Donini L M, De Felice M R, Tagliaccica A, De Bernardini L, Cannella C
Università degli Studi di Roma La Sapienza, Istituto di Scienza dell'Alimentazione, Ple Aldo Moro, 5, 00185, Roma, Italy.
J Nutr Health Aging. 2005 Nov-Dec;9(6):446-54.
The prevalence of pressure sores (PS) ranges from 1 to 18% of in-patients and from 3 to 28% of those admitted to long-term settings. The aim of our study was to verify, a posteriori, how nutritional status influenced the evolution of PS in a population of elderly subjects hospitalised in a long-term care setting.
The charts of 125 patients with ulcerative or necrotic pressure ulcers were evaluated retrospectively. For each subject we took note of: PS characteristics (stage, ulcer surface, evolution), clinical characteristics (comorbidity, adverse clinical events, cognitive, functional and nutritional status).
In 58 patients (46.4%) there was overall healing of the lesions while in 39 patients (31.2%) we had however an "improvement" of PS. The course of PS was not significantly influenced by the patient's physiological characteristics, by cognitive status or by initial characteristics of PS. Instead, we noticed a significant difference in the course of PS as a function of the level of autonomy and clinical status. The course of PS, and in particular the Healing Index, were influenced by the Nutritional Status and, above all, by its course during the treatment period.
The development of PS is multifactorial. Whereas, it is clear that factors other than nutrition influence the risk of developing PS, an important role for nutrition in the development and resolution of PS is suggested. Our data certainly confirm the "Quality indicators for prevention and management of pressure ulcers in vulnerable elders", especially were they say "if a vulnerable elder is identified as at risk for pressure ulcer development and has malnutrition, then nutritional intervention or dietary consultation should be instituted because poor diet, particularly low dietary protein intake, is an independent predictor of pressure ulcer development".
压疮(PS)在住院患者中的患病率为1%至18%,在长期护理机构收治的患者中为3%至28%。我们研究的目的是事后验证营养状况如何影响长期护理机构中住院老年人群体压疮的演变。
回顾性评估125例患有溃疡性或坏死性压疮患者的病历。对于每个受试者,我们记录了:压疮特征(分期、溃疡表面、演变情况)、临床特征(合并症、不良临床事件、认知、功能和营养状况)。
58例患者(46.4%)的皮损总体愈合,而39例患者(31.2%)的压疮有“改善”。压疮的病程不受患者生理特征、认知状态或压疮初始特征的显著影响。相反,我们注意到压疮病程在自主能力水平和临床状态方面存在显著差异。压疮的病程,尤其是愈合指数,受营养状况影响,最重要的是受治疗期间营养状况变化过程的影响。
压疮的发生是多因素的。虽然很明显营养以外的因素会影响压疮发生的风险,但提示营养在压疮的发生和愈合中起重要作用。我们的数据肯定证实了“脆弱老年人压疮预防和管理质量指标”,特别是其中提到的“如果确定脆弱老年人有发生压疮的风险且存在营养不良,那么应进行营养干预或饮食咨询,因为不良饮食,尤其是低蛋白饮食摄入,是压疮发生的独立预测因素”。