Measuring tissue perfusion during pressure relief maneuvers: Insights into preventing pressure ulcers
Measuring tissue perfusion during pressure relief maneuvers: Insights into preventing pressure ulcers
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DOI：
10.1080/10790268.2007.11754584
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发表时间：
2007-01-01
影响因子：
1.7
通讯作者：
Lin, Fang
中科院分区：
文献类型：
--
作者：
Makhsous, Mohsen;Priebe, Michael;Lin, Fang
背景/目的：研究与机械自动动态压力释放系统相比，使用标准轮椅俯卧撑缓解界面压力对组织灌注的影响。设计：在 2 个方案中对 3 组受试者进行重复测量。参与者：20 名 T4 以下的运动完全性截瘫患者、20 名运动完全性四肢瘫痪患者和 20 名身体健全的受试者。 方法：两个 1 小时坐姿方案：动态方案，坐姿每 10 分钟在正常坐姿和减负姿势之间交替；轮椅俯卧撑方案，正常坐姿，标准轮椅俯卧撑每 20 分钟一次。主要结果指标：从坐骨结节上方的臀部测量经皮氧分压和二氧化碳分压，以及在座椅靠背和臀部测量界面压力。计算界面压力变化期间的灌注恶化和恢复时间。结果：在卸载配置中，正常坐姿期间的集中界面压力显着减少，并且组织灌注显着改善。轮椅俯卧撑显示界面压力完全缓解，但组织灌注恢复不完全。结论：界面压力分析并不能提供有关压力缓解操作有效性的完整信息。组织灌注的测量可能有助于建立更有效的策略。标准轮椅俯卧撑所实现的缓解可能不足以恢复坐姿期间受损的组织灌注；可能需要进行交替操作。动态座椅系统提供有效的压力释放，持续降低界面压力，足以完全恢复组织灌注。脊髓损伤 (SCI) 受试者和对照组之间灌注恢复时间的差异引发了关于 SCI 后血管对压力反应变化的重要性的问题。
Background/Objective: To study the effect on tissue perfusion of relieving interface pressure using standard wheelchair pushups compared with a mechanical automated dynamic pressure relief system. Design: Repeated measures in 2 protocols on 3 groups of subjects. Participants: Twenty individuals with motor-complete paraplegia below T4, 20 with motor-complete tetraplegia, and 20 able-bodied subjects.Methods: Two 1-hour sitting protocols: dynamic protocol, sitting configuration alternated every 10 minutes between a normal sitting configuration and an off-loading configuration; wheelchair pushup protocol, normal sitting configuration with standard wheelchair pushup once every 20 minutes.. Main Outcome Measures: Transcutaneous partial pressures of oxygen and carbon dioxide measured from buttock overlying the ischial tuberosity and interface pressure measured at the seat back and buttocks. Perfusion deterioration and recovery times were calculated during changes in interface pressures.Results: In the off-loading configuration, concentrated interface pressure during the normal sitting configuration was significantly diminished, and tissue perfusion was significantly improved. Wheelchair pushups showed complete relief of interface pressure but incomplete recovery of tissue perfusion.Conclusions: Interface pressure analysis does not provide complete information about the effectiveness of pressure relief maneuvers. Measures of tissue perfusion may help establish more effective strategies. Relief achieved by standard wheelchair pushups may not be sufficient to recover tissue perfusion compromised during sitting; alternate maneuvers may be necessary. The dynamic seating system provided effective pressure relief with sustained reduction in interface pressure adequate for complete recovery of tissue perfusion. Differences in perfusion recovery times between subjects with spinal cord injury (SCI) and controls raise questions about the importance of changes in vascular responses to pressure after SCI.