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level,*,Select View-Header and Footer and insert footer text for all slides,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Select View-Header and Footer and insert footer text for all slides,手术室压力性损伤,本课件仅供大家学习学习 学习完毕请自觉删除 谢谢 本课件仅供大家学习学习 学习完毕请自觉删除 谢谢,手术室压力性损伤 本课件仅供大家学习学习 学习,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,手术室压力性损伤课件,关于手术室压疮预防,关于手术室压疮预防,术后,72,小时内发生的压疮其实源于手术室,手术室压疮发生率高达,12%-66%,强的或长时间不间断压力导致,AORN J.2001;73(3):645-657J Wound Ostomy Continence,Nurs.2005;32(1):19-30 AORN,J.2011;l 94(6):,术后72小时内发生的压疮其实源于手术室AORN J.200,手术室压疮发生的时间,外部压力,阻断血流,细胞血流,中断,细胞缺氧,(缺血),细胞开始凋亡,(坏死),坏死进一步,扩大,溃疡,形成,Pressure ulcer in surgical patients,Kimberly-Clark Health Care Education,何晓珍,樊翌明,.,术中褥疮的演技进展,手术室压疮发生的时间外部压力细胞血流细胞缺氧细胞开始凋亡坏死,手术室压疮发生后果,延长住院时间:平均增加,3.5-5,天,增加成本:患者经济,+,医护成本增加,50%,诱发其他并发症:窦道形成,菌血症,败血症,手术室压疮发生后果延长住院时间:平均增加3.5-5天,手术特殊性与多样风险因素,-,手术室压疮,手术患者压疮发生率:,12%-66%,Aronovitch SA.Intraoperatively Acquired PressureUlcer Prevalence:A National Study.J Wound Ostomy Continence Nurs.1999 May;26(3):130-6.,Schouchoff B.Pressure Ulcer Development in the Operating Room.Critical Care Nursing Quarterly.2002 May;25(1):76-82.,Stordeur S,Laurent S,DHoore W.The Importance of Repeated Risk Assessment forPressure Sores in Cardiovascular Surgery.J,Cardiovasc Surg(Torino).1998 Jun;39(3):343-9.,手术室压疮风险因素,手术特殊性与多样风险因素-手术室压疮Aronovitch,按科室分类,科室,发生率,流行率,心外科,17-29.5%,7%,血管外科,9.8-17.3%,脊柱,/,腹部外科,36%,骨科,15-20.6%,6.5%,老年骨科,66%,大外科,/,胸外,27.7%,7%,头颈部,10%,神经外科,5.2%,Pressure ulcer in surgical patients,Kimberly-Clark Health Care Education,按科室分类科室 发生率,按手术时间,手术时间 流行率,3-4hrs,5.8-6.0%,4-5hrs,8.9%,5-6hrs,9.9%,6hrs,9.9%,7hrs,13.2%,按手术时间手术时间,术前,术中,术后,术前风险因素 术中风险因素 术后风险因素,年龄,吸烟,营养状态,.,低血清白蛋白,.,低蛋白,.,淋巴细胞计数低,.,淋巴循环障碍,.,体重,.BMI,低,.,脱水,.,软组织结构改变,合并症,.,糖尿病,.,术前高血压,.,呼吸系统疾病,.,血管疾病,.,贫血,.,神经系统疾病,.,心脏疾病,术前红细胞计数与学血红蛋白计数低,制动或活动力受限制,低血压,患者本身疾病,手术类型,体温过低,.,患者处于低体温状态,.,使用保温毯保持正常体温,麻醉与所用麻醉剂,(镇静剂,催眠剂,麻醉剂,肌肉松弛济,血管扩张剂),血流动力学状态,.,低血压,.,低动脉血压,.,组织灌注量改变,.,体外循环,.,失血,.,体循环血压过低,.,周围循环血减少,在手术室的时间,手术台上的时间,与手术本身花费时间,术中摆放体位,皮肤摩擦力与剪切力,受压部位压力时长与强度,皮肤湿度,/,失禁,皮肤下集聚消毒液,感知觉破坏或丧失,恢复体温所需时间,术后体位,活动水平,手术部位压力,清洁皮肤的频率,头部或床头抬高,环境因素(湿度),术前,术中,术后术前风险因素,手术室压疮风险因素,手术患者特异性,“手术类型,术式,时间,个体因素,术中外因等因素”,压疮最终产生与各个因素的关系,全面考虑及时干预,手术室压疮风险因素手术患者特异性,手术室,压疮,手术室,风险评估,:,评估工具,筛查高危,皮肤管理:皮肤评估保护,营养评估:营养状态,沟通及干预措施:,了解术式,体位,麻醉,时间等,预防性使用敷料,(减少压力,摩擦力,剪切力,保持实行平衡,方便查看),风险评估:评估工具,筛查高危,手术室压力性损伤课件,不同术式风险区域,-,仰卧位,适用范围:,前胸,面,颈,口,骨盆,腹部,四肢,枕部,肩胛骨,手臂手肘,枕部胸椎,腰部,骶尾部,足跟部,Prevention of pressure ulcer in surgical patient,Walton-Geer,March 2009,Vol89,No 3,不同术式风险区域-仰卧位适用范围:枕部 肩胛骨手臂手肘枕部胸,手术室压力性损伤课件,3,岁,室间隔缺損修补术,平卧位,术前,术后揭开美皮康,3岁,室间隔缺損修补术,平卧位术前术后揭开美皮康,3,岁,右颞极蛛网膜囊肿切除术,3,小时,术前,术后揭开美皮康,3岁,右颞极蛛网膜囊肿切除术,3小时术前术后揭开美皮康,不同术式风险区域,-,俯卧位,前额,眼,,耳,下颌,肩膀前面,膝盖,脚背,脚趾,乳房,(女性),髂嵴,生殖器,(男性),小腿,使用范围:,后背,脊柱,腿后部,Prevention of pressure ulcer in surgical patient,Walton-Geer,March 2009,Vol89,No 3,不同术式风险区域-俯卧位前额,眼,肩膀前面膝盖脚背脚趾乳房髂,25,岁,胸,12,、腰,1,椎体骨折后路切开复位植骨融和术,俯卧位,,4,小时,摆体位前准备,术前预知术式贴敷,术后揭开美皮康,摆好体位,25岁,胸12、腰1椎体骨折后路切开复位植骨融和术,
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