【摘要】 目的 探讨3种不同材质枕头在预防神经内科重症监护室(neurological intensive care unit, NICU)患者枕部压力性损伤(pressure injury, PI)的应用效果。方法 采用便利抽样法，选取2022年7月—2023年5月河南省某三级甲等医院NICU收治的234例患者作为研究对象。采用随机数字表法将其分为棉花枕组、水枕组、凝胶枕组，各78例，在常规护理的基础上，分别使用棉花枕、水枕和凝胶枕预防患者枕部PI的发生。比较3组患者枕部压力、枕部PI发生率、枕部皮温、头皮潮湿感。结果 本研究最终纳入208例患者，其中棉花枕组75例、水枕组66例、凝胶枕组67例。(1)棉花枕最大压力、最小压力、平均压力分别为(24.31±9.98)mmHg(1 mmHg≈0.133 kPa)、(10.91±4.01)mmHg、(16.31±5.63)mmHg;水枕组最大压力、最小压力、平均压力分别为(33.96±11.11)mmHg、(17.47±6.07)mmHg、(23.20±6.12)mmHg;凝胶枕最大压力、最小压力、平均压力分别为(19.05±12.03)mmHg、(6.70±2.89)mmHg、(11.92±4.36)mmHg, 3组间最大压力、最小压力、平均压力比较差异均有统计学意义(P<0.001);3组间进行两两比较，结果显示，棉花枕组vs水枕组、棉花枕组vs凝胶枕组、水枕组vs凝胶枕组，最大压力比较差异均有统计学意义(t=5.433、P<0.001,t=2.846、P<0.05,t=7.423、P<0.001);最小压力比较差异均有统计学意义(t=7.654、t=7.101、t=13.100,P<0.001);平均压力比较差异均有统计学意义(t=6.961、t=5.150、t=12.260,P<0.05)。(2)棉花枕组、水枕组、凝胶枕组枕部PI发生率分别为2.67%、4.55%、0,差异无统计学意义(P>0.05)。(3)棉花枕组、水枕组、凝胶枕组的枕部皮温分别为(36.31±1.01)℃、(36.58±0.56)℃、(36.47±0.47)℃,差异无统计学意义(P>0.05)。(4)3组枕部头皮潮湿感比较差异有统计学意义(P<0.001);两两进行组间比较，棉花枕组vs水枕组、棉花枕组vs凝胶枕组差异均有统计学意义(P<0.001);水枕组vs凝胶枕组差异无统计学意义(P>0.05)。结论 NICU患者使用棉花枕、水枕、凝胶枕均是安全的，但使用凝胶枕时枕部承受压力、PI发生率最低，而棉花枕在降低患者头皮潮湿感中的效果最好。更多还原

【Abstract】 Objective To explore the application effect of pillows made of three different materials in the occipital pressure injury(PI) of patients in neurocritical ICU(NICU). Methods A total of 234 patients admitted to NICU of a Grade-A tertiary hospital in Zhengzhou city from July 2022 to May 2023 were selected as study subjects. The patients were divided into 3 groups by random number table method, with 78 cases in each group. Based on conventional care, cotton pillows, water pillows, and gel pillows were used, respectively.Pillow pressure, incidence of occipital PI, occipital skin temperature, and scalp dampness sensation were compared among 3 groups(cotton pillow, water pillow, gel pillow).Results A total of 208 patients were finally included, in which 75 cases of cotton pillow, 66 cases of water pillow, and 67 cases of gel pillow.(1)The maximum pressure, minimum pressure, and average pressure of the cotton pillow were(24.31±9.98) mmHg(1 mmHg≈0.133 kPa),(10.91±4.01)mmHg, and(16.31±5.63)mmHg, respectively; The maximum pressure, minimum pressure, and average pressure of the pillow group were(33.96±11.11)mmHg,(17.47±6.07)mmHg, and(23.20±6.12)mmHg, respectively.There were statistically significant differences in the comparisons of maximum pressure, minimum pressure, and average pressure among 3 groups(P<0.001).Pairwise comparisons were made among 3 groups, and the results showed that there were statistically significant differences in the maximum pressure comparisons between the cotton pillow group and the water pillow group, the cotton pillow group and the gel pillow group, and the water pillow group and the gel pillow group(t=5.433,P<0.001;t=2.846,P<0.05;t=7.423, P<0.001);The differences in the minimum pressure comparisons were statistically significant(t=7.654,t=7.101,t=13.100;P<0.001);Comparison of average pressure differences were all statistically significant(t=6.961,t=5.150,t=12.260;P<0.05).(2)The incidence of pressure injury of cotton pillow, water pillow, and gel pillow groups was 2.67%, 4.55%, and 0%, respectively, with no statistical significance(P>0.05).(3)The occipital skin temperatures of cotton pillow, water pillow and gel pillow groups were(36.31±1.01) ℃,(36.58±0.56) ℃,and(36.47±0.47) ℃, respectively, and there was no significant difference(P>0.05).(4)Comparison of occipital skin moisture sensation difference among 3 groups was statistically significant(P<0.001); Pair-to-group comparison showed that there were statistically significant differences between cotton pillow and water pillow groups, and between cotton pillow and gel pillow groups(P<0.001), while there was no statistically significant difference between water pillow and gel pillow groups(P>0.05). Conclusion It is safe for NICU patients to use cotton pillows, water pillows, and gel pillows. and the incidence of occipital pressure and PI in patients using gel pillow is the lowest, and cotton pillows have the best effect in reducing the moisture sensation of the patient’s scalp.更多还原