Lesões por pressão no intraoperatório de craniotomias : incidência e fatores de risco
Arquivos
Data
2017-07-27
Autores
Guarise, Vanessa 
Orientadores
Diccini, Solange
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Pacientes submetidos à craniotomia podem desenvolver lesão por pressão (LP) no intraoperatório. Objetivo: Avaliar a incidência e os fatores de risco da lesão por pressão no intraoperatório de pacientes submetidos à craniotomia. Método: Estudo prospectivo realizado nas unidades de internação hospitalar, no centro cirúrgico e nas unidades de pós-operatório de um hospital geral privado de São Paulo. O cálculo da amostra foi de 119 pacientes. Foram incluídos pacientes maiores de 18 anos, submetidos a cirurgias eletivas de craniotomia com tempo cirúrgico maior igual a duas horas e sem LP no pré-operatório. Após indução anestésica, o paciente foi posicionado com dispositivos de proteção de pele ajustados ao corpo. Ao final da cirurgia, esses dispositivos foram retirados e a pele do paciente foi avaliada em relação ao desenvolvimento, local e estágio da LP. Os pacientes foram acompanhados no período de 72 horas do pós-operatório (PO), com monitoramento diário em relação à LP. Resultados: Participaram do estudo 134 pacientes, dos quais 119 foram avaliados. A média da idade dos pacientes foi de 52,6 anos, e 52,1% eram do sexo feminino. A maioria dos pacientes (81,5%) foram posicionados em decúbito dorsal. O tempo médio de cirurgia foi de 234,5 minutos. Quanto ao porte da cirurgia, 62,2% dos pacientes foram classificados em porte II, 26,9% como porte III e 10,9% como porte IV. Ao término da cirurgia, 60,5% dos pacientes apresentaram LP. Todas as 140 LP foram classificadas como estágio I. Os locais da LP mais frequentes foram: região do calcâneo (26,5%), sacral (23,6%), olécrano (18,6%) e escapular (15,0%). Após 24 horas de PO, a incidência de LP foi de 5,0% e após 48 e 72 horas de PO, a incidência foi de 2,5% para ambos os períodos. Todas as LP apresentadas foram classificadas em estágio I. O único fator de risco do paciente submetido à craniotomia no intraoperatório foi o porte cirúrgico, porte III e porte IV. Conclusão: A incidência de LP no intraoperatório de craniotomias foi alta, porém todas as lesões foram classificadas como estágio 1. As áreas com maior incidência de LP foram a região do calcâneo e a região sacral. As cirurgias de porte III e IV foram fatores de risco para o aparecimento de LP. A utilização de dispositivos de proteção de pele no intraoperatório auxiliou na prevenção de LP em outros estágios.
Patients undergoing craniotomy may develop pressure injury (PI) on intraoperative. Objective: Evaluate the incidence and the risk factors of PI, in intraoperative of patients undergoing craniotomy. Methods: This prospective study was carried out in hospital admission units, in the surgical center and in the postoperative units at a private general hospital in São Paulo, Brazil. The sample was calculated for 119 patients. Patients over 18 years undergoing elective craniotomy surgery lasting longer than two hours and without PI in preoperative were included. After anesthetic induction, the patient was positioned with skin protecting devices. After surgery, these devices were removed and the skin was evaluated in relation to the development, location and stage of the PI. The patients were followed up within 72 hours postoperatively, with daily monitoring of PI. Results: 134 patients participated in the study, of which 119 were evaluated. The average age was 52.6 years and 52.1% were female. Most of the patients (81.5%) were in dorsal decubitus position. Surgical time averaged 234.5 minutes. Concerning surgical risks, 62.2% of patients were classified into risk II, 26.9% risk III and 10.9% risk IV. At the end of the surgery 60.5% patients had PI. All 140 PI were classified as stage I. The most common PI sites were: heels (26.5%), sacrum (23.6%), olecranon (18.6%) and scapular region (15.0%). After 24 hours postoperative the incidence of PI was 5.0% and after 48 and 72 hours of postoperative, the incidence was 2.5% for both periods. All PI were classified as stage I. The only risk factor of the patient undergoing intraoperative craniotomy was the surgical risk, risk III and risk IV. Conclusion: The incidence of PI in the intraoperative craniotomies was high, but all the lesions were classified as stage I. The regions with the highest incidence of PI were the heels and the sacral region. Surgical risk III and IV had risk factors for PI development. The use of intraoperative skin protection devices helped to prevent PI in other stages.
Patients undergoing craniotomy may develop pressure injury (PI) on intraoperative. Objective: Evaluate the incidence and the risk factors of PI, in intraoperative of patients undergoing craniotomy. Methods: This prospective study was carried out in hospital admission units, in the surgical center and in the postoperative units at a private general hospital in São Paulo, Brazil. The sample was calculated for 119 patients. Patients over 18 years undergoing elective craniotomy surgery lasting longer than two hours and without PI in preoperative were included. After anesthetic induction, the patient was positioned with skin protecting devices. After surgery, these devices were removed and the skin was evaluated in relation to the development, location and stage of the PI. The patients were followed up within 72 hours postoperatively, with daily monitoring of PI. Results: 134 patients participated in the study, of which 119 were evaluated. The average age was 52.6 years and 52.1% were female. Most of the patients (81.5%) were in dorsal decubitus position. Surgical time averaged 234.5 minutes. Concerning surgical risks, 62.2% of patients were classified into risk II, 26.9% risk III and 10.9% risk IV. At the end of the surgery 60.5% patients had PI. All 140 PI were classified as stage I. The most common PI sites were: heels (26.5%), sacrum (23.6%), olecranon (18.6%) and scapular region (15.0%). After 24 hours postoperative the incidence of PI was 5.0% and after 48 and 72 hours of postoperative, the incidence was 2.5% for both periods. All PI were classified as stage I. The only risk factor of the patient undergoing intraoperative craniotomy was the surgical risk, risk III and risk IV. Conclusion: The incidence of PI in the intraoperative craniotomies was high, but all the lesions were classified as stage I. The regions with the highest incidence of PI were the heels and the sacral region. Surgical risk III and IV had risk factors for PI development. The use of intraoperative skin protection devices helped to prevent PI in other stages.
Descrição
Citação
CUNHA, Vanessa Guarise. Lesões por pressão no intraoperatório de craniotomias : incidência e fatores de risco. 2017. [65] p. Dissertação (Mestrado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.