骨科手术患者压力性损伤发生的危险因素及前瞻性护理对策

胡敏岚

[关键词] 骨科手术;压力性损伤;危险因素;护理对策

[中图分类号] R473.6           [文献标识码] B          [文章编号] 1673-9701（2021）18-0167-04

Risk factors of pressure injury in orthopedic surgery patients and prospective nursing strategies

HU Minlan

Department of Anesthesiology， Hubei 672nd Integrated Chinese and Western Medicine Orthopaedic Hospital， Wuhan 430070， China

[Abstract] Objective To explore the risk factors of pressure injury in orthopedic surgery patients， and to propose prospective nursing strategies. Methods The clinical data of 120 orthopedic surgery patients admitted to Hubei 672nd Integrated Chinese and Western Medicine Orthopaedic Hospital from January 2017 to January 2019 were retrospectively analyzed. They were divided into the pressure injury group （case group） and the non-pressure injury group according to whether there was pressure injury. The incidence of stress injury was calculated， and its risk factors were analyzed. Results The incidence of pressure injury in this group was 20.0% （24/120）. There were statistically significant differences between two groups in age， BMI， surgical site，surgical position， surgical time， intraoperative hypothermia， nature of protective materials，intraoperative percussion， intraoperative traction， and use of orthopedic medical devices（P<0.05）. Multivariate logistic regression analysis found that age，BMI，intraoperative hypothermia， percussion， traction， bone medical equipment，and surgical position were the risk factors that affected the occurrence of pressure injury in orthopedic patients（P<0.05）. Conclusion The incidence of pressure injuries in orthopedics patients is relatively high， and there are many influencing factors. Interventions should be made for controllable high-risk factors to reduce the occurrence of pressure injuries.

[Key words] Orthopedic surgery; Pressure injury; Risk factors; Nursing strategy

壓力性损伤是一种组织破溃和坏死[1]，多位于骨隆突处，可表现为完整皮肤或开放性溃疡，可能会伴有疼痛感。骨科手术是术中压力性损伤的危险因素之一，其发生风险要高于综合手术。据相关报道[2]，成人骨科手术患者的压力性损伤发生率为9.56%。术中压力性损伤的出现不仅影响手术的疗效，而且增加医疗费用、社会和家庭照顾者的痛苦和负担，严重者可发生感染导致死亡。压力性损伤属于典型的慢性伤口，愈合起来具有一定的难度，因此，必须积极预防骨科手术患者术中压力性损伤的发生。本研究回顾性分析湖北六七二中西医结合骨科医院2017年1月至2019年1月收治的120例骨科手术患者的临床资料，对压力性损伤的危险因素进行分析，以期为护理对策的制定提供依据，现报道如下。

1 资料与方法

1.1  一般资料

选取湖北六七二中西医结合骨科医院收治手术患者120例，其中男69例，女51例。年龄<75岁者75例，≥75岁者45例。纳入标准：①年龄≥18岁;②术前皮肤正常;③择期手术患者;④首次进行手术治疗者;⑤意识清楚、认知正常;⑥既往能够正常走路;⑦ASA评分1～2级[3];⑧预计手术时间>3 h，全身麻醉;⑨临床资料完整。排除标准：①合并糖尿病者;②病理性骨折;③合并恶性肿瘤者;④既往压力性损伤史者;⑤局麻手术者;⑥严重的肝肾功能不全、心脑学血管疾病者;⑦严重的精神心理疾病，不能配合一般资料收集者;⑧多发性创伤者。

1.2 方法

1.2.1 一般資料的收集方法  根据研究目的，通过查阅文献[5-6]，结合科室专家意见，设计骨科手术患者压疮危险因素调查问卷，对患者术前、术中、术后相关指标进行收集。……