Bogie K M, Nuseibeh I, Bader D L
National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
Paraplegia. 1995 Mar;33(3):141-7. doi: 10.1038/sc.1995.31.
The patient with spinal cord injury is at high risk of tissue breakdown at all times due to a number of adverse factors, such as reduced mobility and anaesthesia. It is therefore essential that each patient is prescribed appropriate support media during initial rehabilitation. In this study, the effectiveness of prescribed wheelchair cushions has been assessed in terms of tissue response at the ischial tuberosities. A total of 42 subjects who had sustained traumatic spinal cord injury within 1 year were monitored on at least two occasions during initial rehabilitation. Changes in transcutaneous gas response (TcPO2 and TcPCO2) were monitored concurrently with regional interface pressures. A series of six transcutaneous gas variables were established, as markers of tissue viability. Non-parametric statistical analyses revealed some significant correlations between these variables. The results of this study also indicate that (1) spinal cord injury subjects with lesions below T6 show a progressive decrease in ability to maintain blood flow in sitting on prescribed support cushions and (2) SCI subjects with lesions above T6 show a progressive improvement in tissue viability status at the seating support interface. Therefore results imply that paraplegics are at a potentially higher risk of tissue breakdown than tetraplegics and thus require effective support cushions with strict adherence to a pressure relief regime.
由于多种不利因素，如活动能力下降和麻醉，脊髓损伤患者随时都有组织破损的高风险。因此，在初始康复期间为每位患者开具合适的支撑介质至关重要。在本研究中，已根据坐骨结节处的组织反应评估了开具的轮椅坐垫的有效性。共有42名在1年内遭受创伤性脊髓损伤的受试者在初始康复期间至少接受了两次监测。经皮气体反应（TcPO2和TcPCO2）的变化与局部界面压力同时进行监测。建立了一系列六个经皮气体变量，作为组织活力的标志物。非参数统计分析揭示了这些变量之间的一些显著相关性。本研究结果还表明：（1）T6以下有损伤的脊髓损伤受试者在坐在开具的支撑坐垫上时维持血流的能力逐渐下降；（2）T6以上有损伤的脊髓损伤受试者在座位支撑界面处的组织活力状况逐渐改善。因此，结果表明截瘫患者比四肢瘫患者有更高的组织破损潜在风险，因此需要有效的支撑坐垫并严格遵守减压方案。
