Protocol for the successful treatment of pressure ulcers.
Protocol for the successful treatment of pressure ulcers.
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DOI：
10.1016/s0002-9610(03)00285-x
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发表时间：
2004-07-01
影响因子：
3
通讯作者：
Lyder, Courtney
中科院分区：
文献类型：
--
作者：
Brem, Harold;Lyder, Courtney
患有压疮的卧床病人死亡的可能性几乎是没有压疮的病人的两倍。如果在早期识别时采用综合方案治疗压疮，几乎所有IV期溃疡都可以避免。此外，这样的方案可以显著降低由IV期溃疡引起的合并症、死亡率和治疗成本。溃疡进展到IV期后的合并症治疗费用远远超过溃疡进展到早期之前的早期治疗费用。我们在此描述了压疮的4个阶段，以及与这些伤口相关的发病机制，费用和并发症。一个全面的12步详细的协议治疗压疮的描述，这包括认识到，每一个病人与有限的流动性是在发展中国家的骶骨，坐骨，转子，或足跟溃疡的风险，每日评估的皮肤，客观测量的每一个伤口，立即启动一个治疗方案，机械清创所有无活力的组织，建立一个潮湿的伤口愈合环境，为营养不良的病人提供营养补充;减轻伤口的压力;消除引流和蜂窝组织;为伤口对传统疗法无效的病人提供生物疗法;物理疗法;以及姑息治疗。所描述的治疗方式的可用性，结合早期识别和定期监测，确保快速愈合，并最大限度地减少发病率，死亡率和成本。
Bed-bound patients with pressure ulcers are almost twice as likely to die as are those without pressure ulcers. If pressure ulcers are treated with a comprehensive regimen upon early recognition, nearly all stage IV ulcers can be avoided. Furthermore, such a regimen can significantly reduce the comorbidities, mortalities, and costs of treatments resulting from stage IV ulcers. The costs of treatments for comorbidities after the ulcer progresses to stage IV far outweigh the costs for early treatment of the ulcer before it progresses beyond the early stages. We describe herein the 4 stages of pressure ulcers, as well as the pathogeneses, costs, and complications associated with these wounds. A comprehensive 12-step detailed protocol for treatment of pressure ulcers is described; this includes recognizing that every patient with limited mobility is at risk for developing a sacral, ischial, trochanteric, or heel ulcer; daily assessment of the skin; objective measurement of every wound; immediate initiation of a treatment protocol; mechanical debridement of all nonviable tissue; establishment of a moist wound-healing environment; nutritional supplementation for malnourished patients; pressure relief for the wound; elimination of drainage and cellulitus; biological therapy for patients whose wounds fail to respond to more traditional therapies; physical therapy; and palliative care. Availability of the described treatment modalities, in combination with early recognition and regular monitoring, ensures rapid healing and minimizes morbidity, mortality, and costs.