手術(shù)室壓力性損傷

1、手術(shù)室壓瘡預(yù)防,關(guān)于手術(shù)室壓瘡預(yù)防,,術(shù)后72小時(shí)內(nèi)發(fā)生的壓瘡其實(shí)源于手術(shù)室手術(shù)室壓瘡發(fā)生率高達(dá)12%---66% 強(qiáng)的或長時(shí)間不間斷壓力導(dǎo)致,手術(shù)室壓瘡流行病學(xué),AORN J. 2001;73(3):645-657J Wound Ostomy Continence Nurs.2005;32(1):19-30 AORN J. 2011;l 94(6):,手術(shù)室壓瘡發(fā)生的時(shí)間,Pressure ulcer in surgical p

2、atientsKimberly-Clark Health Care Education,何曉珍，樊翌明.術(shù)中褥瘡的演技進(jìn)展,手術(shù)室壓瘡發(fā)生后果,延長住院時(shí)間：平均增加3.5-5天增加成本：患者經(jīng)濟(jì)+醫(yī)護(hù)成本增加50%誘發(fā)其他并發(fā)癥：竇道形成，菌血癥，敗血癥,手術(shù)特殊性與多樣風(fēng)險(xiǎn)因素-手術(shù)室壓瘡↑手術(shù)患者壓瘡發(fā)生率：12%-66%,Aronovitch SA. Intraoperatively Acquired Pres

3、sureUlcer Prevalence: A National Study. J Wound Ostomy Continence Nurs. 1999 May;26(3):130 -6.,Schouchoff B. Pressure Ulcer Development in the Operating Room. Critical Care Nursing Quarterly. 2002 May;25(1):76-82.,Storde

4、ur S, Laurent S, D'Hoore W. The Importance of Repeated Risk Assessment forPressure Sores in Cardiovascular Surgery. J Cardiovasc Surg (Torino). 1998 Jun;39(3):343-9.,手術(shù)室壓瘡風(fēng)險(xiǎn)因素,按科室分類,Pressure ulcer in surgical patient

5、sKimberly-Clark Health Care Education,按手術(shù)時(shí)間,術(shù)前，術(shù)中，術(shù)后,手術(shù)室壓瘡風(fēng)險(xiǎn)因素,手術(shù)患者特異性“手術(shù)類型，術(shù)式，時(shí)間,個(gè)體因素，術(shù)中外因等因素”壓瘡最終產(chǎn)生與各個(gè)因素的關(guān)系全面考慮及時(shí)干預(yù),,手術(shù)室壓瘡預(yù)防策略,手術(shù)室壓瘡,,風(fēng)險(xiǎn)評(píng)估:評(píng)估工具，篩查高危皮膚管理：皮膚評(píng)估保護(hù)營養(yǎng)評(píng)估：營養(yǎng)狀態(tài)溝通及干預(yù)措施：了解術(shù)式，體位，麻醉，時(shí)間等預(yù)防性使用敷料（減少壓力

6、，摩擦力，剪切力，保持實(shí)行平衡，方便查看）,術(shù)前評(píng)估干預(yù),不同術(shù)式風(fēng)險(xiǎn)區(qū)域-仰臥位,適用范圍：前胸面，頸，口骨盆腹部四肢,Prevention of pressure ulcer in surgical patientWalton-Geer, March 2009, Vol89,No 3,3歲，室間隔缺損修補(bǔ)術(shù)，平臥位,術(shù)前,術(shù)后揭開美皮康,3歲，右顳極蛛網(wǎng)膜囊腫切除術(shù),3小時(shí),術(shù)前,術(shù)后揭開美皮康,不同術(shù)式風(fēng)險(xiǎn)區(qū)域-俯

7、臥位,使用范圍：后背脊柱腿后部,Prevention of pressure ulcer in surgical patientWalton-Geer, March 2009, Vol89,No 3,25歲，胸12、腰1椎體骨折后路切開復(fù)位植骨融和術(shù)，俯臥位，4小時(shí),擺體位前準(zhǔn)備,術(shù)前預(yù)知術(shù)式貼敷,術(shù)后揭開美皮康,擺好體位,57歲，女，腰4、5椎體滑脫后路復(fù)位+GSS內(nèi)固定,術(shù)前預(yù)知術(shù)式貼敷,術(shù)后揭開美皮康,不同術(shù)式風(fēng)險(xiǎn)區(qū)域-截

8、石位,適用范圍：婦產(chǎn)泌尿生殖,Prevention of pressure ulcer in surgical patientWalton-Geer, March 2009, Vol89,No 3,女，65歲，乙狀結(jié)腸切除術(shù)，截石位，4小時(shí),術(shù)后揭開美皮康,術(shù)前預(yù)知術(shù)式貼敷,不同術(shù)式風(fēng)險(xiǎn)區(qū)域-側(cè)臥位,適用范圍：胸肺腎髖,Prevention of pressure ulcer in surgical patientWal

9、ton-Geer, March 2009, Vol89,No 3,90歲，男，左側(cè)単髖置換術(shù),術(shù)后揭開美皮康,術(shù)前預(yù)知術(shù)式貼敷,術(shù)中干預(yù),術(shù)中觀察干預(yù),定時(shí)檢查皮膚及解除壓力,皮膚保護(hù),約束帶下應(yīng)該加襯墊或敷料骨突部位使用軟硅膠泡沫敷料及減壓墊皮膚檢查每隔15-30min，檢查受壓皮膚及末梢循環(huán),定時(shí)減壓,手術(shù)超過1h時(shí)，適當(dāng)對(duì)受壓皮膚減壓每2h幫助患者放松約束帶加壓時(shí)，避免按摩皮膚,術(shù)前，術(shù)中，術(shù)后三環(huán)節(jié)正確，及時(shí)使