记忆海绵体位垫在妇科截石位手术中预防压力性损伤的效果及其机制研究-现代医学

记忆海绵体位垫在妇科截石位手术中预防压力性损伤的效果及其机制研究

单位：南京医科大学第一附属医院麻醉与围术期医学科, 江苏南京 210029

分类号：R47

出版年·卷·期（页码）：2024·52·第六期（945-952）

摘要：

目的： 探讨记忆海绵体位垫在妇科截石位手术中预防压力性损伤的效果，并从材料的微观结构和理化性质出发，阐明其预防压力性损伤的基本机制。方法： 选取妇科恶性肿瘤截石位手术患者100例，随机数字表法将其分为对照组和观察组各50例，分别使用硅凝胶体位垫和记忆海绵体位垫。采用Tactilus压力感应系统记录手术开始前(T₀)、麻醉后(T₁)、手术开始时(T₂)以及术中0.5 h(T₃)、1 h(T₄)、2 h(T₅)、3 h(T₆)和手术结束时(T₇)患者骶尾部的最大压强、平均压强及患者与手术床面的平均接触面积。手术结束后评估患者压损发生情况。结合仪器分析技术，从组成成分、材质特性、吸湿性能和玻璃化转变温度阐明记忆海绵体位垫分散压力的基本原理。结果： (1) 观察组和对照组压损发生率分别为4.0%、16.0%，组间差异有统计学意义(P＜0.05)；(2) 对照组患者T₁～T₇时间点骶尾部的最大压强、平均压强均大于观察组，平均接触面积均小于观察组，组间差异有统计学意义(P＜0.05)；(3) 记忆海绵体位垫的主要化学成分是聚醚型聚氨酯，孔隙率较小，密度大，吸湿性较低，玻璃化转变温度为15.26 ℃，具有慢回弹性能。结论： 记忆海绵体位垫因其独特的材料特性，在妇科截石位手术中能增加患者与手术床面的平均接触面积，分散压力和减小界面压强，有效降低压损发生率，本研究为预防压力性损伤提供了参考。

Objective: To explore the effect of memory foam pad in preventing pressure injury(PI) during gynecological lithotomy, and to elucidate the basic mechanism of preventing PI based on the microstructure and physical and chemical properties of the material. Methods: 100 patients undergoing lithotomy surgery for gynecological malignancies were divided into a control group and an observation group according to the random number table method, with 50 patients in each group. The observation group used memory foam pads, while the control group used silicone gel pads. Using the Tactilus pressure sensing system, we recorded the maximum pressure, average pressure, and average contact area between the patient's sacrococcygeal area and the surgical bed at different time points: before surgery(T₀), after anesthesia(T₁), at the start of surgery(T₂), 0.5 h(T₃), 1 h(T₄), 2 h(T₅), 3 h(T₆), and at the end of surgery(T₇). After the surgery, the incidence of PI was evaluated. Combined with instrumental analysis techniques, the basic principle of pressure distribution of memory foam pads was elucidated from composition, material properties, moisture absorption performance, and glass transition temperature. Results: (1) Compared with the control group(16.0%), the incidence of PI in the observation group(4.0%) was significantly lower(P<0.05);(2) The maximum and average pressures at the sacrococcygeal of the control group patients at T₁~T₇ were greater than those of the observation group, the average contact area was smaller than that of the observation group, and the difference had statistical significance(P<0.05);(3) The main chemical component of memory foam pads was polyether polyurethane, with smaller porosity, greater density, lower moisture absorption, a glass transition temperature of 15.26 ℃, and slow resilience. Conclusion: Memory foam pads can increase the average contact area, distribute pressure and reduce the interface pressure due to its unique material characteristics, which can effectively reduce the incidence of PI during gynecological lithotomy position surgery. This study provides reference for preventing PI.

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