1、黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2凝胶海绵垫联合每4 h翻身1次护理干预对重症颅脑损伤术后昏迷患者医院获得性压疮风险的影响李蕾，胡玉娜，邹辉煌河南省人民医院郑州大学人民医院中心ICU，河南郑州450000摘要目的：探讨凝胶海绵垫联合每4 h翻身1次护理干预对重症颅脑损伤术后昏迷患者医院获得性压疮（HAPU）风险的影响。方法：回顾性分析2019年1月2020年1月河南省人民医院收治的83例重症颅脑损伤术后昏迷患者的临床病历资料，按照患者家属意愿及护理方案不同分为单一干预组41例和联合干预组
2、42例。单一干预组采用每4 h翻身1次护理干预，联合干预组在单一干预组每4 h翻身1次基础上予以凝胶海绵垫护理干预。比较两组患者干预后12 h HAPU发生风险、HAPU护理效果、干预24 h后骶尾部压红面积、住院时间及家属护理工作满意度。结果：干预后12 h，联合干预组HAPU低风险发生率高于单一干预组，HAPU中风险、HAPU高风险发生率低于单一干预组，差异有统计学意义（2=20.840、4.338、4.672，P0.05），两组患者HAPU极高风险发生率比较，差异无统计学意义（2=3.188，P0.05）。联合干预组 HAPU 无症状发生率高于单一干预组，红斑及 HAPU 总发生率低于单
3、一干预组，差异有统计学意义（2=17.522、4.443、4.028，P0.05）。干预后24 h，联合干预组骶尾部压红面积小于单一干预组，住院时间短于单一干预组，差异有统计学意义（t=7.060、7.869，P0.05）。联合干预组患者家属护理工作满意度高于单一干预组，差异有统计学意义（2=5.332，P0.05）。结论：对重症颅脑损伤术后昏迷患者采用凝胶海绵垫联合每4 h翻身1次护理干预，不仅能降低患者HAPU发生风险，降低HAPU发生率，还能缩短患者住院时间，提升患者家属护理工作满意度。关键词重症颅脑损伤；凝胶海绵垫；定时翻身；医院获得性压疮doi10.3969/j.issn.1004-
4、5775.2023.02.035学科分类代码320.71中图分类号R473.73文献标识码BEffect of Gel Sponge Mat Combined with Nursing Intervention Once Every 4 h on Risk of Hospital-acquired Bedsore in Comatose Patients After Severe Craniocerebral Injury Operation/LI Lei,HU Yu-na,ZOU Hui-huang/ICU,Henan Provincial People s Hospital,Zhengzh
5、ou University People s Hospital Center,Zhengzhou,Henan,450000,ChinaAbstract Objective:To investigate the effects of gel sponge pad combined with nursing intervention once every 4 h on therisk of hospital acquired pressure ulcers(HAPU)in coma patients after severe craniocerebral injury.Methods:The cl
6、inicalmedical records of 83 postoperative coma patients with severe craniocerebral injury who were admitted to the hospital from January2019 to January 2020 were retrospectively analyzed,and they were divided into single intervention group(41 cases)and combinedintervention group(42 cases)according t
7、o the wishes of the patientsfamilies and different nursing plans.The single interventiongroup was given the nursing intervention of turning over once every 4 h,and the combined intervention group was given the gelsponge pad nursing intervention on the basis of turning over once every 4 h in the sing
8、le intervention group.The risk of HAPU at12 h after the intervention,the nursing effect of HAPU,the reddened area of the sacrococcygeal region at 24 h after theintervention,the length of hospital stay and the nursing satisfaction of family members were compared between the two groups.Results:12 h af
9、ter the intervention,the incidence of low-risk HAPU in the combined intervention group was higher than that inthe single-intervention group,and the incidences of medium-risk HAPU and high-risk HAPU were lower than those in the single-intervention group,and the differences were statistically signific
10、ant(2=20.840,4.338,4.672,P0.05).There was no statisticallysignificant difference in the incidence of extremely high risk of HAPU between the two groups(2=3.188,P0.05).Theasymptomatic incidence of HAPU in the combined intervention group was higher than that in the single intervention group,and thetot
11、al incidence of erythema and HAPU was lower than that in the single intervention group,and the differences were statisticallysignificant(2=17.522,4.443,4.028,P0.05).After 24 h of intervention,the sacrococcygeal reddening area in the combinedintervention group was smaller than that in the single inte
12、rvention group,and the length of hospital stay was shorter than that inthe single intervention group,with statistically significant differences(t=7.060,7.869,P0.05).The nursing satisfaction of familymembers in the combined intervention group was higher than that in the single intervention group,and
13、the difference wasstatistically significant(2=5.332,P0.05).Conclusion:For comatose patients with severe craniocerebral injury after surgery,theuse of gel sponge pads combined with nursing intervention every 4 h can not only reduce the risk of HAPU,reduce the incidenceof HAPU,but also shorten the hos
14、pitalization time of patients and improve the satisfaction of family members in nursing work.245黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2重症颅脑损伤属于严重脑外伤疾病，病情复杂多变，进展迅速，致死率和致残率极高，患者术后通常会经历一段昏迷时期，长期卧床时医院获得性压疮（HAPU）发生率较高，造成患者病情恶化，甚至引发患者死亡，因此，采取有效方式预防HAPU具有重要意义1。目前，临床针对 HAPU 主
15、要有变换体位和应用 HAPU 护理工具两种方式，HAPU护理工具种类众多，如减压垫、透明贴等2。本研究选取凝胶海绵垫和每4 h翻身1次两种方法对重症颅脑损伤术后昏迷患者实施HAPU干预，旨在观察护理效果，为临床护理提供有效依据，现报告如下。1资料与方法1.1一般资料回顾性分析2019年1月2020年1月河南省人民医院收治的83例重症颅脑损伤术后昏迷患者的临床病历资料，按照患者家属意愿及护理方案不同分为单一干预组41例和联合干预组42例。单一干预组中男26例，女15例；年龄2857岁，平均年龄（42.837.01）岁；致伤原因为交通事故19例，高处跌落15例，暴力殴打7例；昏迷时间73165 h
16、，平均昏迷时间（119.2721.51）h。联合干预组中男 25例，女 17 例；年龄 2959 岁，平均年龄（44.197.20）岁；致伤原因为交通事故20例，高处跌落14例，暴力殴打8 例；昏迷时间 72168 h，平均昏迷时间（121.0823.37）h。两组患者一般资料具有可比性（P0.05）。本研究经医院医学伦理委员会批准并通过。1.2入选标准纳入标准：（1）经脑CT检查确诊为重症颅脑损伤。（2）均行手术治疗，目前处于昏迷状态。（3）全身皮肤无破损。（4）临床病历资料完整。排除标准：（1）合并严重心肝肾等器质性病变。（2）家属存在精神障碍疾病，无法有效沟通。（3）昏迷时间短于3 d。1.3方法单一干预组采用每4 h翻身1次护理干预。护理人员仅每4 h为患者翻身1次，由2名护理人员共同完成。操作步骤为患者保持仰卧位后，将患者双手交叉放于腹部，然后使患者双腿屈膝，将一侧前臂置于患者肩颈下方，一侧前臂置于患者双腿弯曲处，移动患者变为左侧卧位，变换体位时力度适当，避免拖、拉、拽等行为。翻身结束后保持患者上腿向前方屈膝，下腿伸直略弯曲，防止腿部受压。最后为患者摆放好枕头，提高其舒适性和
