| Objective: This study analyzed the Influencing factors for acute intraoperative pressure-induced injury in surgical patients.And compared Braden,revised Braden,Norton and Waterlow four kinds of stress injury risk assessment scale for surgical patients with acute pressure injury during the operation of the reliability,validity and predictability.Explored a pressure injury assessment system that is more suitable for Chinese surgical patients,thus providing a more scientific theoretical basis for the prevention of acute pressure injury in the operation.Subjects: From February to August 2017,502 patients undergoing scheduled surgery in a general hospital in Lanzhou participated in the study,258 males(51.4%)and 244 females(48.6%),age ranged 18~79 years,mean age 52.93 ± 12.84 years.Methods: This experiment is a descriptive study.Assess and investigate the Influencing factors for stress injury in patients who met the inclusion and exclusion criteria during the entire study and record relevant information.(1)On the day before surgery under natural light on patient body skin examination by two independent registered nurses that were trained at the same time.Application of four kinds of scales simultaneously and independently to the same patient for preoperative visit assessment and documentation.(2)On the day of surgery,when the patient enters the operation room,the patient is subjected to a full-body skin examination again by the same investigator as before to prevent invasive stress injury.Immediately judge the patient's intraoperative acute pressure injury before the patient leaves the operating room at the end of surgery.Data using SPSS22.0 statistical software for analysis.Results:(1)A total of 29 patients developed pressure injury with a rate of 5.8%.Of the 16patients(55.2%),only one place of stress injury occurred.Thirteen patients(44.8%)had multiple sites Occurred pressure injury,injury site up to 44.(2)The differences were statistically significant indicators into non-conditional logistic regression analysis,that is age,BMI,diabetes,serum total protein,white blood cell count,total lymphocytes,surgical site,surgical position,anesthesia time,cardiopulmonary bypass index,We found that the Influencing factors of acutepressure injury were history of previous diabetes(OR = 3.256,P = 0.016),duration of anesthesia(OR = 2.678,P = 0.000)and total serum protein(OR=1.194,P=0.049).(3)The Cronbach's coefficients of Braden scale,Braden revised scale,Norton scale and Waterlow scale were 0.724,0.602,0.768,0.737,respectively,of which the Norton Scale had the largest Cronbach's coefficient.The Cronbach's coefficient of the scale was 0.426-0.773 after the six items in the Braden scale were removed respectively.The Cronbach's coefficient of the scale was the largest(0.773)after removing the item "nutrition status";The Cronbach's coefficient of the scale was 0.439-0.710 after removing the current item from the seven items in the Braden revised scale.The Cronbach's coefficient of the scale was the largest(0.710)after removing the item "size / height";The Cronbach's coefficient of the five items in the Norton scale were 0.557-0.807 after removing the current item,respectively,of which the Cronbach's coefficient was the largest(0.807)after removing the item "physical condition";After the entries of the Waterlow scale were removed,the Cronbach's coefficients were all <0.7.The factors of the four scales are basically the same as those of the original idea.(4)The AUC of Braden scale,Waterlow scale and Braden revised scale are lower,which are 0.647,0.729,0.641 respectively;Norton scale AUC is 0.747,higher than the other three scales.The P values of AUC in four scales were all <0.05.When the diagnostic value of Braden scale is 19,the corresponding Youden index has the largest sensitivity and specificity of 62.1% and 72.7% respectively;Braden revised scale in the diagnostic value of 22 points,the corresponding Youden index is the largest,the sensitivity and specificity at this time were 55.2%,82.2%;Norton scale in the diagnostic value of 17 points,the corresponding Youden index the largest,the sensitivity and specificity at this time were 72.4%,78.6%;Waterlow scale in the diagnostic value of 13 points,the corresponding Youden index the largest,the sensitivity and specificity at this time were 93.1% and 42.3%.Conclusions:(1)Surgical patients are at high risk for stress injury.In this study,the incidence of acute pressure injury during surgery was 5.8%.Fifty percent of the stress injury occurred in the sacrococcygeal.(2)The four risk assessment scales of stress injury have better reliability and validity in patients undergoing elective surgery.Although only the Braden revised scale and the Norton scale have a better predictive value,the Norton Scale Predictive ability is better than Braden revised scale: The recommended scale used diagnostic threshold of 17 points,at this time the sensitivity and Specificity are also more balanced;There is still room for improvement in improving the reliability and validity of the scale.The "nutritional status" in the Braden scale,the "body / height" in the Braden revised scale,and the "physical status" in the Norton scale are first consider the adjustment of the entry.(3)The history of diabetes mellitus,operation time and serum total protein are the Influencing factors of acute pressure injury duringoperation.Patients with previous history of diabetes than patients with no history of diabetes prone to acute intraoperative pressure injury;the longer the operation,the lower total serum protein content of patients prone to acute intraoperative pressure injury.Therefore,preoperative nutritional status of patients should be fully assessed and targeted interventions.(4)Evaluation items of stress injury risk assessment scale are considered as the most important Influencing factors of stress injury,but not all of the four scales are included in the history of diabetes,surgery time and serum total protein in acute Stress injury Influencing factors,so the scale does not predict the occurrence of acute intraoperative pressure injury very accurately.In the future research,we should further improve the Influencing factors of intraoperative acute pressure injury to the assessment items of each scale,and focus on the reliability and validity of the four kinds of scales in the operating rooms of different hospitals,and improved the risk assessment scale for acute intraoperative acute pressure injury in Chinese surgical patients so as to provide an objective quality assessment basis for intraoperative nursing work and reduce the incidence of acute pressure-induced injury. |
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