Kirby John P, Gunter Oliver L
Washington University, St. Louis, Barnes-Jewish Hospital, St Louis, Missouri 63110, USA.
Curr Opin Crit Care. 2008 Aug;14(4):428-31. doi: 10.1097/MCC.0b013e328306a031.
To review recent work on pressure ulcer prevention and treatment in the intensive care unit within the context of previous work.
Although pressure ulcerations are an age-old and relatively common problem, their pathophysiology, risk factors for their development, and treatment options lack complete understanding. Most of the available literature is based on noncritical care patient clinical experience in noncritical care journals. Previous estimates of pressure ulcer underestimate the problem in high-acuity intensive care units. Available risk factors in previously validated tools may not be accurate in the intensive care unit patient population. However, the current literature provides an initial footing for intensivists to improve their pressure ulcer prevention and treatment methods that will become increasingly important for clinical certification as well as research.
Preventing and treating pressure ulcers will continue to be a troublesome problem for intensivists. Accurate assessments and comparisons remain problematic across a heterogeneous intensive care unit population. Risk stratification schema need tailoring to the problems of intensive care unit patients. Treatment modalities may not prevent all pressure ulcer development or extension. Available data support dedicated training of nurses and physicians to maximize local intensive care unit resources to minimize the impact of pressure ulceration.
在以往工作的背景下，综述重症监护病房压力性损伤预防与治疗的近期研究进展。
尽管压力性损伤是一个由来已久且相对常见的问题，但其病理生理学、发生的危险因素及治疗方案仍未被完全了解。现有大多数文献基于非重症护理患者在非重症护理期刊上的临床经验。以往对压力性损伤的估计低估了高 acuity 重症监护病房中的问题。先前经过验证的工具中可用的危险因素在重症监护病房患者群体中可能并不准确。然而，当前的文献为重症监护医生改进其压力性损伤的预防和治疗方法提供了初步基础，这对于临床认证和研究将变得越来越重要。
预防和治疗压力性损伤对重症监护医生来说仍将是一个棘手的问题。在异质性的重症监护病房患者群体中，准确的评估和比较仍然存在问题。风险分层方案需要根据重症监护病房患者的问题进行调整。治疗方式可能无法预防所有压力性损伤的发生或扩展。现有数据支持对护士和医生进行专门培训，以最大限度地利用当地重症监护病房资源，将压力性损伤的影响降至最低。
