CAJ | 학술논문

目的：探讨主动脉夹层手术患者压疮预防皮肤管理的实施方法与效果。方法应用Waterlow 压疮危险因素评估表对134例主动脉夹层手术患者手术前、后的皮肤状况进行评估，针对存在的压疮危险因素实施相应的预防措施，包括术前实施针对性的健康教育，提高患者落实压疮预防措施的依从性；术中使用硅胶凝胶垫、透明贴、泡沫敷料等防护垫减轻对受压部位的压力以及手术进行超过2 h后，每半小时抬起患者头部、足部，变换受力点；术后定时翻身、使用气垫床等。结果患者术前压疮评分为（10.43±2.79）分，术后压疮评分为（13.93±3.28）分。134例患者术前均无压疮；术后1 d 发生Ⅰ期压疮3例，压疮发生率为2.24%。术后3例压疮中，其中1例为消瘦，2例为手术时间过长（分别为11.5，14.5 h），术后压疮评分为22~23分，均属于非常危险。结论主动脉夹层患者围术期存在较高的压疮风险，实施针对性预防措施能有效降低压疮发生率。手术过程长时间固定体位致躯干局部受压持续时间过长，是围术期压疮预防的最大难点，也是今后需要研究解决的问题。
목적：탐토주동맥협층수술환자압창예방피부관리적실시방법여효과。방법응용Waterlow 압창위험인소평고표대134례주동맥협층수술환자수술전、후적피부상황진행평고，침대존재적압창위험인소실시상응적예방조시，포괄술전실시침대성적건강교육，제고환자락실압창예방조시적의종성；술중사용규효응효점、투명첩、포말부료등방호점감경대수압부위적압력이급수술진행초과2 h후，매반소시태기환자두부、족부，변환수력점；술후정시번신、사용기점상등。결과환자술전압창평분위（10.43±2.79）분，술후압창평분위（13.93±3.28）분。134례환자술전균무압창；술후1 d 발생Ⅰ기압창3례，압창발생솔위2.24%。술후3례압창중，기중1례위소수，2례위수술시간과장（분별위11.5，14.5 h），술후압창평분위22~23분，균속우비상위험。결론주동맥협층환자위술기존재교고적압창풍험，실시침대성예방조시능유효강저압창발생솔。수술과정장시간고정체위치구간국부수압지속시간과장，시위술기압창예방적최대난점，야시금후수요연구해결적문제。
Objective To explore the skin management methods for preventing pressure ulcers in the patients with aortic dissection surgery. Methods Totals of 134 cases of patients with aortic dissection surgery were implemented the standardized and personalized skin management methods for preventing pressure ulcers. The“Waterlow patients pressure sore risk assessment scale”was applied in assessing the skin condition of preoperative and postoperative patients. The prevention methods according to the risk factors of pressure ulcer,including the targeted health education,improve the compliance of prevention methods;using the silicone gel pad,water gel or foam dressing to decompress the pressurized parts during the operation,when the operation time was over 2 hours, lifted patients' head and foot every half hour and changing stress points;during the postoperative time turning-over and using the air bed. Results The scores of pressure ulcer were(10. 43 ±2. 79)and(13. 93 ±3. 28)before and after surgery. All the 134 patients did not have pressure ulcer before surgery. One day after the operation, 3 patients had phaseⅠpressure ulcer,with an incidence of 2. 24% . Within the 3 cases of pressure ulcer patients, 1 patient was emaciation,2 patients had long operation time(11. 5 and 14. 5 hours,respectively),whose pressure ulcer scores were 22 to 23 belong to the risk level. Conclusions Patients with aortic dissection during perioperative period have a high risk of pressure sores. The implementation of specific preventive measures can effectively reduce the incidence of pressure sores. Long procedure and partial compression caused by fixed position are the greatest difficulties in preventing the pressure sores,and they are also the problems needed to be solved in the future.