【摘要】 目的 探究基于Langer线的无损伤针穿刺体位对肿瘤化疗患者输液港难免性黏胶相关皮肤损伤的预防效果。方法 通过平行胸部Langer线对床头抬高60～90°和平卧位穿刺进行皮肤软组织力学、表皮屏障功能理论分析，然后选取2019年5月至2020年5月南京医科大学第一附属医院肿瘤科79例植入胸壁输液港、既往应用Ⅳ3000及液体敷料皮肤保护性屏障仍出现输液港黏胶相关性皮肤损伤的患者为研究对象。采用前瞻性自身前后对照，干预前采用平卧位穿刺，干预后床头抬高60～90°穿刺，比较两种穿刺体位对输液港黏胶相关性皮肤损伤预防效果和带针期间舒适度的影响。结果 干预后患者输液港黏胶相关性皮肤相关性损伤总发生率较干预前显著降低(P<0.001),机械性损伤发生率、接触性皮炎发生率较干预前显著降低(均P<0.05),输液港带针期间舒适度较干预前明显提高(P<0.001),且不增加患者穿刺时的疼痛感(P=0.692)。结论 床头抬高60～90°穿刺可降低肿瘤化疗患者输液港难免性黏胶相关皮肤损伤，提高患者带针期间的舒适度。更多还原

【Abstract】 Objective To observe the effect of different patient’s position during injury-free needle insertion to preven unavoidable medical adhesive-related skin injuries(MARSI)among cancer patients undergoing chemotherapy based on Langer’s line. Methods Considering the medical adhesive products applied parallel to the direction of Langer’s lines, the mechanical properties of skin and soft tissue, and skin barrier function were analyzed for the needle insertion of supine and with the head of bed 60～90°. A total of 79 oncology patients from the First Affiliated Hospital of Nanjing Medical University, who had implanted infusion port on the chest wall and had experienced adhesive-related skin injuries despite the use of Ⅳ3000 and liquid dressing skin protective barriers from May 2019 to 2020 were included. A before-after prospective study design which identified a pre-intervention group with supine and post-intervention group with head of bed 60-90° for needle insertion were used, then the effects of patient positioning on MARSI prevention and the comfort degree were compared between the two positions. Results The total incidence of MARSI was significantly lower after intervention than before(P<0.001). Both the rates of mechanical injuryand dermatitiswere significantly decreased in post-intervention group(P<0.05). The comfort levels were significantly improved after the interventionas well(P<0.001), while the pain associated with needle insertion was similar between the two groups(P=0.692). Conclusions For patient positioning during needle insertion on the chest wall of oncology patients undergoing chemotherapy, with head of the bed 60～90° is better for unavoidable MARSI prevention, affording a higher comfort.更多还原