Peterson Matthew J, Gravenstein Nikolaus, Schwab Wilhelm K, van Oostrom Johannes H, Caruso Lawrence J
James A. Haley Department of Veterans Affairs Medical Center, HSR&D/RR&D Center of Excellence, 8900 Grand Oak Circle, Tampa, FL 33637, USA.
J Rehabil Res Dev. 2013;50(4):477-88. doi: 10.1682/jrrd.2012.03.0040.
Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4-6 h. All participants had specific skin areas (206 +/- 182 cm(2)) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/- 184 cm(2)) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.
定期为患者翻身以预防压疮并降低界面压力是护理标准，但先前的研究发现，标准翻身并不能缓解非残疾受试者中所有有风险组织部位的压力。为了确定这在高危患者中是否同样如此，我们使用界面压力映射评估了常规翻身对缓解骶周区域有风险组织压力的有效性。有压疮形成风险的卧床患者（n = 23，Braden评分<18）在接受4 - 6小时常规翻身护理期间，每30秒记录一次其骶周皮肤 - 床界面压力。所有参与者都有特定的皮肤区域（206±182平方厘米），在超过95%的观察期内压力超过升高的阈值。观察了13名参与者在三个不同体位（仰卧、向左翻身、向右翻身）的情况，所有参与者都有特定的皮肤区域（166±184平方厘米），在超过95%的观察期内压力超过阈值。高危患者即使翻身，其皮肤区域在整个住院期间可能始终处于风险中。医疗服务提供者并不了解他们翻身干预措施实际的组织减压效果（或缺乏效果），这可能部分解释了为什么压疮缓解策略并不总是成功的。缓解有风险组织的压力是预防压疮的必要部分，但翻身操作本身需要改进。
