体外循环手术术中获得性压力性损伤发生的危险因素

Risk factors for intraoperative acquired pressure injury during cardiopulmonary bypass surgery

摘要

目的 分析和探讨体外循环手术中患者术中获得性压力性损伤（intraoperative acquired pressure injury，IAPI）发生的危险因素，为预防IAPI提供临床依据。 方法 采用病例对照研究，回顾性收集2020年1月至2021年12月于北京协和医院进行体外循环手术中发生IAPI的16例患者作为病例组，从进行体外循环手术的526例患者中随机抽取64例（1：4）作为对照组。比较2组的一般资料、体质指数（body mass index，BMI）、吸烟、合并症、术前化验结果、术前Braden压力性损伤评分、术中情况等，采用logistic回归分析体外循环手术中患者发生压力性损伤的危险因素。 结果 526例行体外循环手术的患者中共16例（3.04%）发生IAPI。单因素分析显示，患者BMI、糖尿病、白蛋白、术前Braden压力性损伤评分、手术时间、转机体温在2组之间的差异有统计学意义（P<0.05）。多因素logistic回归和ROC曲线分析显示，糖尿病（OR=0.038，95%CI=0.002~0.575，P=0.018）、BMI（OR=0.041，95%CI=0.004~0.459，P=0.011）、术前Braden压力性损伤评分（OR=0.302，95%CI=0.139~0.656，P=0.003）是造成体外循环手术IAPI发生的危险因素。 结论 BMI<18.5或>23.9 kg/m²、合并糖尿病、术前Braden压力性损伤评分偏低为体外循环手术IAPI的高危因素。

Abstract

Objective To investigate the risk factors for intraoperative acquired pressure injury（IAPI） in patients undergoing cardiopulmonary bypass surgery，and to provide clinical evidence for the prevention of IAPI. Methods A case-control study was conducted. A total of 16 patients who experienced IAPI during cardiopulmonary bypass surgery in Peking Union Medical College Hospital from January 2020 to December 2021 were enrolled as case group，and 64 patients（1∶4） were randomly selected from 526 patients who underwent cardiopulmonary bypass surgery and were enrolled as control group. The two groups were compared in terms of general information，body mass index（BMI），smoking，comorbidities，preoperative laboratory results，preoperative Braden score for pressure injury，and intraoperative condition，and a logistic regression analysis was used to identify the risk factors for IAPI in patients undergoing cardiopulmonary bypass surgery. Results Among the 526 patients undergoing cardiopulmonary bypass surgery，16（3.04%） experienced IAPI. The univariate analysis showed that there were significant differences between the two groups in BMI，diabetes mellitus，albumin，preoperative Braden score for pressure injury，time of operation，and bypass temperature（P<0.05）. The multivariate logistic regression analysis and the ROC curve analysis showed that diabetes mellitus［odds ratio（OR）=0.038，95%CI=0.002-0.575，P=0.018］，BMI（OR=0.041，95%CI=0.004-0.459，P=0.011），and preoperative Braden score for pressure injury（OR=0.302，95%CI=0.139-0.656，P=0.003） were significant risk factors for IAPI during cardiopulmonary bypass surgery. Conclusion BMI<18.5 kg/m² or >23.9 kg/m²，comorbidity with diabetes mellitus，and a relatively low preoperative Braden score for pressure injury are high-risk factors for IAPI during cardiopulmonary bypass surgery.

关键词

心脏体外循环手术 / 手术室 / 压力性损伤 / 危险因素

Key words

cardiopulmonary bypass / operating room / pressure injury / risk factors

基金资助

中央高水平医院临床科研资助项目(2022-PUMCH-B-031)