妇科截石位术压力性损伤发生情况及其影响因素分析

目的 探讨妇科截石位术压力性损伤发生情况及其影响因素，为降低压力性损伤风险提供科学依据。 方法 前瞻性选取行妇科截石位术患者613例，根据是否发生压力性损伤分为发生组、未发生组。统计妇科截石位术压力性损伤发生部位与分期分布情况。比较2组年龄、体重指数、贫血、低蛋白血症、术前焦虑、手术时间、漏尿、术中低体温、压力性损伤史、应用血管活性药物、术中出汗、糖尿病、高血压、慢性肝病、高脂血症、心脏病分布情况，采用多因素Logistic回归方程分析妇科截石位术压力性损伤发生的影响因素，并分析Braden评分、Waterlow量表评分对妇科截石位术压力性损伤的预测价值。 结果 613例行妇科截石位术患者压力性损伤发生率为7.99%（49/613），发生部位从高到低依次为骶尾部（42.86%）、坐骨（18.37%）、支腿架接触部位（14.29%）、肩胛（10.20%）、头后部（8.16%）、约束带（6.12%）；压力性损伤分期以Ⅲ期（32.65%）最常见；骶尾部、坐骨部位Ⅲ期和Ⅳ期压力性损伤较常见。发生组和未发生组年龄、体重指数、贫血、低蛋白血症、术前焦虑、手术时间、漏尿、术中低体温、压力性损伤史、应用血管活性药物、术中出汗、糖尿病、高血压、慢性肝病分布差异有统计学意义（P＜0.05）；发生组和未发生组高脂血症、心脏病分布差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，年龄＞70岁、偏瘦、低蛋白血症、手术时间≥2 h、术中低体温、有压力性损伤史、应用血管活性药物、术中出汗、合并糖尿病、合并慢性肝病是妇科截石位术压力性损伤的影响因素（P＜0.05）。发生组术前Braden评分低于未发生组，Waterlow量表评分高于未发生组，差异有统计学意义（P＜0.05）。Braden评分预测妇科截石位术压力性损伤的敏感度为63.27%，特异度为86.70%；Waterlow量表评分预测妇科截石位术压力性损伤敏感度为57.14%，特异度为88.30%；Braden评分+Waterlow量表评分预测妇科截石位术压力性损伤的敏感度为71.43%，特异度为93.09%；Braden评分+Waterlow量表评分预测妇科截石位术压力性损伤的AUC大于单一Braden评分、Waterlow量表评分（P＜0.05）。 结论 妇科截石位术存在不同程度压力性损伤风险，年龄＞70岁、偏瘦、低蛋白血症、手术时间≥2 h、漏尿、术中低体温、有压力性损伤史、应用血管活性药物、术中出汗、合并糖尿病、合并慢性肝病是发生压力性损伤的影响因素；Braden评分、Waterlow量表能有效预测压力性损伤风险，建议针对以上因素采取预防措施，以降低妇科截石位术压力性损伤事件发生率。

Analysis on the occurrence and influencing factors of pressure injury in gynecological lithotomy

Objective To investigate the occurrence and influencing factors of pressure injury(PI) in gynecological lithotomy, and to provide scientific basis for reducing the risk of PI.Methods A total of 613 patients undergoing gynecological lithotomy were prospectively divided into occurrence group and non-occurrence group according to presence or absence of PI. The location and stage distribution of PI in gynecological lithotomy were calculated. The age, body mass index(BMI), anemia, hypoproteinemia, preoperative anxiety, duration of operation, leakage of urine, hypothermia during operation, history of PI, use of vasoactive drugs, intraoperative sweating, diabetes, hypertension, chronic liver disease, hyperlipidemia, and heart disease were compared between the two groups. Multivariate Logistic regression equation was used to analyze the influencing factors of PI in gynecological lithotomy, and the predictive value of Braden score and Waterlow scale score on PI in gynecological lithotomy was analyed.Results The incidence of PI in 613 patients undergoing gynecological lithotomy was 7.99%(49/613). The high to low sites were sacrococcygeal(42.86%), sciatic(18.37%), leg support contact(14.29%), scapula(10.20%), posterior part of head(8.16%) and restraint belt(6.12%); Stage Ⅲ(32.65%) was the most common stage of PI; Stage Ⅲ and Ⅳ PI in sacrococcygeal and sciatic sites were more common. There were significant differences in age, BMI, anemia, hypoproteinemia, preoperative anxiety, duration of operation, leakage of urine, hypothermia, PI history, use of vasoactive drugs, intraoperative sweating, diabetes, hypertension and chronic liver disease in occurrence group and non-occurrence group(P＜0.05). There was no significant difference in the distribution of hyperlipidemia and heart disease between the occurrence group and the non-occurrence group(P＞0.05). Multivariate Logistic regression analysis showed that age＞70 years, being lean, hypoproteinemia, duration of operation ≥2 h, hypothermia during operation, history of PI, use of vasoactive drugs, intraoperative sweating, diabetes combined with chronic liver disease were the influencing factors of PI in women undergoing lithotomy(P＜0.05). The preoperative Braden score of the occurrence group was lower than that of the non-occurrence group, while the score of Waterlow scale was higher than that of the non-occurrence group(P＜0.05). The sensitivity and specificity of Braden score in predicting PI after gynecological lithotomy were 63.27% and 86.70%, respectively. The sensitivity and specificity of Waterlow scale in predicting PI after gynecological lithotomy were 57.14% and 88.30%, respectively. The sensitivity and specificity of Braden score + Waterlow scale in predicting PI after gynecological lithotomy were 71.43% and 93.09%, respectively. The AUC of Braden score+Waterlow scale score in predicting PI after gynecological lithotomy was greater than that of single Braden score and Waterlow scale score(P＜0.05).Conclusion There are different degrees of PI risk in gynecologic lithotomy. Age＞70 years, being lean, hypoproteinemia, duration of operation ≥2 h, leakage of urine, hypothermia during operation, history of PI, use of vasoactive drugs, intraoperative sweating, diabetes combined with chronic liver disease are the influencing factors of PI. Braden score and Waterlow scale can effectively predict the risk of PI. It is recommended to take preventive measures against the above factors to reduce the incidence of PI during gynecological lithotomy.