摘要目的:比较手术室系统化护理和常规护理在降低脊柱骨折伴脊髓损伤患者术中压力性损伤中效果。方法:采用回顾性病例对照研究分析2018年1月至2019年12月西安交通大学附属红会医院收治的285例颈椎或胸腰椎骨折伴脊髓损伤患者临床资料，其中男168例，女127例；年龄38～59岁[(47.8±8.5)岁]。患者均行后路减压植骨融合内固定术。138例实施手术室系统化护理，进行术前、术中和术后的系统化评估和管理(观察组)；147例实施常规术中护理，仅进行术中的压疮预防护理(对照组)。比较两组术后当天压力性损伤发生率、术后3 d损伤程度及损伤部位、术后当天和3 d损伤面积，其中损伤程度根据美国国家压疮顾问组(NPUAP)发布的新的压力性损伤分期评估。结果:观察组术后当天压力性损伤发生率[5.1%(7/138)]低于对照组[12.2%(18/147)]( P<0.05)。术后3 d损伤程度Ⅰ期、Ⅱ期、Ⅲ期压力性损伤发生率[2.9%(4/138)、2.2%(3/138)、0.0%]也均低于对照组[8.2%(12/147)、3.4%(5/147)、0.6%(1/147)]( P<0.05)。术后3 d两组膝部、胸部、面部和髂前上棘发生压力性损伤发生率差异均无统计学意义( P>0.05)，其中观察组面部和髂前上棘压力性损伤的总占比为71%(5/7)，对照组的总占比为83%(15/18)( P>0.05)。观察组的损伤面积在术后当天和术后3 d分别为(3.2±1.2)cm 2和(3.2±1.1)cm 2，均小于对照组[(5.1±1.5)cm 2、(5.1±1.4)cm 2]( P<0.01)。 结论:相比于常规术中护理方法，手术室系统化护理可显著降低或减少脊柱骨折合并脊髓损伤患者术中压力性损伤的发生率、损伤程度和损伤面积，值得临床推广应用。

abstractsObjective:To compare the effect of systematic nursing in operating room and routine nursing in reducing intraoperative stress injury in patients with spinal fracture and spinal cord injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 285 patients with cervical or thoracolumbar fracture associated with spinal cord injury admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2018 to December 2019, including 168 males and 127 females, with the age of 38-59 years [(47.8±8.5)years]. All patients underwent posterior decompression and fusion with internal fixation. Of all, 138 patients received systematic nursing in operating room including systematic evaluation and management before, during and after operation (observation group), and 147 patients received routine nursing including only intraoperative preventive care of pressure ulcer (control group). The incidence of pressure injury on the day after operation, degree of injury and location of injury at postoperative 3 days, and area of injury on the day after operation and at postoperative 3 days were compared between the two groups. The degree of injury was evaluated using the new stress injury staging assessment published by the American National Pressure Ulcer Advisory Panel (NPUAP).Results:The incidence of pressure injury in observation group [5.1% (7/138)] was lower than that in control group [12.2% (18/147)] on the day after operation ( P<0.05). The incidence of stage I, stage II, and stage III pressure injury in observation group [2.9% (4/138), 2.2% (3/138), 0.0%] was also lower than that in control group [8.2% (12/147), 3.4% (5/147), 0.6% (1/147)] at postoperative 3 days ( P<0.05). There was no significant difference in the incidence of pressure injury in the knee, chest, face and anterior superior iliac spine between the two groups ( P>0.05). The total proportion of pressure injury in the face and anterior superior iliac spine was 71% (5/7) in observation group, showing no significant difference from that in control group [83% (15/18)] ( P>0.05). The area of injury was (3.2±1.2)cm 2 and (3.2±1.1)cm 2 in observation group on the day after operation and at postoperative 3 days, lower than that in in control group [(5.1±1.5)cm 2 and (5.1±1.4)cm 2] ( P<0.01). Conclusion:Compared with the routine nursing, systematic nursing in operating room can significantly reduce the incidence, degree and area of intraoperative pressure injury in patients with spinal fracture accompanied by spinal cord injury, and deserves clinical promotion.