壓瘡防護流程介入對降低手術病人壓瘡之成效分析

Pressure Ulcer Prevention Procedure on Reducing Incidence and Rank of Pressure Ulcer in Patients with Surgery

10.6343/ISU.2015.00042

黃梅藍

手術中壓瘡 ； 壓瘡防護流程 ； 接受手術病人 ； peri-operative pressurs ulcer ； pressure ulcer prevention procedure ； patients with surgery

義守大學醫務管理學系學位論文

2015年

碩士

高家常

繁體中文

研究背景:壓瘡(pressure ulcer)是臨床照護重要的品質指標之一。手術中壓瘡占所有壓瘡發生率之12-66％，手術中壓瘡除了增加病患住院天數與醫療成本外，也衝擊醫院的醫療照護品質。 研究目的: 探討手術中壓瘡防護流程介入對降低手術中壓瘡發生率與壓瘡等級之成效。 研究方法: 採病歷回溯方式收集在南部某一教學醫院之手術室比較手術中壓瘡防護流程介入前三個月(n= 101)與後三個月(n= 130)的壓瘡發生率與壓瘡等級。 選擇標準為:20歲以上、採全身麻醉、手術時間大於或等於四小時、接受耳鼻喉科進行頭頸部腫瘤切除後整形外科再以顯微手術將血管及游離皮瓣縫合的病人，或是神經外科行腰椎融合-後融合採俯臥手術的病人、手術前沒有壓瘡。資料分析包括:人口統計學、疾病史和手術相關因素，分析方法有描述性統計、卡方檢定、t-tests、ANOVAs。 研究結果: 介入前後兩組與六組之間在年齡、性別、Hct、Hb、BMI、手術時間、手術姿勢(平躺或俯臥)、慢性疾病(高血壓、糖尿病)等變項沒有顯著差異。手術中壓瘡防護流程(PUPP)介入前三個月的壓瘡發生率依序為: 9.5% (2/42)，3.7%(1/27)，6.3%(2/32)；手術中壓瘡防護流程(PUPP)介入後三個月的壓瘡發生率，依序為: 25.0%(9/36)，17.0%(8/47)，8.50%(4/47)。執行PUPP前4.95% (5/101)較執行後16.2%(21/130) 的壓瘡發生率顯著增加(Chi-square=5.70,p =0.03)；但六組間並無顯著差異。PUPP介入前壓瘡等級中一級有3位，二級1位，三級1位； PUPP介入後壓瘡等級下降，皆為一級。 結論:手術中壓瘡防護流程(PUPP)介入可以降低手術中壓瘡發生率與壓瘡等級。

Background: Pressure ulcer (PU) is a quality indicator in healthcare organizations. PU does not only elevate health costs but also threats medical quality. About 12-66 % of peri-operative patients may experience PU. Objective: The objective of the study was to compare the incidences of PU between before and after implementation of the pressure ulcer prevention procedure (PUPP) in patients receiving surgery. Methods: This study was a comparison with retrospective research design. Data were collected from medical records 3-month before (BI, n=101) and 3-month after (AI, n=130) implementation of the PUPP at a hospital in southern Taiwan. PUPP was a standard of operation procedure developing for reducing perioperative PU. Subjects were above 20-years old, receiving a Microsurgical Reconstruction in Head Neck Using Free Flaps or a Spinal Posterior Surgery, at least 240 minutes of time of surgery and no PU occurrence before surgery. Data included demographics, disease history, and operation attritions. Analytical strategy included descriptive statistics, Chi-square, t-tests, and ANOVAs. Results: There were no significant differences in age, gender, Hct, Hb, BMI, time of surgery, surgical position (supine/prone), and chronic disease (Diabetes Mellitus/hypertension) between AI and BI groups and cross the six months. The incidence of the PU at the consequent months were 9.5%(2/42), 3.7%(/127), 6.3%(2/32), 25.0%(9/36), 17.0%(8/47), and 8.5% (4/47). The incidence of PU of AI (4.95% [5/101] was higher than those of BO (16.2% [21/130]; Chi-square=5.70, p =0.03). All the PU in the AI group demonstrated at rank I (n=21); whereas, those in the BI group demonstrated at rank I (n=3) and rank II and III each (n=1). Conclusion: PUPP is promise of effective for this study. Continue studying on PUPP to prevent the incidence and rank of PUPP is need.

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