某醫學中心手術臥位與手術壓瘡嚴重度之分析

Analysis of the Sevevity of Intraoperative Position- Related Pressure Sore in a Medical Center

10.6142/VGHN.33.1.13

林麗華(Li-Hua Lin)；莊馥蓮(Fu-Lien Chuang)；劉秋玉(Chiu-Yu Liu)；吳幸芬(Shing-Fen Wu)；唐苡甄(Yi-Chen Tang)

手術壓瘡 ； 手術臥位 ； pressure sore ； operative positioning

榮總護理

33卷1期（2016 / 03 / 01）

13 - 20

繁體中文

本回溯性研究旨在分析南部某醫學中心手術病人的臥位與手術壓瘡發生率、面積、級數之差異。樣本資料取自該醫學中心2014年1月至12月「手術室、恢復室病人流程管理系統」與google雲端壓瘡紀錄表，結果發現19,302位病人(25,649人次)有568位(1126人次)於手術期間產生壓瘡，壓瘡發生率為4.4%，以男性(p=63.6%)且全身麻醉(p=99.1%)較多；級數以第一級壓瘡為多(p=83.5%)，其次是第二級壓瘡(p=15.8 %)；壓瘡發生率以手術姿勢俯臥最多(p=16.6%)，二級以上壓瘡以側臥發生率最高(p=34.1%)；在壓瘡面積上，仰臥和側臥者大於俯臥者；期望本研究結果能增進手術室醫護人員對手術壓瘡的認識，進而提出有效預防與改善措施，以提升手術全期照護品質；研究數據可做為醫療院所設定手術壓瘡品管閾值，手術室實證研究方向之參考。

This study investigated and compared the development rates, areas, and grades of pressure sores in surgical patients in four operative positions at a medical center. This retrospective cohort study was designed using data from January to December 2014 which were extracted from the operation and postoperative recovery room management systems, and the records on pressure sores were uploaded onto Google Cloud. During the study period, 25,649 surgeries were conducted on 19,302 patients in the medical center. Of these, pressure sores developed after 1,126 surgeries in 568 patients; these patients were analyzed further. The rate of pressure sore development was 4.4%, with the majority being first grade sores (83.5%), followed by second grade sores (15.8%). Furthermore, compared with female patients, more male patients had pressure sores (63.6%). In addition, most surgeries under general anesthesia (99.1%) resulted in pressure sore development. Four types of surgery supine to prone highest incidence of pressure ulcers (16.6%). The degree of pressure ulcers at a ratio of more than two highest occurrence of side (34.1%). The supine and lateral positions caused significantly more pressure sore development than did the prone position. The current study results can serve as a reference for developing nursing management for perioperative pressure sore development and also aid in improving patient care quality by providing further evidence-based research results.

1. 醫院評鑑暨醫療品質促進會(2011，7 月)．台灣臨床成效指標．取自http://www.tzuchi.com.tw/a_f/f_hl/download/files/file-01-01-01.pdf
2. European Pressure Ulcer Advisory Panel. (2014, September). Now Available: New 2014 International Pressure Ulcer Guidelines! Retrieved from https://www.npuap.org/now-available-new-2014-international-pressure-ulcer-guidelines/
3. Adedeji, R.,Oragui, E.,Khan, W.,Maruthainar, N.(2010).The importance of correct patient positioning in theatres and implications of mal-positioning.Journal of perioperative practice,20(4),143-147.
4. Armstrong, D.,Bortz, P.(2001).An integrative review of pressure relief in surgical patients.AORN Journal,73(3),645-674.
5. Bulfone, G.,Marzoli, I.,Quattrin, R.,Fabbro, C.,Palese, A.(2012).A longitudinal study of the incidence of pressure sores and the associated risks and strategies adopted in Italian operating theatres.Journal of perioperative practice,22(2),50-56.
6. Connor, T.,Sledge, J. A.,Bryant-Wiersema, L.,Stamm, L.,Potter, P.(2009).Identification of pre-operative and intraoperative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures.Urologic nursing,30(5),289-295+305.
7. Fu Shaw, L.,Chang, P. C.,Lee, J. F.,Kung, H.Y.,Tung, T. H.(2014).Incidence and Predicted Risk Factors of Pressure Ulcers in Surgical Patients: Experience at a Medical Center in Taipei, Taiwan.BioMed Research International,2014,1-9.
8. Gunningberg, L.(2004).Risk, prevalence and prevention of pressure ulcers in three Swedish health-care settings.Journal of Wound Care,13(7),286-290.
9. Huang, H. Y.,Chen, H. L.,Xu, X. J.(2013).Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers: a meta-analysis.Ostomy Wound Manage,59(4),36-48.
10. Kandilov, A. M.,Coomer, N. M.,Dalton, K.(2014).The Impact of Hospital-Acquired Conditions on Medicare Program Payments.Medicare & medicaid research review,4(4),1-23.
11. Lumbley, J. L.,Ali, S. A.,Tchokouani, L. S.(2014).Retrospective review of predisposing factors for intraoperative pressure ulcer development.Journal of Clinical Anesthesia,26(5),368-374.
12. Schoonhoven, L.,Defloor, T.,Grypdonck, M. H.(2002).Incidence of pressure ulcers due to surgery.Journal of Clinical Nursing,11(4),479-487.
13. Scott, E. M.,Buckland, R.(2005).Pressure ulcer risk in the peri-operative environment.Nursing Standard,20(7),74-86.
14. Walton-Geer, P. S.(2009).Prevention of pressure ulcers in the surgical patient.AORN Journal,89(3),538-552.
15. Webster, J.,Lister, C.,Corry, J.,Holland, M.,Coleman, K.,Marquart, L.(2015).Incidence and Risk Factors for Surgically Acquired Pressure Ulcers: A Prospective Cohort Study Investigators.Journal of wound, Ostomy, and Continence Nursing,42(2),138-144.
16. Wright, K. M.,Van Netten, Y.,Dorrington, C. A.,Hoffman, G. R.(2014).Pressure Injury Can Occur in Patients Undergoing Prolonged Head and Neck Surgery.Journal of Oral and Maxillofacial Surgery,72(10),2060-2065.
17. 張昭惠、陳惠玲、陳香祺(2007)。降低神經外科手術患者壓瘡發生率之方案。護理雜誌，54(6)，53-60。

1. 闞秋萍,魏玉芳,呂欣怡,吳明穎,王宜婷(2019)。運用根本原因分析降低手術病人壓傷發生率。領導護理，20(4)，123-141。
2. 李麗紅,吳佩姍(2020).一位麻醉護理師照護腰椎間盤切除術患者之手術全期護理經驗.彰化護理,27(3),62-74.
3. 蕭夢漩,吳如香(2021)。口腔癌實行皮瓣重建手術之手術全期護理。志為護理-慈濟護理雜誌，20(1)，103-112。
4. 葉惠玲,楊曜蓮,陳莊皓勛(2022)。一位頸椎脊髓損傷行脊髓電刺激術之手術全期護理。領導護理，23(4)，100-114。
5. 葉惠玲,楊曜蓮,張妤凡(2022)。一位脊椎壓迫性骨折行經皮椎體成形術之手術全期護理。志為護理-慈濟護理雜誌，21(6)，98-107。