Use of high-resolution, high-frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development.
Use of high-resolution, high-frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development.
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DOI：
10.1097/00129334-200611000-00010
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发表时间：
2006-11-01
影响因子：
2.4
通讯作者：
Dyson, Mary
中科院分区：
文献类型：
--
作者：
Quintavalle, Paul R;Lyder, Courtney H;Dyson, Mary
目的：利用高分辨率超声研究压疮的发病机制，并探索该技术在临床症状出现前检测早期压疮的实用性。设计：一项观察性前瞻性研究，比较了从119名确定有压疮发生风险的长期护理机构居民中获得的高分辨率超声图像（Braden量表评分为18或更低），图像来自15名健康志愿者（医学生和住院医师）。常见的压疮网站进行了扫描，包括脚跟，骶骨，坐骨结节。设置：一个医疗中心和一个长期的护理facility.INTERVENTION：解剖部位普遍接受的压疮发展的风险进行了扫描，使用高分辨率超声，该网站没有皮肤破裂的视觉证据。将从长期护理机构居民获得的图像与从健康志愿者获得的正常图像进行比较。此外，红斑的临床评估结果的文件进行了审查，记录，并与高分辨率超声发现为每个特定sitems.MEASUREMENTS：所获得的图像被分类为不可读，正常，或异常。分类为异常的图像进一步按异常发现的深度分类：模式1（深）或模式2（浅）。对分类为异常发现模式1（深部）的图像进行进一步分类，并根据异常发现的解剖位置进行细分：亚组1，仅真皮下区域的异常发现;亚组2，真皮下和真皮异常发现;亚组3，真皮下、真皮和表皮下水肿。模式2（浅表）包括图像与异常发现仅限于真皮/表皮junction.Results：630（55.3%）的长期护理居民获得的图像是不同的，从健康志愿者获得的图像。被分类为正常的健康志愿者的图像具有预期的超声结果，即超声反射的均匀模式，允许可视化各种皮肤层（表皮、浅表乳头状真皮、深层网状真皮和皮下组织）和皮下组织（真皮下）。然而，从有压疮发展风险的居民中获得的许多图像（55.3%）具有不同皮肤层内区域不可见的模式，被指示液体或水肿的区域中断。此外，大多数图像（79.7%）与异常的超声模式没有文件的红斑。结论：高分辨率超声是一种有效的工具，调查皮肤和软组织的变化与记录的发病机制的压力溃疡。压疮的发展是一个由深至浅的真皮层，再至表皮层的渐进过程。真皮水肿仅存在于真皮下水肿。换句话说，在没有皮下水肿的情况下，从未有过真皮水肿的证据。通过使用高分辨率超声在可见的临床体征之前检测软组织损伤和水肿，更好地了解压疮的发病机制，可以更早，更有针对性地制定压疮预防计划，从而减少疼痛和痛苦，提高患者的生活质量并节省伤口护理成本。
OBJECTIVES: To investigate the pathogenesis of pressure ulcers utilizing high-resolution ultrasound and to explore the utility of this technology for the detection of incipient pressure ulcers prior to visual clinical signs.DESIGN: An observational prospective study comparing high-resolution ultrasound images obtained from 119 long-term-care facility residents determined to be at risk for pressure ulcer development (Braden Scale score of 18 or less) with images obtained from 15 healthy volunteers (medical students and medical residents). Common pressure ulcer sites were scanned, including the heels, sacrum, and ischial tuberosity.SETTING: A medical center and a long-term-care facility.INTERVENTION: Anatomic sites universally accepted as at risk for pressure ulcer development were scanned using high-resolution ultrasound; the sites did not have visual evidence of skin breakdown. The images obtained from the long-term-care facility residents were compared with images considered normal that were obtained from healthy volunteers. In addition, documentation of the clinical assessment finding for erythema was reviewed, recorded, and compared with the high-resolution ultrasound finding for each specific site.MEASUREMENTS: The images obtained were classified as not readable, normal, or abnormal. The images classified as abnormal were further classified by depth of abnormal finding: pattern 1 (deep) or pattern 2 (superficial). The images classified with the abnormal finding pattern 1 (deep) were further classified and subdivided by anatomic location of abnormal finding(s): subgroup 1, abnormal findings in the subdermal area only; subgroup 2, subdermal and dermal abnormal findings; and subgroup 3, subdermal, dermal, and subepidermal edema. Pattern 2 (superficial) included images with abnormal findings limited to the dermal/epidermal junction.RESULTS: 630 (55.3%) of the images obtained from the long-term-care residents were different from the images obtained from the healthy volunteers. The healthy volunteers' images classified as normal had the expected ultrasound findings for homogeneous pattern of ultrasound reflections, allowing for visualization of various skin layers (epidermis, superficial papillary dermis, deep reticular dermis, and hypodermis) and subcutaneous tissue (subdermal). However, many images (55.3%) obtained from the residents at risk for pressure ulcer development had patterns where areas within the various skin layers were not visible, interrupted by areas indicative of fluid or edema. Moreover, most images (79.7%) with abnormal ultrasound patterns did not have documentation of erythema.CONCLUSION: High-resolution ultrasound is an effective tool for the investigation of skin and soft tissue changes consistent with the documented pathogenesis of pressure ulcers. A progressive process for pressure ulcer development from deep subdermal layers to superficial dermal then epidermal layers can be inferred. Dermal edema was only present with subdermal edema. In other words, there was never evidence of dermal edema in the absence of subdermal edema. A better understanding of the pathogenesis of pressure ulcers through the use of high-resolution ultrasound to detect soft tissue damage and edema before visible clinical signs could lead to earlier and more focused pressure ulcer prevention programs, resulting in reduced pain and suffering for improved patient quality of life and wound care cost savings.