降低俯卧位手术中的皮肤损伤

Decreasing Intraoperative Skin Damage in Prone-Position Surgeries.

机构信息

At the University of California, Los Angeles (UCLA), Los Angeles, California, US, Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, Los Angeles School of Nursing and David Geffen School of Medicine; Jessica Crocker, BA, is Project Director, Division of Geriatrics, David Geffen School of Medicine; and Vicky Nguyen, MSN, is Graduate Student, School of Nursing. Lauren Robertson, BS, is Senior Quality Control Analytical Associate, ImmunityBio, Los Angeles, California. Deborah Nourmand, MSN, RN, is Registered Nurse, UCLA Santa Monica Surgery Center, Santa Monica, CA. At the School of Nursing, UCLA, Emily Chirila, BSN, is Nursing Student; Mohamed Laayouni, MSN, is Nursing Student; Ofelia Offendel, MSN, is Student Nurse; Kelly Peng, BA, is Graduate Student Research Assistant; and Stephanie Anne Romero, MSN, is Graduate Student Researcher. Gerry Fulgentes, MSN, RN, CWOCN, PCCN, is Clinical Manager, Wounds, Ostomy, and Continence Services, UCLA Santa Monica Medical Center. Heather E. McCreath, PhD, is Adjunct Professor, Division of Geriatrics, David Geffen School of Medicine, UCLA.

出版信息

Adv Skin Wound Care. 2024 Aug 1;37(8):413-421. doi: 10.1097/ASW.0000000000000186.

DOI:10.1097/ASW.0000000000000186

PMID:39037095

Abstract

OBJECTIVE

To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery.

METHODS

In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data.

RESULTS

Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants.

CONCLUSIONS

Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.

摘要

目的

确定亚表皮水分（SEM）测量是否有助于发现和预防俯卧位手术中的术中获得性压力性损伤（IAPI）。

方法

在这项针对接受俯卧位手术的患者（术前组 n = 39，干预组 n = 48，100 例历史对照组）的临床试验中，研究人员检查了术前应用多维灵活硅酮泡沫（MFSF）敷料对面部、胸部和髂嵴的影响。在术前、术后和术后每天进行皮肤视觉评估和 SEM 测量，最多持续 5 天或直至出院。电子病历回顾包括人口统计学、医疗和手术数据。

结果

在 187 名总参与者中，76 名（41%）为女性。参与者的平均年龄为 61.0 ± 15.0 岁，9.6%为西班牙裔（n = 18），9.6%为亚裔（n = 18），6.9%为黑人和非裔美国人（n = 13），73.8%为白人（n = 138）。参与者的 Scott-Triggers IAPI 风险评分平均为 1.5 ± 1.1。在术前无红斑的患者中，与术前组相比，干预组患者面部和胸部术后红斑的发生率较低。此外，与术前组相比，干预组患者所有部位的 SEM 定义的 IAPI 发生率较低。MFSF 敷料克服了手术时间、肤色和体重指数等 IAPI 风险因素，使干预组的 IAPI 减少。