What is pressure sores?
Who is prone to pressure sores? According to a guidelines for the treatment of pressure sores issued in 2014 by the European Pressure Ulcer Advisory Group (EPUAP) and the National Pressure Ulcer Advisory Group (NPUAP), pressure sores are local damage to the skin or/and subcutaneous tissue, usually located in the protruding part of the bone, caused by pressure or pressure combined shear force. Skin pressure ulcer is a universal problem in rehabilitation treatment and nursing.
According to relevant literature reports, about 60,000 people die each year from pressure sores syndrome. The prone parts of pressure sores occur mostly in the bone protrusion where there is no muscle wrapping or thin muscle layer, lack of adipose tissue protection and are often pressurized: (1) The supine position is good in the occipital protrusion, Scapular, elbow, spinal bulge, sacral tail, heel. (2) The lateral position is good in the ear, shoulder peak, elbow, ribs, hip, the inner and outer side of the knee joint and the internal and external ankle.
(3) The prostrate position is good in the ear, cheek, shoulder, female breast, male genitalia, iliac crest, knee, toe.
The susceptibility factors of pressure sores were, in turn, motor decrease, skin change and age increase, so long-term bedridden patients, patients with spinal cord injury and the elderly, especially elderly bedridden patients, became high-risk groups with pressure sores.
is pressure sores common? The literature shows that the incidence of pressure sores in comprehensive hospitals is 3%~14%, the incidence of pressure sores in patients with spinal cord injury is 25%~85%, and 8% is related to death, the incidence of pressure sores in patients with neurological diseases is 30%~60%, and the incidence of pressure sores in hospitalized elderly people is 10%~25%,
The mortality rate of elderly people with pressure sores increased 4 times times more than that of elderly people who did not have pressure sores, and the fatality rate of unhealed wound was 6 times times higher than that of wound healing.
The literature reported that 23% of nosocomial pressure sores were related to surgery, the incidence of pressure sores in surgical patients increased with the prolongation of operation time, the operation time of more than 2.5 hours was a risk factor for pressure sores, and the incidence of postoperative pressure sores was 21.2% in patients with operation time of more than 4 hours. Why use alginate dressing to treat pressure sores?
Dressing is an option for the treatment of pressure sores, and in theory, there are a variety of dressings that can be applied to pressure sores.
Alginate Dressing has high absorbability, can absorb all kinds of wound, ulcer and other liquid produced, and is conducive to the wet healing of the wound, can cushion pressure, shear force, friction, effective prevention of pressure sores, high biocompatibility, non-allergic, no stimulation. A Cochran review analyzed the relevant studies (including 6 studies and a total of 336 participants), comparing the application of common alginate dressings with hydrogel dressings, alginate dressings containing silver ions, and thermal radiation dressings in the treatment and nursing of pressure sores.
It is found that these new dressings show good results in the treatment and nursing of pressure sores, and there are no great differences in the effects of several dressings, but they are superior to traditional ordinary gauze and other dressings.
Staging of pressure sores (1) Suspicious deep tissue damage-subcutaneous soft tissue is damaged by pressure or shear force, local skin integrity but can appear color changes such as purple or brownish red, or lead to congestion of blisters.
In comparison with surrounding tissues, soft tissues in these damaged areas may have pain, hard chunks, sticky seepage, moisture, fever, or cold. (2) Phase I pressure sores during the rosy period-"red, swollen, hot, painful or numb, lasting 30 minutes do not fade" in the bone protrusion of the skin integrity accompanied by the pressure of the non-fading of the limited erythema.
Dark skin may not have significantly pale changes, but its color may differ from that of surrounding tissue.
(3) Phase II pressure sores inflammatory infiltration period-"purple red, knot, pain, blisters", the dermis part is missing, manifested as a shallow open ulcer, accompanied by a pink wound bed (wound), no carrion, may also be manifested as a complete or ruptured serum blister. (4) Phase III pressure sores shallow ulcer period-epidermis breakage, ulcer formation.
Typical characteristics: The whole layer of skin tissue is missing, visible subcutaneous fat exposure, but bones, tendons, muscles are not exposed, there is carrion, but the depth of tissue loss is not clear, may contain stealth and tunnels.
(5) Phase IV pressure sores necrosis ulcer period-intrusion into the lower dermis, muscle layer, bone surface, infection expansion, typical characteristics: The whole layer of tissue loss, accompanied by bone, tendon or muscle exposure, some parts of the wound bed has carrion or scab, often there is stealth or tunnel.
(6) The typical characteristics of pressure sores that cannot be staged-all layers of tissue are missing, the bottom of the ulcer is covered with carrion (yellow, yellowish brown, gray, green or brown), or the wound bed has scab adhesion (carbon, brown or black).
Clinical Application Research French researchers conducted a comparative study, the experimental group of patients in the first 4 weeks before treatment using alginate dressing, the latter 4 weeks using hydrogel dressing, the control group is the whole use of hydrogel dressing; a total of 110 participants, all of whom were over 65 years of age, Phase III and phase fourth, were patients with pressure sores. The effect of dressing is measured by reducing the proportion of wound size, and the greater the proportion, the better the effect. The results showed that the effect of the experimental group was significantly better than that of the control group, and the wound healing was obviously accelerated. The study also showed that choosing the right dressing at different stages of pressure sores helps the wound heal more quickly.
Among them, alginate dressing was first used to strengthen the effect of debridement and macrophage activity, and to promote the formation of granulation tissue, and then the use of hydrogel dressing was mainly to keep the wound environment moist. Thai scholars have made a comparative study on the use of alginate dressings containing silver ions and sulfadiazine silver cream in the nursing of pressure sores.
Alginate dressings have a slightly better effect than sulfadiazine silver cream, and more importantly for patients, the maximum cost of using alginate dressings is about 80% of the latter, greatly reducing the financial burden on patients.
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A large number of studies have shown that the new dressings have accelerated wound healing, reduced patients ' pain, reduced the number of drug change, and reduced Light nurse workload and other advantages, has been more and more used in clinical. The U.S. National pressure Ulcer Advisory panel suggested that the wound should be evaluated each time the dressing is replaced to ensure that the dressing used at the time is appropriate and that the wound is moist and dry around the wound to prevent impregnation. Evaluate the patient's general condition, replenish the nutrition in time, recommend different dressings according to the patient's condition combined with the guide, and make the new dressing better serve the patients with pressure sores.
