The Application Value Of Transcutaneous Oxygen/carbon Dioxide Pressure Monitoring In The Early Warning Of Emergency Patients With Pressure Ulcers

ObjectivesTranscutaneous oxygen pressure(TcPO2)and transcutaneous carbon dioxide pressure(TcPCO2)have a number of applications in the area of emergency medicine.This research aims to explore the application value of these two in monitoring in early warning emergency patients with pressure ulcers,analyze the relevant factors of early warning emergency patients with high risk of acute sores.Moreover,this paper attempts to implement the coefficient of transcutaneous oxygen pressure(TcPO2 CV)to predicate the risk of sores.MethodsThis research is based on the consecutive emergency patients who were under care in the emergency department of Qilu Hospital of Shandong University during March 2017 to June 2017.Emergency patients over 18 years old,who signed the informed consent and did not suffer from pressure ulcers,are included in the dataset.The patients suffering from burn injury or skin diseases and patients developing sores in 2 hours after being observed are excluded.The basic data of patients involved includes age,Body Mass Index(BMI),gender,smoking history,observing time,Braden Risk Assessment Scale,Waterlow's Pressure Ulcer Scale,Norton Score,body temperature(?),pulse(beat per minute,bpm),respiratory(rate per minute,rpm),systolic blood pressure(mmHg),diastolic blood pressure(mmHg),average pressure(mmHg),pulse oxygen saturation(%),blood sugar(mmol/L),pH,blood lactic acid(mmol/L),arterial CO2 pressure(mmHg),arterial O2 pressure(mmHg),hemoglobin(g/L),serum albumin(g/L),white blood cell(*109/L),neutrophil(%),lymphocyte(%),potassium(mmol/L),sodium(mmol/L),chloridion(mol/L),Alanine transaminase(IU/L),glutamic-oxalacetic transaminease(IU/L),blood urea nitrogen(mmol/L)and serum creatinine(umol/L).After being observed,these emergency patients were detected the TcPO2 and TcPCO2 immediately.The stable value of TcPO2 and TcPCO2 of were taken as the initial data in 10-15 minutes.In the meanwhile,patients had the blood routine test,serum electrolyte test and arterial blood gas analysis and vital signs,oxyhemoglobin saturation and blood flow detection results were recorded.This research adopted the transcutaneous oxygen/carbon dioxide pressure monitor(TCM4,Radiometer,Denmark).The skin of sacrococcygeal region and intercostal space in the chest were selected as the monitoring point and clean it with rubbing alcohol.According to the operation standard,the sensor would be put on the monitoring point after being calibrated by standard gas.The sensor after 4 hours,continuous service should be changed to prevent the skin from burns since the temperature of the sensor is over 42-44?.This study is carried out with the review and approval of the ethics committee of Qilu Hospital.This research applies a number of data mining techniques through the software,SPSS 19.0.The measurement data is noted by mean ± standard deviation,the count data is expressed by frequency.Measurement data comparison between the two groups chooses t test,the comparison of classification variables applies chi-square test.Linear correlation analysis is implemented to explore the linear relationship between two variables.This research selects binary Logistic regression analysis to correct confounding factors,and calculates the odds ratio(OR)and 95%Confidence Interval(95%CI).Through receiver-operating characteristic curve(the ROC curve),this research calculates the area under the curve(AUC)and Youden's index,determines the cut-off value,and assumes p-value<0.05 is statistically significant.Results1.This database of this study contains 186 patients with emergency care,including 101 males(54.3%)and 85 females(45.7%).In the dataset,There are 157 cases(84.4%)staying in emergency room less than 24 hours,22 cases(11.8%)between 24 to 72 hours,7 cases(3.8%)over 72 hours.11 cases suffer I phase pressure ulcer(5.91%).The single factor analysis indicates that Braden scores(p= 0.002),Norton scores(p<0.001)and Waterlow scores(p = 0,008)are statistically significant in the two groups.2.Braden score is linearly correlated with Norton score and Waterlow score respectively;TcPO2 and TcPCO2 are linearly correlated with arterial blood gas analysis PO2 and PCO2.3.Aaccording to high-risk Braden scale(<15)with low-risk(15 points or higher),the dataset can be divided into two groups.Based on the single factor analysis of two groups patients,the differences of age(66.50 ± 17.23 vs.58.07± 18.63,p = 0.014),temperature(37.02±0.80 vs.36.72 ± 0.65,p =0.023),systolic blood pressure(122.28 ± 22.79 vs.131.09 ± 22.90,p =0.039),the average pressure(89.31 ± 17.61 vs.95.51 ± 16.01,p = 0.042),arterial oxygen pressure(106.58 ±43.67 vs.84.52 ±36.12,p = 0.018),serum albumin(43.09 ±16.20 vs.51.13 ± 16.76,p = 0.023),TcPO2 of chest(89.39 ?24.43 vs.71.32 ± 19.68,p<0.001),TcPO2 of sacrococcygeal region(59.61±21.59 vs.75.26 ±21.61,p<0.001),and TcP02 CV(34.08± 14.74 vs.15.92±18.86,p<0.001)are statistically significant.4.Implementing the logistic regression model with six indicators,TcPO2 CV,age,body temperature,systolic blood pressure,blood oxygen pressure,serum albumin,this research concludes that TcPO2 CV(OR = 64.073,95%CI = 1.171?3505.881,p = 0.042)and arterial blood oxygen pressure(OR ?1.027,95%CI = 1.008?1.048,p = 0.006)are independent risk factors for the development of Braden scale in patients with high risk.5.Based on the maximum corresponding value of the Youden's index,in the subject's working characteristic curve(ROC curve),the AUC is 0.883,and the cut-off value of TcPO2 CV is fixed at 20%.Conclusions1.Braden Risk Assessment Scale,Norton score and Waterlow's Pressure Ulcer Score are correlated with the occurrence of I phase of pressure ulcers during the observing time of emergency patients.Besides,Braden scale is linearly correlated with Norton scale and Waterlow's score.2.TcPO2 CV is an independent risk factor for patients under emergency care to develop pressure ulcers.More than 20%TcPO2CV indicates a high risk of pressure ulcers according to the Braden Risk Assessment Scale,and therefore these patients require intensive care in order to avoid sores.