Characteristics And Prevention Of Intraoperative Pressure Injury In Surgical Patients

ObjectiveTo clarify the characteristics of patients with intraoperative pressure injury and the relationship between pressure injury and tissue oxygen in the major compressed site.The clinical effect of fluidized positioner is also explored in the prevention of intraoperative pressure injury,and to provide a reference for clinical nursing to prevent intraoperative pressure injury and future research.Methods1.Investigate the prevalence,incidence and characteristics of intraoperative pressure injury for the whole year.Then the patients with intraoperative pressure injury were selected as case group.Adopting the method of individual matched case-control study,patients in a ratio of 1:2 matched were included into the control group at the same time,further analyze characteristics of patient with intraoperative pressure injury.2.The method of prospective study is adopted to select 100 patients undergoing thoracic surgery,using near infrared tissue oxygen parameter testing instrument to investigate the relationship between tissue oxygen and pressure injury during operation.3.The patients were divided into experimental group(n = 120)and control group(n=120)by a prospective randomized control method.During surgical procedure,the patients in the experimental group was used the fluidized positioner to support and protect the skin under pressure while the multi-layered foam dressing was used in the control group.The skin situation of the two groups were observed and compared at the end of the operation,2 hours after the operation and 24 hours after the operation.And operative position related pain of two groups in 24 hours after surgery were also compared.Results1.The prevalence and incidence of intraoperative pressure injury was 0.57% and 0.45% respectively.Among them,pressure injury in stage 1 accounted for 87.59% of the total.The incidence was highest in patients aged 41~55 years.Thoracic surgery has the highest incidence among different types of surgery.The incidence of pressure injuries was high in facial,sacrococcygeal,anterior superior iliac spine,and foot.2.In the case-control study investigating perioperative characteristics of patients with intraoperative pressure injuries,univariate regression analysis results showed that the weight,NRS score no less than 1,Braden score less than 23,preoperative hospitalization days,preoperative albumin abnormalities,anesthesia duration,surgery duration,duration in the operating room,surgical level,postoperative hospitalization days,total duration of hospitalization,and postoperative complications were statistically significant.3.In the case-control study investigating perioperative characteristics of patients with intraoperative pressure injuries,the multivariate regression analysis showed that weight(OR=1.087,P=0.035),preoperative Braden score less than 23 points(OR=4.873,P=0.038),preoperative albumin abnormalities(OR=8.332,P=0.013)and postoperative complications(OR=4.467,P=0.030)were the significant characteristics of patients with intraoperative pressure injury.4.The tissue oxygen in the hip tissues of the patients with and without pressure injuries changed with time,P<0.05.Regardless of time,there was no difference in the main effect of tissue oxygen between the two groups,P>0.05.There was an interaction between the time and the occurrence of pressure injury,P<0.05,that is,the changes of tissue oxygen in the two groups of patients during the operation were different.There were significant differences between the two groups in tissue oxygen minimum value,the difference between the maximum and postural position,and the difference between minimum and postural position,P<0.05.5.The tissue oxygen in the foot tissues of patients with and without pressure injury changed with time,P<0.05.Regardless of time,there was no difference in the main effect of blood oxygen between the two groups,P>0.05.There was no interaction between the time factor and the formation of pressure injury,that is,there was no statistical difference in the change of tissue blood oxygen between the two groups during the operation,P>0.05.6.In discussing the application effect of fluidized positioner in prevention of pressure injury,immediate evaluation at the end of the operation showed that 5 cases of blanchable erythema occurred in the experimental group(4.17%)and 12 cases of blanchable erythema occurred in the control group(10%).Two hours after the operation,1 case in the experimental group had decreased area of blanchable erythema,2 cases in the control group had decreased area of blanchable erythema,and 1 case had pressure ulcer in stage 1.24 hours after surgery,no pressure injuries occurred in the experimental group,and 1 case in the control group had stage 1 pressure ulcers.The result of regression analysis showed that the patients whose operation duration had gone through over 4 hours with fluidized positioner had can reduce less risk of blanchable erythema by using fluidized positioner rather than using multi-layered foam dressing after controlling other factors,OR=5.874,P<0.05.7.In discussing the fluidized positioner in the application effect of prevention of operative position related pain,there was no statistical difference in the incidence 24 hours after surgery between the experimental group and the control group,P>0.05.Position related pain scores of the two groups were statistically significant,P<0.05.Conclusions1.Not only important characteristics of surgical patients can be assessed to prevent the occurrence of the intraoperative pressure injury,but also the tissue oxygen changes of main parts under pressure can demonstrate the risk of pressure injury.At the same time,nurses should also be positive attention to postoperative complications in patients with intraoperative pressure injury with more effective observation and treatment.2.The application of fluidized positioner can effectively protect the intraoperative skin under pressure.The use of fluidized positioner can reduce the extent of postoperative operative position related pain.3.Operating room nurses should pay attention to the prevention of high incidence of pressure injuries,strengthen skin handover and cooperation with ward nurses in departments with high incidence of it,so as to effectively protect and reduce the occurrence of pressure injuries.