Changes of transcutaneous oxygen pressure in compressed areas of surgical patients: A prospective study of influencing factors.

OBJECTIVE: To compare the transcutaneous oxygen pressure (tcpO2) measurement values and changes in compressed areas of surgical patients before and after surgery and to explore the related factors influencing the tcpO2 changes before and after surgery. METHODS: Researchers selected 100 patients who underwent elective surgery in a tertiary comprehensive hospital from November 2021 to September 2022. A self-designed general information questionnaire was used to collect patient general information and disease-related data, including gender, age, smoking and drinking history, hypertension, diabetes, local skin temperature and humidity, related biochemical indicators, and activities of daily living score. Researchers used a transcutaneous oxygen pressure meter to measure and record the tcpO2 of the compressed areas (sacrococcygeal area, scapula area, and heel area) before and after surgery. RESULTS: Among the 100 patients, 37.00 % (37/100) developed type I/II pressure ulcers after surgery, and 30 patients (81.08 %) showed regression within 2 h after surgery. There was no statistically significant difference in the preoperative tcpO2 measurement values of the scapula and heel areas between the group with and without pressure ulcers, but the preoperative tcpO2 measurement value of the sacrococcygeal area in the group without pressure ulcers was higher than that in the group with pressure ulcers (P < 0.01). The factors affecting the preoperative tcpO2 measurement value of the sacrococcygeal area were smoking and surgical type. After surgery, the tcpO2 measurement values of the three areas in the group with pressure ulcers were significantly lower than those in the group without pressure ulcers (P < 0.01). Comparing the tcpO2 values of different areas, it was found that the tcpO2 value was lowest in the sacrococcygeal area, followed by the heel area, and the tcpO2 value in the scapula area was highest both before and after surgery (P < 0.01). The main factors affecting the postoperative tcpO2 measurement value were diabetes, Glassgow score, surgical time, and intraoperative red blood cell transfusion. CONCLUSION: The measurement of tcpO2 is related to the incidence of surgically acquired pressure ulcers, and this technology may become an important tool for quantitative assessment of the risk of pressure ulcers.

Explore the effect of pressure and time of compression on the risk of intraoperatively acquired pressure injury based on theoretical framework: A prospective study.

Surgery is a high risk factor for the occurrence of pressure injury (PI). On the basis of theoretical research, pressure and duration of pressure are key factors affecting PI. Pressure is affected by the individual pressure redistribution capacity. So our study aims to explore how the surgery time and pressure intensity affect the occurrence of PI and what are the risk factors. A prospective study. A total of 250 patients who underwent elective surgery in a grade-A general hospital from November 2021 to February 2023 were selected and divided into a group of 77 patients with IAPI (intraoperatively acquired pressure injury) and a group of 173 patients with no IAPI. Visual pressure inductive feedback system and body composition analysis technology were used to record the local pressure value and change of patients before and after anaesthesia. Relevant data of the patients were collected to explore the influencing factors. The maximum pressure and average pressure at the pressure site of the same patient changed before and after anaesthesia, and the pressure after anaesthesia was significantly higher than that before anaesthesia. There was no statistical difference in the average pressure after anaesthesia (p > 0.05), but the maximum pressure in the IAPI group was higher than that in the non-occurrence group (p < 0.05). The average pressure multiplied by the operation time in IAPI group is significantly higher than that in the non-IAPI group (p < 0.01). Multiple linear regression analysis (stepwise regression) showed that fat-free weight, age, waist circumference, body mass index (BMI) and gender were taken as independent variables into the regression model, affecting the maximum pressure. In addition, operation time ≥4 h may be a high risk factor for IAPI. In future studies, more objective research tools can be applied to improve the accuracy of predicting the risk of IAPI. In addition to gender and BMI, follow-up studies may consider including measures such as waist circumference and fat-free body weight in IAPI risk assessment to guide the clinical nursing work more scientifically.

Comparison of four risk assessment scales in predicting the risk of intraoperative acquired pressure injury in adult surgical patients: a prospective study.

OBJECTIVE: To develop and compare four predictive models for intraoperative acquired pressure injury (IAPI) in surgical patients. METHODS: One hundred patients undergoing various surgeries (hepatobiliary, pancreas, spleen, gastrointestinal, and cardiac surgeries) at Ruijin Hospital from November 2021 to September 2022 were included in this prospective cohort study. Four pressure injury risk assessment scales were used to measure the pressure injury risk: the Braden scale, Munro Pressure Injury Risk Assessment Scale, Scott Triggers tool, and CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale. The patients were divided into the IAPI group and non-IAPI group. RESULTS: In total, 37% of patients (37/100) developed class I/stage pressure injury (erythema) after surgery, which resolved within 2 hours after surgery in 86.49% of cases and further progressed to class II/stage or higher pressure injury within 6 days in 15.63% of cases. The application effects of the four commonly used risk assessment tools were compared with the sensitivity, specificity, and area under the receiver operating characteristic curve. The Munro Scale showed the best sensitivity and area under the receiver operating characteristic curve among the four tools for postoperative assessment, but its specificity was only 20.63. CONCLUSIONS: More appropriate assessment tools are required for IAPI risk evaluation.

Double-balloon enteroscopy reliably directs surgical intervention for patients with small intestinal bleeding.

AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention. METHODS: We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding. RESULTS: Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 (96%) patients. Enteroscopy provided accurate localization of the bleeding in 53 (95%) of 56 patients, but failed to disclose the cause of bleeding in 4 (7%). There was one case with negative intraoperative finding (2%). Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor (GIST) was most frequently diagnosed (55%). CONCLUSION: Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.

[Value of enteroscopy in localization diagnosis of small intestinal hemorrhage].

OBJECTIVES: To study the value of enteroscopy in determining bleeding lesion of small intestine. METHODS: Clinical data of ten cases with small intestinal bleeding diagnosed by enteroscopy were analyzed retrospectively from June 2003 to June 2004. RESULTS: Bleeding sites disclosed by enteroscopy were consistent with those confirmed by operation in 10 patients,but qualitative diagnosis was not consistent in 2 patients. CONCLUSIONS: Enteroscopy is a safe,reliable and valuable modality for diagnosing bleeding lesion of small intestine.