臺灣博碩士論文加值系統

本研究目的旨在評估高密度泡棉材質與脂肪墊材質使用於脊椎手術中之壓瘡預防效果與經濟效益，採實驗設計，以Xsensor量測胸部與腸骨嵴受壓點之壓力值（mmHg），並依據國際腸造廔協會及美國國家壓瘡學會所訂定之壓瘡分級標準，進行壓瘡評估，於北部某醫學中心手術室進行收案。首先以30位健康個案，進行前驅試驗，藉以校正Xsensor的擺置與測量方式，之後再選取30位接受俯臥脊椎手術且時間超過3小時之個案進行正式研究。排除條件包含急診手術、糖尿病或周邊血管阻塞、手術時間少於3小時，Braden scale得分少於16分及術前皮膚有破損情形者。研究測量，比較兩側胸部與腸骨嵴受壓點的平均壓力值、最高壓力值與接觸面積。參與研究者，右胸與右腸骨嵴以高密度泡棉作為減壓輔助物，左胸與左腸骨嵴則使用脂肪墊。追蹤手術後30分鐘發生壓瘡個案，在24、48與72小時壓瘡恢復的情形。資料以SPSS for window套裝統計軟體12.0版進行資料的統計分析處理，包括：描述性統計、chi-square、Pearson’s correlation 、independent t-test、pair t-test與logistic regression。以P值小於0.05作為顯著水準考驗的標準。
研究結果顯示手術後30分鐘，在120個受壓點中，發生壓瘡有9個（佔7.5％），第一級壓瘡有8個，第二級則有1個。所有的壓瘡情形都在手術後48小時恢復。體重是決定壓瘡之最顯著的因素。對於女性，年齡在65歲以下，體重小於50㎏，手術時間預期超過4小時，腸骨嵴較易產生壓瘡。脂肪墊量測所得之平均壓力值與最高壓力值均顯著低於泡棉墊。然而，脂肪墊與泡棉墊對壓瘡預防效果並無顯著差異。
有鑒於本研究結果發現，同尺寸脂肪墊價格高達泡棉墊的250倍，建議脊椎手術病人發生壓瘡的風險性較高時，應考慮以脂肪墊作為壓瘡預防之用。兼具減壓效果及合理價格的減壓材質，尚待日後探討。
關鍵字：脊椎手術、壓瘡、減壓介面、減壓材質

The purpose of this study was focused on evaluating the effect of high-density foam and action pad on the prevention of pressure sore during spinal surgery and their economical costs. The research is an experimental design conducted in an operating room of a medical center in northern Taiwan. The pressure at chest and iliac pressure points were measured by Xsensor and presented as mmHg. The stage of pressure was evaluated according to pressure scale published by IAET(International Association of Enterostomal Therapy) and NPUAP (National Pressure Ulcer Advisory Panel) . Thirty healthy adults were firstly enrolled as the pilot study to adjust the placement and measurement of Xsensor prior to enroll the 30 adult subjects receiving spine surgery in prone position for longer than 3 hours. The exclusive criteria were: emergency surgery, whom have diabetes mellitus or peripheral arterial occlusive disease, operating time less than three hours, Braden scale less than 16 points, no skin break before surgery. Measures underwent comparison were: the average pressure, the highest pressure, and the contact area of the two chest pressure points and two iliac pressure points. For each subject, the right chest and iliac were supported by two high-density foams, and the left chest and iliac were supported by two action pads. Subjects who presented pressure sore change were follow-up at 30 minutes, 24hours, 48 hours and then 72 hours after surgery. Data was processed by SPSS (Statistics Package for Social Science 12.0 for Windows) and the major statistical procedures applied were: descriptive statistic, Chi-square, Pearson’s correlation, independent T-test, Pair T-test and logistic regression. A p value less than .05 was taken as significant.
The results indicated that there were 9 out of 120 points (7.5%) developed pressure sores at 30 minutes after surgery, eight were at first grade and one were at second stage. All the pressure sores were resolved at 48 hours after surgery. Body weight was the most significant determinant of pressure sore. Iliac bone prominence, woman, age of 65 or under, weight under 50kg, and surgery over four hours were more risky to develop pressure sore. The mean and peak pressures measured from action pads were significantly less than the ones from high-density foams. However, the prevalence rate of pressure sores was not significantly different between high-density foam and action pad groups.
Since the cost of action pad is 250 times of the high-density foam, the results of this research suggest that the use of action pad is considered when risk to develop pressure sore is high. It requires further research to prove which pressure-relieving cushion is the most effective with reasonable cost.
Keywords: spine surgery; pressure sores; pressure interface,
pressure-relieving material

目錄 頁數
致謝 ．．．．．．．．．．．．．．．．．．． ．．． Ⅰ
中文摘要 ．．．．．．．．．．．．．．．．． ．．．．． Ⅲ
英文摘要 ．．．．．．．．．．．．．．．．． ．．．．． Ⅴ
目錄 ．．．．．．．．．．．．．．．．．．．．．． Ⅷ
圖表目錄 ．．．．．．．．．．．．．．．．．．．．．． Ⅹ
第壹章 緒論
第一節研究題目背景分析．．．． ．．．．．．．．．．． 1
第二節 研究問題與目的．．．．．．．．．．．．．．．． 2
第三節 名詞界定．．．．．．．．．．．．．．．．．．． 3
第貳章 文獻查證
第一節 脊椎手術與壓瘡發生部位．．．．．．．．．．．． 4
第二節 壓瘡的發生機轉．．．．．．．．．．．．．．．． 8
第三節 手術中期壓瘡發生的危險與促成因子．．．．．．．11
第四節 壓瘡危險性評估量表．．．．．．．．．．．．．．15
第五節 減輕術中壓瘡發生率相關措施之文獻報導．．．．．16
第六節 壓瘡發生相關成本分析之文獻報導．． ．．．．． 19
第參章 研究方法與步驟
第一節 研究架構．．．．．．．．．．．．．．．．．．．22
第二節 研究設計．．．．．． ．．．．．．．．．．．． 23
第三節 研究對象．．．．．．．．．．．． ．．．．．． 23
第四節 研究工具．．．．．．．．．．．．．．．． ．． 24
第五節 資料收集．．．．．．．．．．．．．．．．．．．27
第六節 研究資料處理與分析方法．．．．．．．．．．．．28
第七節 研究對象權益保護．．．．．．．．．．．．．．．28
第肆章 研究結果
第一節 個案基本資料．．．．．．．．．．．．．．．．．30
第二節 手術姿勢下受壓點兩種襯墊之壓力值．．．．．．．32
第三節 健康組與手術組受壓點壓力測量值的比較．．．．．37
第四節 影響受壓點壓力值的相關因素．．．．．．．．．．38
第五節 脊椎手術病患術後壓瘡評估結果與受壓點皮膚顏色
恢復時間．．．．．．．．．．．．． ．．．．． 42
第六節 研究對象的個人特質與壓瘡發生率的分析．．． ． 45
第七節 性別在受壓點壓力的差異分析．．．．．．．．．．45
第八節 術後30分鐘壓瘡與相關因素分析．．．．．．．．．49
第伍章 討論
第一節 脊椎手術病患於術後壓瘡發生率．．．．．．．．．53
第二節 不同材質的減壓效果．．．．．．．．．．．．．．54
第三節 造成脊椎手術病患於術後壓瘡發生之危險因子探討．58
第四節 使用不同減壓材質，手術病患壓瘡發生率的差異．．60
第五節 選用高密度泡棉材質或脂肪墊材質之考慮素．．．．60
第六節 選用高密度泡棉材質或脂肪墊材質在預防壓瘡之效果
與成本分析及差異之相關因素．．．．．．．．．．61
第陸章 結論與建議
第一節 結論．．．．．．．．．．．．．．．．．．．．．63
第二節 建議．．．．．．．．．．．．．．．．．．．．．64
第三節 限制．．．．．．．．．．．．．．．．．．．．．65
參考文獻
中文部份．．．．．．．．．．．．． ．．．．．．．．．66
英文部分．．．．．．．．．．．．．．．．．．．．．． 66
附錄
附錄一 個人特質與手術特質調查表．．．．．．．．．．．72
附錄二 手術前壓瘡調查表．．．．．．．．．．．．．．．73
附錄三 手術後壓瘡調查表．．．．．．．．．．．．．．．74
附錄四 壓力測試3D圖形範例．．．．．．．．．．．．．．75
附錄五 人體試驗委員會同意函．．．．．．．．．．．．．76

圖表目錄 頁數
表一 受試者特質描述分析．．．．．．．．．．．．．．77
表二 健康組受壓點分析．．．．．．．．．．．．．．．78
表三 手術組受壓點分析．．．．．．．．．．．．．．．79
表四 受壓點壓力測量值的比較．．．．．．．．．．．．80
表五 健康組受壓點壓力測量值的相關性．．．．．．．．81
表六 手術組受壓點壓力測量值的相關性．．．．．．．．82
表七 受壓點壓瘡情形的比較．．．．．．．．．．．．．84
表八 術後30分鐘受壓點未恢復膚色情形．．．．．．．．85
表九 性別與受壓點壓力的差異分析．．．．．．．．． 86
表十 術後30分鐘壓瘡與相關因素分析．．．．．．．． 87
表十一 術後30分鐘壓瘡與主要相關因素分析．．．．．． 88

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