文档介绍：AMDA Clinical Practice Guideline(CPG) for Pressure Ulcers 美国医师协会压疮临床实践指南
For Medical Directors and Attending Physicians
适合于卫生主管和主治医师
What is a Pressure Ulcer? 压疮是什么?
Any skin lesion – usually over a bony prominence – caused by unrelieved pressure resulting in damage to underlying tissue
皮肤损伤_通常发生在骨隆突处_是压力和/或剪力、摩擦力对皮下组织损伤的结果。
Pressure Ulcers May Not be Preventable 有些压疮是难以避免的
Aggressive measures can reduce but not eliminate the incidence of pressure ulcers积极的预防措施能够降低压疮的发生率,但并不能彻底消灭压疮;
Can develop despite best efforts of clinical team in high risk patients尽管临床小组作出最大的努力,但高风险的病人仍有压疮发生
Every effort should be made to prevent pressure ulcers要通过任何方式的努力来预防压疮;
A systematic approach to recognize and manage pressure ulcers is needed需要用系统化的管理方法来识别和管理压疮。
Factors Affecting Pressure Ulcer Development 促成压疮发生的四大直接因素
Pressure压力
Shearing剪切力
Friction摩擦力
Moisture潮湿
AMDA Pressure Ulcer CPG Steps压疮临床实践指南包括:
Recognition识别
Assessment/Root Cause Analysis评估和分析根本原因
Treatment治疗
Monitoring监护
Pressure Ulcers CPG Recognition压疮识别
Document any history of pressure ulcers in the medical record在病历中记录压疮的全部历史资料;
Thoroughly examine all skin surfaces on admission入院时仔细全面检查病人的皮肤;
Identify all primary risk factors识别所有基本的风险因素
Pressure Ulcers CPG Recognition压疮识别
Distinguish types of ulcers辨别溃疡的类型
Vascular insufficiency/ischemia (venous stasis and arterial ischemic ulcers)血管机能不全/局部缺血(静脉淤滞和动脉缺血性溃疡)
Neuropathic 神经性的
Pressure压力性的
Pressure Ulcers CPG Recognition压疮识别
Primary risk factors for development of pressure ulcers are:形成压疮的原发危险因素:
Impaired/decreased mobility活动性受到限制或者减少
Co-morbid conditions, ., diabetes mellitus糖尿病等合并症
Urinary or fecal incontinence失禁
Undernutrition, malnutrition, & hydration deficits营养不良、脱水
Impaired diffuse or localized blood flow血流灌注受限或者局部淤血
Drugs such as steroids that may affect wound healing类固淳药品的使用影响伤口康复;
History of a healed pressure ulcer压疮痊愈的经历
Resident refusal of some aspects of care & treatment居民拒绝给予局部的护理和治疗
Intrinsic risks due to aging老龄化为固有的危险因素
Pressure Ulcers CPG