中华护理杂志 ›› 2025, Vol. 60 ›› Issue (8): 1012-1018.DOI: 10.3761/j.issn.0254-1769.2025.08.019
冉凌霄(
), 王东敏, 许珂, 王聪, 曹华, 寸薇, 蒋艳(
)
收稿日期:2024-11-04
出版日期:2025-04-20
发布日期:2025-04-22
*通讯作者:
蒋艳,E-mail:hxhljy2018@163.com作者简介:冉凌霄:女,本科(硕士在读),护士,E-mail:rlx3504815801@163.com
基金资助:
RAN Lingxiao(
), WANG Dongmin, XU Ke, WANG Cong, CAO Hua, CUN Wei, JIANG Yan(
)
Received:2024-11-04
Online:2025-04-20
Published:2025-04-22
摘要:
目的 对国内外基于人体三维模型的有限元分析(finite element analysis,FEA)在压力性损伤(pressure ulcer,PU)预防中应用的原始研究进行范围审查,旨在提供改善PU预防策略的新方向。 方法 系统检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库、维普医学数据库、Engineering Village Compendex等数据库,检索时限为建库至2024年7月29日。以澳大利亚乔安娜布里格斯研究所的范围综述指南为方法学框架,对结果进行分析和规范化报告。结果 纳入30篇文献。基于人体三维模型的FEA一般方法为建立几何模型、网格划分、定义材料属性、施加载荷和边界条件、方程求解。根据纳入研究的主要内容,基于人体三维模型的FEA在PU预防中的应用涉及风险人群识别(n=9)、体位管理(n=9)、预防性敷料(n=10)、支撑面(n=7)4个范畴。结论 基于人体三维模型的FEA为PU生物力学机制研究创造了条件,为临床预防措施的补充和优化提供了科学依据。未来研究应一方面加强临床实践与仿真技术的结合,另一方面需不断优化仿真技术和干预方案。
冉凌霄, 王东敏, 许珂, 王聪, 曹华, 寸薇, 蒋艳. 基于人体三维模型的生物力学仿真在压力性损伤预防中应用的范围综述[J]. 中华护理杂志, 2025, 60(8): 1012-1018.
RAN Lingxiao, WANG Dongmin, XU Ke, WANG Cong, CAO Hua, CUN Wei, JIANG Yan. Application of biomechanical simulation based on three-dimensional human body model in preventing pressure ulcers:a scoping review[J]. Chinese Journal of Nursing, 2025, 60(8): 1012-1018.
| [1] | Li ZY, Lin F, Thalib L, et al. Global prevalence and incidence of pressure injuries in hospitalised adult patients:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2020,105:103546. |
| [2] |
韩燕, 王怀远, 孙艳红, 等. 老年住院压力性损伤患者营养支持的最佳证据总结[J]. 中华护理杂志, 2022, 57(19):2339-2344.
DOI URL |
| Han Y, Wang HY, Sun YH, et al. Evidence summary of nutri-tional support for elderly inpatients with pressure injuries[J]. Chin J Nurs, 2022, 57(19):2339-2344. | |
| [3] | 韩琳, 裴菊红, 马玉霞, 等. 成人无创通气设备相关面部压力性损伤风险评估与预防指南[J]. 中华护理杂志, 2024, 59(17):2093-2095. |
| Han L, Pei JH, Ma YX, et al. Guideline for risk assessment and prevention of noninvasive ventilation related facial pre-ssure injuries in adults[J]. Chin J Nurs, 2024, 59(17):2093-2095. | |
| [4] | Keenan BE, Evans SL, Oomens CWJ. A review of foot finite element modelling for pressure ulcer prevention in bedrest:current perspectives and future recommendations[J]. J Tissue Viability, 2022, 31(1):73-83. |
| [5] | 王彩萍, 刘雅慧, 韩晓彤, 等. U型气囊垫的设计及在预防术中压力性损伤中的应用[J]. 中华护理杂志, 2018, 53(12):1519-1521. |
| Wang CP, Liu YH, Han XT, et al. Design and application of U-shaped gas-pad for prevention of intraoperative stress injury[J]. Chin J Nurs, 2018, 53(12):1519-1521. | |
| [6] |
Lockwood C, dos Santos KB, Pap R. Practical guidance for know-ledge synthesis:scoping review methods[J]. Asian Nurs Res, 2019, 13(5):287-294.
DOI PMID |
| [7] | Chen YF, Shen YX, Wang K, et al. Mechanical analysis of deep tissue injury during sitting in patients with spinal cord injury via parametric finite element model[J]. Biomech Model Mecha-nobiol, 2022, 21(5):1573-1584. |
| [8] |
Fougeron N, Connesson N, Chagnon G, et al. New pressure ulcers dressings to alleviate human soft tissues:a finite element study[J]. J Tissue Viability, 2022, 31(3):506-513.
DOI PMID |
| [9] | Gefen A, Krämer M, Brehm M, et al. The biomechanical effi-cacy of a dressing with a soft cellulose fluff core in prophy-lactic use[J]. Int Wound J, 2020, 17(6):1968-1985. |
| [10] | Jia JY, Gong SB, Zhang AL, et al. Stiffening of the gluteal muscle increased the intramuscular stress:an in-silico impli-cation of deep tissue injury[J]. Heliyon, 2023, 9(2):e13459. |
| [11] | Katz T, Gefen A. The biomechanical efficacy of a hybrid sup-port surface in protecting supine patients from sacral pre-ssure ulcers[J]. Int Wound J, 2023, 20(8):3148-3156. |
| [12] | Lee W, Won BH, Cho SW. Finite element modeling for predi-cting the contact pressure between a foam mattress and the human body in a supine position[J]. Comput Methods Bio-mech Biomed Engin, 2017, 20(1):104-117. |
| [13] |
Levy A, Frank MB, Gefen A. The biomechanical efficacy of dressings in preventing heel ulcers[J]. J Tissue Viability, 2015, 24(1):1-11.
DOI PMID |
| [14] |
Levy A, Gefen A. Computer modeling studies to assess whether a prophylactic dressing reduces the risk for deep tissue injury in the heels of supine patients with diabetes[J]. Ostomy Wound Manage, 2016, 62(4):42-52.
PMID |
| [15] | Levy A, Gefen A. Assessment of the biomechanical effects of prophylactic sacral dressings on tissue loads:a computational modeling analysis[J]. Ostomy Wound Manage, 2017, 63(10):48-55. |
| [16] | Levy A, Schwartz D, Gefen A. The contribution of a direc-tional preference of stiffness to the efficacy of prophylactic sacral dressings in protecting healthy and diabetic tissues from pressure injury:computational modelling studies[J]. Int Wound J, 2017, 14(6):1370-1377. |
| [17] |
Linder-Ganz E, Shabshin N, Itzchak Y, et al. Strains and stre-sses in sub-dermal tissues of the buttocks are greater in pa-raplegics than in healthy during sitting[J]. J Biomech, 2008, 41(3):567-580.
PMID |
| [18] |
Luboz V, Petrizelli M, Bucki M, et al. Biomechanical modeling to prevent ischial pressure ulcers[J]. J Biomech, 2014, 47(10):2231-2236.
DOI PMID |
| [19] |
Luboz V, Perrier A, Bucki M, et al. Influence of the calcaneus shape on the risk of posterior heel ulcer using 3D patient-specific biomechanical modeling[J]. Ann Biomed Eng, 2015, 43(2):325-335.
DOI PMID |
| [20] |
Moerman KM, van Vijven M, Solis LR, et al. On the impor-tance of 3D,geometrically accurate,and subject-specific finite element analysis for evaluation of in-vivo soft tissue loads[J]. Comput Methods Biomech Biomed Engin, 2017, 20(5):483-491.
DOI PMID |
| [21] | Peko L, Gefen A. Deep tissue loads in the seated buttocks on an off-loading wheelchair cushion versus air-cell-based and foam cushions:finite element studies[J]. Int Wound J, 2017, 14(6):1327-1334. |
| [22] | Peko L, Barakat-Johnson M, Gefen A. Protecting prone positio-ned patients from facial pressure ulcers using prophylactic dressings:a timely biomechanical analysis in the context of the COVID-19 pandemic[J]. Int Wound J, 2020, 17(6):1595-1606. |
| [23] | Ragan R, Kernozek TW, Bidar M, et al. Seat-interface pressures on various thicknesses of foam wheelchair cushions:a finite modeling approach[J]. Arch Phys Med Rehabil, 2002, 83(6):872-875. |
| [24] |
Schwartz D, Gefen A. An integrated experimental-computatio- nal study of the microclimate under dressings applied to intact weight-bearing skin[J]. Int Wound J, 2020, 17(3):562-577.
DOI PMID |
| [25] |
Sopher R, Nixon J, Gorecki C, et al. Exposure to internal muscle tissue loads under the ischial tuberosities during sitting is elevated at abnormally high or low body mass indices[J]. J Biomech, 2010, 43(2):280-286.
DOI PMID |
| [26] |
Sopher R, Nixon J, McGinnis E, et al. The influence of foot posture,support stiffness,heel pad loading and tissue mecha-nical properties on biomechanical factors associated with a risk of heel ulceration[J]. J Mech Behav Biomed Mater, 2011, 4(4):572-582.
DOI PMID |
| [27] | Sopher R, Nixon J, Gorecki C, et al. Effects of intramuscular fat infiltration,scarring,and spasticity on the risk for sitting-acquired deep tissue injury in spinal cord injury patients[J]. J Biomech Eng, 2011, 133(2):021011. |
| [28] | Su P, Lun QL, Lu D, et al. Biomechanical changes on the typ-ical sites of pressure ulcers in the process of turning over from supine position:theoretical analysis,simulation,and expe-riment[J]. Ann Biomed Eng, 2022, 50(6):654-665. |
| [29] |
Then C, Menger J, Benderoth G, et al. Analysis of mechanical interaction between human gluteal soft tissue and body supports[J]. Technol Health Care, 2008, 16(1):61-76.
PMID |
| [30] | van Zwam WGH, van Turnhout MC, Oomens CWJ. Risk factors for developing heel ulcers for bedridden patients:a finite element study[J]. Clin Biomech, 2020,78:105094. |
| [31] | Wagnac EL, Aubin CE, Dansereau J. A new method to generate a patient-specific finite element model of the human buttocks[J]. IEEE Trans Biomed Eng, 2008, 55(2 Pt 1):774-783. |
| [32] |
Zeevi T, Levy A, Brauner N, et al. Effects of ambient condi-tions on the risk of pressure injuries in bedridden patients-multi-physics modelling of microclimate[J]. Int Wound J, 2018, 15(3):402-416.
DOI PMID |
| [33] | 伦庆龙, 苏鹏, 卢达, 等. 辅助仰卧位侧翻过程压疮易发部位的生物力学建模与实验研究[J]. 中国生物医学工程学报, 2022, 41(3):310-319. |
| Lun QL, Su P, Lu D, et al. Biomechanical modeling and experimental study on the common sites of pressure ulcers in the process of assisted turning over from supine position[J]. Chin J Biomed Eng, 2022, 41(3):310-319. | |
| [34] | 田园, 梁慧敏, 程秀玲, 等. 侧卧角度对骶尾部软组织压力的有限元分析[J]. 中国矫形外科杂志, 2023, 31(6):533-537. |
| Tian Y, Liang HM, Cheng XL, et al. A finite element analysis on sacrococcygeal soft tissue pressure at different lateral positioning angles[J]. Orthop J China, 2023, 31(6):533-537. | |
| [35] |
Peko Cohen L, Ovadia-Blechman Z, Hoffer O, et al. Dressings cut to shape alleviate facial tissue loads while using an oxygen mask[J]. Int Wound J, 2019, 16(3):813-826.
DOI PMID |
| [36] | Grigatti A, Gefen A. The biomechanical efficacy of a hydro-gel-based dressing in preventing facial medical device-related pressure ulcers[J]. Int Wound J, 2022, 19(5):1051-1063. |
| [37] | 梁循, 李志莹, 蒋洪迅. 基于图的点云研究综述[J]. 计算机研究与发展, 2024, 61(11):3870-3896. |
| Liang X, Li ZY, Jiang HX. Research on graph-based point cloud:a survey[J]. J Comput Res Dev, 2024, 61(11):3870-3896. | |
| [38] | 聂文忠, 张绍祥, 王成焘. 基于冷冻切片的人体腰椎三维有限元模型[J]. 医用生物力学, 2007, 22(3):260-263. |
| Nie WZ, Zhang SX, Wang CT. Construction of 3D lumbar finite element model based on cryosegmentation[J]. J Med Biomech, 2007, 22(3):260-263. | |
| [39] | Young T. The 30 degree tilt position vs the 90 degree lateral and supine positions in reducing the incidence of non-blanching erythema in a hospital inpatient population:a randomised controlled trial[J]. J Tissue Viability, 2004, 14(3):88-96. |
| [40] |
周艳, 郭方达, 林晶晶. 智能体压测量床垫的设计和应用[J]. 中华护理杂志, 2023, 58(12):1533-1536.
DOI URL |
|
Zhou Y, Guo FD, Lin JJ, et al. Design and application of the intelligent body pressure measuring mattress[J]. Chin J Nurs, 2023, 58(12):1533-1536.
DOI URL |
|
| [41] |
江小琼, 蔡福满, 侯祥庆, 等. 皮肤监测温度在压力性损伤风险预警中的应用研究[J]. 中华护理杂志, 2020, 55(1):32-38.
DOI URL |
|
Jiang XQ, Cai FM, Hou XQ, et al. Application research of skin temperature monitoring in early warning of pressure injury[J]. Chin J Nurs, 2020, 55(1):32-38.
DOI URL |
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