Study On Intervention Of Skin Microclimate On Intraoperative Acquired Pressure Injury In Patients Undergoing Posterior Spinal Surgery

Objective: To observe and compare the effects of different microclimate interventions on local skin temperature,humidity and the incidence of intraoperative acquired pressure injury(IAPI)in patients undergoing posterior spinal surgery,explore the intervention characteristics and effects of different measures on microclimate at local compressed skin,which aimed to provide the reference and basis for building scientific,reasonable and effective prevention system of IAPI in patients undergoing posterior spinal surgery.Methods: In this study,a randomized controlled experimental study was conducted.A total of 102 patients with posterior spinal surgery who met the inclusion criteria were randomly divided into control group(34 cases),head support group(34 cases)and foam dressing group(34 cases)in a grade A tertiary hospital in Wuhan City,Hubei Province.The control group was given conventional pressure injury prevention measures,and the other two intervention groups were given corresponding intervention measures.The patients’ core body temperature,skin temperature and humidity at the facial zygomatic area were measured and recorded before surgical position placement.During the surgery,the temperature of the patients’ facial zygomatic area was continuously monitored and the vital signs of the patients were recorded.Humidity and temperature of the patients’ facial zygomatic area were measured immediately at the end of the surgery,and the compression of the patients’ facial skin was evaluated immediately and 3 days after surgery.On this basis,compared and identified the difference of the patients’ facial indicators of skin microclimate and the incidence of IAPI in the three groups.Results: A total 102 patients were included in the final study.(1)There were no significant differences in the general demographic data,surgical data and indicators among the three groups(P >0.05).(2)The incidence of IAPI in the control group was 23.53%,the head support group was 2.94%,and the foam dressing group was 5.88%.There were significant differences in the the incidence of IAPI among the three groups,and the intervention groups were significantly lower than the control group(P < 0.01).(3)The comparison results of the skin humidity at the zygomatic area at the beginning and the end of the surgery among the three groups showed that the patients’ skin humidity at the zygomatic area in the foam dressing group changed the least during the whole operation compared with the other two groups(adjusted P < 0.001).(4)The results of repeated-measures analysis of variance showed that the average skin temperature at the zygomatic area in the head support group was significantly lower than that in the foam dressing group and the control group after the operation up to 2.5 h(P<0.01).When the operation up to 4 h,the patients in the head support maintained a lower skin temperature(below 33.5℃)at the zygomatic area.The above results showed that head support had a significant intervention effect on the skin temperature at the compressed area(P<0.05),the intervention effect size of the head support was(0.638-0.882)℃ compared with the control group.Conclusion: Both head support and foam dressing can improve the skin microclimate of the compressed area to a certain extent,maintain the normal blood circulation of the local compressed skin tissue,exert a beneficial influence on the pressure tolerance of the local compressed skin tissue,and thereby reduce the incidence of IAPI.This study further reveals the relationship between the skin microclimate and IAPI,and meanwhile,it also provides a new method and strategy for preventing the occurrence of IAPI and its related research.