Incidence and Clinical Symptoms of Hourglass and Sandwich-shaped Tissue Necrosis in Stage IV Pressure Ulcer.
Incidence and Clinical Symptoms of Hourglass and Sandwich-shaped Tissue Necrosis in Stage IV Pressure Ulcer.
复制标题
第四期压疮沙漏状和三明治状组织坏死的发病率和临床症状。
DOI：
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
H. Oka
中科院分区：
文献类型：
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作者：
T. Ohura;N. Ohura;H. Oka
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测量压疮中深部组织损伤 (DTI) 的压疮结果提高了作者对 DTI 的理解。作者的多学科团队还发现了以前未探索过的组织坏死模式。
目标
说明这些新的组织坏死模式并报告其在医院环境中的发生率。
方法
2002 年 6 月至 2006 年 6 月，日本一家医院的多学科伤口护理团队使用标准化护理方案对 326 个伴有深部组织损伤 (DTI) 的 IV 期压疮进行 CT 扫描和超声检查，以探讨进行性组织恶化的情况。
结果
发现并说明了压疮坏死的两种新模式。所有患者每两周由多学科团队连续检查和治疗。在连续样本的326例患者中，194例（60%）为常见DTI并伴有柱状坏死，其中7例夹在浅层和深层坏死之间相对健康的组织。其余132例（40%）有沙漏状坏死区，其中20例呈夹心状坏死。沙漏状坏死与骨突出处的剪切力和压力的组合有关。三明治状的沙漏状坏死通常看似可以治愈浅表组织，但会因深层坏死液化和脱落而重新开放。
结论
了解这些不同类型坏死的形态、恶化和愈合过程有助于团队识别和管理以前不可预测的 DTI，提高工作人员、患者和家人的期望，并减少对压疮发展的误解。
UNLABELLED
Measuring pressure ulcer outcomes for deep tissue injury (DTI) in pressure ulcers has improved the authors' understanding of DTI. The authors' multidisciplinary team has also identified previously unexplored patterns of tissue necrosis.
OBJECTIVE
Illustrate these new patterns of tissue necrosis and report their incidence in a hospital setting.
METHODS
Progressive tissue deterioration was explored using CT scans and ultrasonography of 326 Stage IV pressure ulcers with deep tissue injuries (DTI) managed by a multidisciplinary wound care team using standardized protocols of care in a Japanese hospital from June 2002 to June 2006.
RESULTS
Two new patterns of pressure ulcer necrosis were found and are illustrated. All patients were checked consecutively and treated by the multidisciplinary team every 2 weeks. Among the consecutive sample of 326 patients, 194 (60%) were common DTI with column-shaped necrosis, including 7 with relatively healthy tissue sandwiched between shallow and deep necrosis. The remaining 132 (40%) had hourglass-shaped area of necrosis, including 20 with sandwiched-shaped necrosis. Hourglass shaped necrosis was associated with a combination of shear forces and pressure over a bony prominence. Sandwich-shaped hourglass necrosis often appeared to heal the superficial tissue but was reopened with deep necrosis that liquified and sloughed.
CONCLUSION
Understanding the morphology and course of deterioration and healing of these different types of necrosis has helped the team recognize and manage previously unpredictable DTI, improving staff, patient, and family expectations, and reducing misunderstandings about pressure ulcer development.