Menezes Sónia, Rodrigues Regina, Tranquada Raquel, Müller Sofia, Gama Karina, Manso Tânia
Serviço de Anestesiologia, Hospital Central do Funchal, Funchal, Portugal.
Acta Med Port. 2013 Jan-Feb;26(1):12-6. Epub 2013 Apr 24.
The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors.
Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS = 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury.
Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS = 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn't found a statistically significant relationship.
The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance.
合适的手术体位是一个常常被低估但必须予以考虑的关键步骤，因为它可能导致严重但可预防的损伤。本研究的目的是评估手术体位导致损伤的发生率，并试图确定其危险因素。
进行了为期一年的前瞻性研究，纳入了不同外科专科拟行择期手术的患者。在手术前对患者进行评估，排除标准为：年龄<18岁、美国麻醉医师协会（ASA）评分>III、有记录的神经病变或神经肌肉疾病。将以下情况视为体位导致的损伤：指压后不可逆的红斑和/或持续>30分钟、压痛点剧痛且与手术部位无关（视觉模拟评分法 - VAS = 7）以及周围神经损伤。我们评估了以下变量：性别、年龄、体重指数、ASA分级、麻醉技术、体位类型、手术持续时间及其与术后损伤的关系。
在纳入研究的172例患者中，围手术期损伤的发生率为12.2%，但其中5例患者有不止一处损伤（压痛点疼痛 + 神经病变）。约9.9%的患者主诉压痛点剧痛（视觉模拟评分法 - VAS = 7），4.7%出现周围神经病变，0.6%有指压不褪色的红斑。在发生损伤的患者组中，在年龄、性别、麻醉技术、手术持续时间和体位方面未发现显著差异。关于ASA分级，发现ASA II级和III级患者的损伤发生率（90.5%）高于ASA I级患者（9.5%），p < 0.05。体重指数>30 Kg/m²也显示出与术后损伤的发生有统计学显著关联，p < 0.001。在对神经病变损伤的单独分析中发现，体重指数>30 Kg/m²与神经病变的发生有关，p < 0.05。关于其余变量及其与术后神经病变的关系，未发现有统计学显著关系。
围手术期预防损伤（包括神经病变）的科学证据有限。对患者进行术后评估至关重要，因为这有助于早期识别损伤并进行记录和指导。
