Study On The Relation Between Skin Microclimate And Intraoperative Pressure Injury

Objective:1.Describe the occurrence of intraoperative pressure injuries in patients undergoing spinal surgery in prone position in a tertiary grade-A hospital in Wuhan.2.To explore the changes of microclimate(skin temperature and humidity)in the press area of patients undergoing the surgery.3.To analyze the relation between skin microclimate and intraoperative pressure injury.4.Find out the related risk factors of intraoperative pressure injury in patients undergoing spinal surgery in prone position,and infer the key points of implementing preventive measures,so as to provide scientific basis for effective prevention and reduction of intraoperative pressure injury.Methods:In this study,the convenience sampling method was used to select 99 patients who underwent elective spinal surgery from March 2018 to October 2018 in the surgical operating room of a tertiary grade-A hospital in Wuhan,Hubei Province.A data collection table was established through literature review and group discussion.The table mainly includes the general data of patients,the changes of microclimate in the press area during operation and the occurrence of pressure injury.Data collection is completed by trained and qualified researchers.The general information of patients and laboratory test results were checked and filled in through reviewing the medical records.The temperature and humidity of the skin surface were measured by WTM-2000 wireless temperature monitor and Fiskell skin moisture meter during the operation(2 cm under zygoma and 2 cm in front of anterior superior iliac spine).The body temperature of the subjects was continuously monitored with a body temperature probe(nasopharynx).At the same time,the ambient temperature and relative humidity of the operating room are controlled at 22-24 ? and 50-55%.The temperature of the presse area at the beginning and end of the operation,every 30 minutes within the whole operation period were measured and recorded,and the humidity of thepresse area at the beginning and the end of the operation.The skin condition of patients immediately before and after the operation were assessed and recorded,and the daily tracking of intraoperative pressure injuries was continued until 3 days after operation.Data statistics methods vary according to data types: Chi-square test is used for comparison of counting data;t test or variance analysis is used for comparison of metrological data conforming to orthodox distribution;Mann-WhitneyU test is used for non-orthodox distribution metrological data or grade data.Risk factors associated with intraoperative pressure injury were analyzed by binary logistic regression.Results:1.A total of 99 subjects were studied,10 cases(40 sites)suffered from intraoperative pressure injury,and the incidence of pressure injury was 10.1%.Intraoperative pressure injuries occurred more frequently within 24 hours after the operation.The zygoma and anterior superior iliac spine were the most common sites of pressure injury.Anyhow,all the pressure injury turned out to be well healed.2.Comparison of skin microclimate at different time points?Skin temperature(1)The skin temperature of zygomatic bone and anterior superior iliac spine increased continuously in group A.Two comparisons of temperatures at different time points showed that there were significant differences between the two adjacent time points from the beginning of operation to 2.5h after operation start(P < 0.05);from 2.5 h to 4h after operation start,only the temperatures between 3.5h to 4h,was significantly different,that of the other adjacent time points had no statistical significance(P > 0.05).Anterior superior iliac spine: There were significant differences between the temperatures of two adjacent time points from the operation start to 4h during the operation(P < 0.05);there was no significant difference between the temperatures of 4h to 4.5 h after operation start(P > 0.05).(2)In group B,the skin temperature of zygoma and anterior superior iliac spine continued to rise.Zygoma: The temperature was no significant difference between the two adjacent time points from the operation beginning to 4.5h during the operation(P > 0.05).Anterior superior iliac spine: From the operation start to 2.5h after operation beginning,only thetemperatures between 0.5 h and 1h was statistically significantly different(P < 0.05),that of the other adjacent times had no statistical significance(P > 0.05);From 2.5h to 4h,only the temperatures between 3h to 3.5h was not statistically significantly different,there were significant differences in the temperatures of the other adjacent time points(P< 0.05);Comparisons of the temperatures between 4h to 4.5h after operation start,the difference was not statistically significant(P >0.05).?Skin humidity(1)zygomatic bone: There were significant differences between groups A and B(P < 0.05).(2)Anterior superior iliac spine:There was no significant difference between groups A and B(P > 0.05).3.Inter-group comparison of skin microclimate at press area at the same time point?Temperature comparisons(1)zygomatic bone: There was no significant difference between group A and group B from the beginning of operation to 3h after operation start(P > 0.05);There was significant difference between group A and group B from 3.5 h to4.5 h after operation start(P < 0.05);The change of skin temperature in group B was greater than that in group A,the difference was statistically significant(P < 0.05).(2)Anterior superior iliac spine: From the beginning of operation to 4 h after operation start,there was no significant difference between group A and group B(P > 0.05);At 4.5 h after operation start,there was significant difference between group A and group B(P<0.05);Temperature change in group B was greater than that in group A,the difference was statistically significant(P < 0.05).?Humidity comparisons(1)At the beginning of the operation,there was significant difference between group A and group B(P < 0.05);At the end of the operation,there was no significant difference between group A and group B(P > 0.05);The amount of humidity change in group B was larger than that in group A(P < 0.05).(2)At the anterior superior iliac spine,there were significant differences between group A and group B at the beginning and the end of the operation(P < 0.05),and there was no significant difference in the amount of humidity change(P > 0.05).4.Univariate analysis showed that gender,intraoperative hypotension,core temperature,skin temperature and skin humidity were related to intraoperative pressure injury(P < 0.05).Logistic regression analysis showed that intraoperative hypotension(OR = 6.9,P < 0.05),core temperature(OR = 11.5,P < 0.05)and surface temperature(OR = 7.0,P < 0.05)were risk factors for intraoperative pressure injury.Conclusions:The incidence of intraoperative pressure injury was 10.1% in patients undergoing spinal surgery in prone position.With the prolongation of operation time,the skin surface temperature,humidity and core temperature of the pressure injury group and the non-pressure injury group increased continuously.The changes of skin temperature and humidity are different in different parts of the skin.Nursing staff should pay much attention to the skin temperature of the press part during the operation.The zygomatic part can be interfered with precautions at 3h after operation start and the anterior superior iliac spine for 4 h after operation beginning.Targeted measures can be taken to reduce the skin temperature and the occurrence of intraoperative pressure injury.Elevated core temperature,elevated skin temperature and Intraoperative hypotension,were the main risk factors for intraoperative pressure injury.