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目的研究清醒气管插管患者自主摆放体位预防术中压疮形成的效果及其在临床中的可行性。方法将60例均需在全麻俯卧位下手术患者,随机分为两组,即实验组(自主摆放体位组)和对照组(被动摆放体位组),每组30例。实验组患者采用环甲膜穿刺气管内表面麻醉后,纤支镜引导清醒气管插管成功后,根据自身的舒适度配合医务人员摆放俯卧位,然后行诱导麻醉;对照组患者采用全麻气管插管后,由医务人员根据手术需要为患者摆放俯卧位。手术结束后,及时将患者改变为仰卧位,观察两组患者皮肤受压情况手术后即刻、术后30分、术后3天进行比较。结果术毕对照组皮肤反应发生率为63.3%,而实验组的皮肤反应发生率为6.7%,实验组压疮危险评分明显低于对照组,差异有统计学意义。结论全麻下俯卧位手术的患者,在纤支镜引导下清醒气管插管后患者自行摆放俯卧位的方法,可以降低术中压疮发生的风险。
Objective To study the effect of self-positioning of patients with conscious endotracheal intubation in preventing intraoperative pressure ulcer formation and its feasibility in clinical practice. Methods Sixty patients who needed surgery under general anesthesia in prone position were randomly divided into two groups: experimental group (autopositive group) and control group (passive placement group), 30 cases in each group. Patients in the experimental group were treated with cricothyroid membrane puncture on the inner surface of the trachea. After the bronchoscope guided the tracheal intubation, the patients were placed in the prone position according to their own comfort and then induced anesthesia. The patients in the control group were treated with tracheal anesthesia After intubation, medical staff placed prone position for the patient according to the needs of surgery. After surgery, the patient was changed to supine position in time. The compression of the skin of the two groups of patients was observed immediately after surgery, 30 minutes after surgery and 3 days after surgery. Results The incidence of skin reaction was 63.3% in the control group, while the incidence of skin reaction in the experimental group was 6.7%. The risk score of pressure ulcer in the experimental group was significantly lower than that in the control group, and the difference was statistically significant. Conclusions Patients undergoing prone surgery under general anesthesia can reduce the risk of intraoperative pressure ulcer by placing the prone position on their own after the tracheal intubation guided by fiberoptic bronchoscopy.