Pernik Mark N, Seidel Hudson H, Blalock Ryan E, Burgess Andrew R, Horodyski MaryBeth, Rechtine Glenn R, Prasarn Mark L
University of Texas, Houston, TX, United States.
University of Florida, Gainesville, FL, United States.
Injury. 2016 Aug;47(8):1801-5. doi: 10.1016/j.injury.2016.05.018. Epub 2016 Jun 4.
Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth.
To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3kPa, and 3) maximal pressure (Pmax).
In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8kPa, p<0.001).
This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.
目前美国大多数紧急转运方案都要求使用脊柱板（SB）来帮助固定创伤患者。然而，有人担心其使用与发生压疮的风险相关。一种替代设备，即真空床垫夹板（VMS），先前的研究已表明它是脊柱板的可行替代品，但尚无单一研究深入阐述组织界面压力。
为确定VMS对身体易发生压疮部位施加的压力是否小于脊柱板，我们招募健康受试者，让他们以随机顺序躺在这两种设备上，同时记录压力测量值。将传感器放置在躺在每种设备上的每个受试者的枕骨、肩胛骨、骶骨和足跟下方。使用三个参数来分析这两种设备之间的差异：1）所有活动单元的平均压力，2）超过9.3kPa的单元数量，3）最大压力（Pmax）。
在所有区域，VMS中所有活动单元的平均压力均显著降低。在超过9.3kPa的单元数量方面，我们发现VMS中骶骨和肩胛骨处显著减少，枕骨处无差异，而在使用VMS的受试者足跟处高于此值的单元明显更多。所有区域的Pmax均显著降低，在检查骶骨时不到一半（104.3对41.8kPa，p<0.001）。
本研究并未排除VMS发生压疮的可能性，尽管我们测量的大多数区域的压力都显著降低。这些结果表明，与脊柱板相比，VMS可能降低压疮发生的发生率和严重程度。需要进一步的前瞻性试验来确定这些结果是否会转化为更好的临床结果。
