraoperative Use of Additional Foam Dressings for Prevention of Acute Acquired Pressures Sores in Spinal Surgeries

Objective To compare the outcomes of acute acquired pressure sores from spinal surgeries between the use of pressure-relieving pads and prophylactic foam dressings combined with the use of pressure-relieving pads.Methods Generally healthy and surgically nave patients with lumbar intervertebral disc dislocation(n=428)were randomly divided into treatment group on routine pressure relief and additional prophylactic use of foam dressings(n=214)and control group on routine pressure relief only(n=214).Pressure sore profiles were recorded and staged on anterior superior iliac spine(ASIS)while the maximum diameters of sore erythema were measured in centimeter on the discharge from OR.Patients were followed up at postoperative 24h to examine the pressure sore profiles of ASIS.Results On the discharge,the overall,stageⅠandⅡ pressure sore rates in treatment group were 5.1%、3.7% and 1.4% respectively,significantly lower than those in control group(16.8%,10.7% and 6.1%); the maximum erythema diameter in treatment group was(2.3±0.3)cm,significantly smaller than that in control group([4.1±0.4]cm).At the follow-up visit of postoperative 24h,the overall,stageⅠandⅡ pressure sore rates in treatment group were 5.6%,4.2% and 1.4% respectively,significantly lower than those in control group(20.1%,12.1% and 7.9%); the maximum erythema diameter in treatment group was(2.2±0.3)cm,significantly smaller than that in control group([4.3±0.3]cm).Conclusion The intraoperative use of foam dressings combined with the pressure-relieving pads effectively decreased the incidence and severity of acute intraoperatively acquired pressure sores,significantly reduced the injured area and controlled the progression of pressure sores within postoperative 24h.