Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Hamburg, Germany.
Dtsch Arztebl Int. 2010 May;107(21):371-81; quiz 382. doi: 10.3238/arztebl.2010.0371. Epub 2010 May 28.
Pressure sores are a serious complication of multimorbidity and lack of mobility. Decubitus ulcers have become rarer among bed-ridden patients because of the conscientious use of pressure-reducing measures and increased mobilization. Nonetheless, not all decubitus ulcers can be considered preventable or potentially curable, because poor circulation makes some patients more susceptible to them, and because cognitive impairment can make prophylactic measures difficult to apply.
A systematic literature search was performed in 2004 and 2005 in the setting of a health technology assessment, and a selective literature search was performed in 2009 for papers on the prevention of decubitus ulcers.
Elderly, multimorbid patients with the immobility syndrome are at high risk for the development of decubitus ulcers, as are paraplegic patients. The most beneficial way to prevent decubitus ulcers, and to treat them once they are present, is to avoid excessive pressure by encouraging movement. At the same time, the risk factors that promote the development of decubitus ulcers should be minimized as far as possible.
Malnutrition, poor circulation (hypoperfusion), and underlying diseases that impair mobility should be recognized if present and then treated, and accompanying manifestations, such as pain, should be treated symptomatically. Over the patient's further course, the feasibility, implementation, and efficacy of ulcer-preventing measures should be repeatedly re-assessed and documented, so that any necessary changes can be made. Risk factors for the development of decubitus ulcers should be assessed at the time of the physician's first contact with an immobile patient, or as soon as the patient's condition deteriorates; this is a prerequisite for timely prevention. Once the risks have been assessed, therapeutic measures should be undertaken on the basis of the patient's individual risk profile, with an emphasis on active encouragement of movement and passive relief of pressure through frequent changes of position.
压疮是多种疾病和缺乏活动的严重并发症。由于认真使用减压措施和增加活动，卧床不起的患者中褥疮变得越来越少见。但是，并非所有压疮都可以认为是可预防或可治愈的，因为血液循环不良使某些患者更容易发生压疮，并且认知障碍会使预防措施难以实施。
在 2004 年和 2005 年进行卫生技术评估时进行了系统的文献检索，并在 2009 年对预防压疮的文献进行了选择性文献检索。
患有行动不便综合征的高龄、多病的患者以及截瘫患者发生压疮的风险很高。预防压疮最有益的方法是通过鼓励运动来避免过度受压。同时，应尽可能最小化促进压疮发展的危险因素。
如果存在营养不良、血液循环不良（灌注不足）和影响活动能力的基础疾病，则应识别并加以治疗，并应对症治疗伴随的表现，如疼痛。在患者的整个病程中，应反复重新评估和记录预防溃疡的措施的可行性、实施情况和效果，以便进行必要的更改。应在医生首次接触不能活动的患者或患者病情恶化时评估压疮发生的危险因素，这是及时预防的前提。一旦评估了风险，就应根据患者的个体风险状况采取治疗措施，重点是积极鼓励运动，并通过频繁改变体位来被动缓解压力。
