Nursing technique for promoting wound healing of pressure ulcer-Development of a new animal model to elucidate effectiveness of shear to the wound healing-

政府在2002年引入了惩罚制度，惩罚未能遵守压疮管理三项任务的人。由于这个系统，成功地降低了PU的患病率，并缩短了愈合时间。然而，到目前为止，顽固性脓液仍然存在。PU愈合的延迟因素之一是剪切。在护理干预中不可避免地会发生剪切力，例如将患者置于抬头姿势或改变姿势。在临床环境中，由于传感器的限制，很难监测剪切力。因此，研究人员试图建立一种新的动物模型来阐明剪切对伤口愈合的影响。首先，我们利用我们原有的动物模型，在侧翼区域施加8 kg压力和0.5，1，1.5 kg向尾侧的剪切6小时，来研究剪切力的强度与PU愈合的关系。高剂量组创面因组织坏死和浅表溃疡形成而延迟愈合。真皮乳头变平，可见红细胞渗出和血栓形成。到第14天，真皮中平行于皮肤表面的胶原纤维以及皮下和肌肉层坏死。其次，我们试图测量压力和剪切负荷引起的红肿强度。使用近红外线设备和成像软穿戴，我们将红色的强度从主观值转换为客观值。近红外线对坏死组织的透过率相对值为31-71%。创面无坏死组织者占90~122%。根据这些结果，计算了预测效度，并显示出良好的效度(符合率：75%)。此外，我们还尝试将动物模型的结果合并到有限元模型中。在简单加载条件下完成了样机模型。

Government introduced penalty system for failure to comply with the three tasks for pressure ulcer (PU) management in 2002. Owing to this system, the prevalence of PU successfully reduced and a healing time was also shortened. However, refractory Pus have remained to date. One of the delayed factors for PU healing is shear. Shear forces occur inevitably with nursing interventions such as positioning patients in head-elevated positions or position changes. In clinical settings, it is very difficult to monitor shear forces because of a limited sensor. Thus, researches try to develop a new animal model to elucidate effectiveness of shear to the wound healing. Firstly, we examined the relationship between the intensity of the shear force and PU healing using our original animal model Eight kg of pressure and 0.5, 1, 1.5 kg shear toward the caudal side were applied for 6 hours to the flank region. The higher group's wound healing was delayed by the necrotic tissue and the shallow ulcer development. Papillary dermis was flat and extravasations of red blood cells and thrombosis were seen. Collagen fibers in the dermis paralleled skin surface and subcutaneous and muscle layer necrosis were seen up to Day 14. Secondarily, we tried to measure the intensity of redness resulting from pressure and shear loading. Using a near-infrared device and an imaging soft wear, we converted the intensity of the redness from subjective values to objective values. The relative values of permeability of near-infrared rays in the necrotic tissues were 31 -71%. While those in the wound without necrotic tissue were 90-122%. According to these results, the predictive validity was calculated and demonstrated good validity (agreement rate: 75%). Moreover, we tried to incorporate the animal model results into a finite element model. A prototyped model was completed under the simple loading.