Pressure Ulcer

Pressure Ulcer也就是bedsore或decubitus ulcer
通常在住院時期前2週發生，在短短2-6小時之內就可能出現pressure ulcer，一旦發生就很難復原
所以最重要的就是預防啦！

Risk factor
1.immobility
2.limited activity
3.impaired nutritional status
4.impaired circulation
5.altered level of consciousness

預防包括兩部分
1.skin care:注意bony prominence的部分，減少皮膚曝露在潮溼的狀況下(如:失禁，流汗，傷口drainage)
2.relieving or redistributing pressure:最少2小時要翻一次身，坐輪椅的病人1小時就要改變姿勢一次
睡氣墊床

stage I - intact skin , nonblanchable erythema (只在epidermis)
stage II - extension through epidermis, shallow ulcer(吃到dermis未超出)
stage III - full thickness without extension through fascia(吃出dermis到subcutaneous)
stage IV - full thickness with destruction of underlying tissue(muscle.bone.tendon)

治療

-pressure relieving device
-occlusive dressing
-pain control
-normal saline for clean,
-use of topical agent promote wound healing
(silver sulfadiazine,bacitracin zinc,Neosporin,Polysporin)
-removal of necrotic debris
-注意:避免會妨礙傷口癒合的東西(antiseptic agents,如H2O2,Dakin solution)


-protein intake 1.25-1.5g/kg/day
-vitaimn C 500mg PO daily
-zinc sulate 220mg PO daily

如果經過2-4週治療後還一直有exudate或沒有癒合
可以考慮2 week trial of topical antibiotics(silver sulfadiazine, double antibiotics)


electircal stimulation,radiant heat,negative pressure therapy,surgical intervention