| 摘要: | 目前臨床具多種經過驗證的壓傷風險評估工具，但鮮少有針對術前、術中及術後評估造成俯臥位手術壓傷之風險因子評估，因此，本研究的目的為探討俯臥位手術術前、術中及術後之壓傷風險因子；以橫斷式研究，於某大學之附屬醫院手術室進行調查。研究工具為病人特質、手術特質，Munro壓傷評估表，以SPSS-20.0進行資料處理，以描述性統計、邏輯斯迴歸進行資料分析。
本研究共收案233人，結果顯示在個人及手術特質部分，若手術病人身體質量指數（body mass index, BMI）大於28kg/m2或小於18.5kg/m2、心血管疾病、活動上需要轉移協助、活動方面無法移動需要全力協助、手術中體溫、手術總時數、手術失血量超過400ml，與有無壓傷顯著相關。再進一步將有顯著影響壓傷之變項進行多變量邏輯斯回歸分析後，可知在預測有無壓傷的分析中，BMI指數過重的病人發生壓傷是BMI指數正常病人的1.719倍（p<.05)，BMI過輕或肥胖的病人發生壓傷則是BMI正常病人的2.318倍( p<.05)，手術總時數每增加一小時，有壓傷的機率就會變為1.565倍( p<.001)，表示BMI指數過重、過輕或肥胖、手術中體溫異常以及手術總時數愈高的研究對象有壓傷的機率亦愈高。
期盼研究結果能提供手術室護理人員依病人不同特性及早預測俯臥位手術發生壓傷發生之危險因素，於術前提供適當預防措施，並減少術後壓傷之發生，以提供完整之手術全期照護，進而促進整體醫療品質的提升。
There are several validated pressure injury risk assessment tools in clinical practice. However, there is a lack of assessment of risk factors for pressure injuries occurring in the prone position during preoperative, intraoperative, and postoperative periods. Therefore, the aim of this study is to explore the risk factors for pressure injuries in surgeries performed in the prone position before, during, and after the procedure. This cross-sectional study was conducted in the operating rooms of a university-affiliated hospital. The study variables included personal and demographic characteristics, medical and surgical characteristics, and the Munro Pressure Ulcer Risk Assessment Scale. Data analysis was carried out using SPSS-20.0, employing descriptive statistics and logistic regression for data analysis.
This study included a total of 233 participants, and the results showed a significant association between the occurrence of pressure injuries and several variables. These variables include a body mass index (BMI) greater than 28 kg/m2 or less than 18.5 kg/m2, cardiovascular disease, the need for assistance in movement, abnormal body temperature during surgery, increased total duration of surgery, and surgical blood loss exceeding 400 ml. Furthermore, a multivariate logistic regression was conducted on variables that showed a significant impact on pressure injuries. The results revealed that overweight patients with a BMI greater than 28 had an odds ratio of 1.719 for developing pressure injuries compared to patients with a normal BMI (p < .05). Additionally, underweight or obese patients an odds ratio of 2.318 for having pressure injuries compared to those with a normal BMI (p < .05). For each additional hour of surgery, the odds ratio of developing pressure injuries increased to 1.565 (p < .001). This suggests that individuals with abnormal BMI (overweight or underweight, obese), abnormal body temperature during surgery, and longer total surgery duration have a higher probability of developing pressure injuries.
It is anticipated that the findings of this research can serve as a reference for operating room nursing staff. By identifying risk factors for pressure injuries in patients undergoing prone position surgery based on different patient characteristics, early prediction and appropriate preventive measures can be implemented before surgery to reduce the occurrence of postoperative pressure injuries. This aims to provide comprehensive perioperative care, ultimately contributing to the improvement of overall healthcare quality. |
