Burk Ruth S, Parker Angela, Sievers Lisa, Rooney Melissa B, Pepperl Anathea, Schubert Christine M, Grap Mary Jo
School of Nursing, University of Texas, Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030, United States.
CVS Minute Clinic, Richmond, VA, United States.
Intensive Crit Care Nurs. 2015 Jun;31(3):148-54. doi: 10.1016/j.iccn.2014.11.001. Epub 2015 Jan 27.
High-frequency ultrasound may evaluate those at risk for pressure ulcers. Images may be obtained by clinicians with limited training. The prone position is recommended for obtaining sacral scans but may not be feasible in the critically ill. This study investigated image quality using multiple operators and a variety of patient positions.
Sacral scans were performed in three randomised positions in 50 volunteers by three different investigators using a 20 MHz ultrasound system. General linear models and ANOVA random effects models were used to examine the effects of operator and position on image quality rating, and measures of dermal thickness and dermal density.
The best scan for each position and operator was used for analysis (n=447 images). Image rating varied by operator (p=0.0004), although mean ratings were 3.5 or above for all operators. Dermal thickness was less for the prone position than in 90° or 60° side-lying positions (p=0.0137, p=0.0003). Dermal density was lower for the prone position than for the 90° or 60° positions (p<0.0001 for both).
These data show that overall scan quality was acceptable in all positions with all operators. However, differences were found between side-lying positions and the prone for dermal thickness and dermal density measures.
高频超声可评估压疮风险人群。临床医生经有限培训即可获取图像。推荐采用俯卧位进行骶骨扫描，但对于危重症患者可能不可行。本研究使用多名操作人员和多种患者体位调查图像质量。
三名不同研究人员使用20兆赫超声系统，对50名志愿者在三种随机体位下进行骶骨扫描。使用一般线性模型和方差分析随机效应模型，检验操作人员和体位对图像质量评分、皮肤厚度测量值和皮肤密度测量值的影响。
分析采用每个体位和操作人员的最佳扫描图像（n = 447张图像）。图像评分因操作人员而异（p = 0.0004），不过所有操作人员的平均评分均为3.5或以上。俯卧位的皮肤厚度小于90°或60°侧卧位（p = 0.0137，p = 0.0003）。俯卧位的皮肤密度低于90°或60°体位（两者p均<0.0001）。
这些数据表明，所有操作人员在所有体位下的总体扫描质量均可接受。然而，在皮肤厚度和皮肤密度测量方面，侧卧位与俯卧位之间存在差异。
