Study On The Application Of The Risk Assessment Table Of Munro Adult Operating Room Pressure Ulcer In General Anesthesia

Objective:To test the reliability,validity and prediction ability of the Chinese version of Munro adult pressure ulcer risk-assessment scales(Munro scales),Braden scales,Qian Weiming pressure ulcer risk-assessment scales(Qian Weiming scales)on patients with general anesthesia surgery.Analyze the superiority and limitation of Munro scale in clinical application.Methods:Randomly selected 270 patients undergoing general anesthesia from December 2016 to April 2017 in a top three hospital in Anhui Province.Inclusion criteria: Age over 18 years of age,surgical duration longer than 2 hours,no damage to the skin at the site of compression.General patient data and skin conditions were obtained on the day before surgery,three trained investigators used the Munro scale,Braden scale,and Qian Weiming scales to assess pressure ulcers in all selected cases at the beginning of the surgery,at the end of the surgery,and at the anesthesia recovery room.If no occurrence of pressure ulcers was detected,the patients were followed up until the third day.If pressure ulcers were observed,postoperative follow-up continues until the patient was discharged.The reliability,predictive ability,sensitivity,specificity,positive predictive value and negative predictive value were calculated.Results:Total 261 valid cases were selected,of which 35 cases had intraoperative pressure ulcers and the incidence of pressure ulcers was 13.4%.Among them,there were 1 stage II pressure ulcer and the rest were stage I pressure sores.Pressure ulcers occurred at the site of the sacrococcygeal end,which occurred in 28 cases(80.0%).The department with the most pressure sores was cardiac surgery in 13 cases(44.8%).The best critical value of the Munro scales was 8,24.5 and 28.5 at the beginning of the operation,at the end of the operation and at the anesthesia recovery room,respectively.The best critical value of the Braden scale was 18.5,11.5 and 13.5 at the beginning of the operation,at the end of the operation and at the anesthesia recovery room,respectively.The best critical value of Qian Weiming scale was 12.5,13.5 and 13.5 at the beginning of the operation,at the end of the operation and at the anesthesia recovery room,respectively.The area under the ROC curve of the three different scales at the beginning of the operation above was 0.653,0.596,0.652.The area under the ROC curve of the three different scales at the end of the operation above was 0.872,0.548,0.792.The area under the ROC curve of the three different scales at the anesthesia recovery room above was 0.868,0.773,0.813.Three scales were used to assess the risk of pressure ulcers in the surgical patients before,during,and after the anesthesia recovery room.Each scale had an AUC greater than 0.5 for each time period.The Munro scale had the highest AUC in all three time periods,followed by the Qian Weiming e scale,and the Braden scale was slightly inferior to both.Conclusion:Munro scales is more suitable for the assessment of patients’ pressure ulcer risk than the Braden scale and Qian Weiming scales,but the preoperative risk assessment needs to be improved.