Goode P S, Allman R M
Division of Geriatrics and Gerontology, University of Alabama, Birmingham.
Med Clin North Am. 1989 Nov;73(6):1511-24. doi: 10.1016/s0025-7125(16)30613-7.
Pressure ulcers are a common problem for older persons. Complications associated with pressure ulcers include infection and even death for some patients. Pressure is the primary pathogenic factor, but shearing forces, friction, and moisture are also important. Immobility, nutritional status, and age-related factors seem to be significant risk factors. Preventive care includes use of assessment tools to identify high risk patients, frequent repositioning, air or foam mattresses that reduce pressure over bony prominences, as well as careful attention to optimizing the overall patient condition. When pressure ulcers do develop, the treatment plan should include adequate nutrition including protein, vitamin C, and zinc supplements as indicated; systemic antibiotics for sepsis, cellulitis, osteomyelitis, or the prevention of bacterial endocarditis; and local wound care that eliminates necrotic tissue, decreases bacterial load, and provides a physiologic, pressure-free environment allowing the wound to heal. Specialized beds may be considered in some patients, particularly those with larger ulcers. Surgery is an option in older persons who are operative candidates. For some patients with pressure ulcers, appropriate treatment goals may focus on providing comfort rather than curing the ulcer.
压疮是老年人常见的问题。与压疮相关的并发症包括感染，甚至有些患者会死亡。压力是主要致病因素，但剪切力、摩擦力和潮湿也很重要。活动受限、营养状况以及与年龄相关的因素似乎是重要的危险因素。预防护理包括使用评估工具来识别高危患者、频繁翻身、使用能减轻骨隆突处压力的气垫床或泡沫床垫，以及密切关注优化患者整体状况。当压疮确实发生时，治疗方案应包括根据需要提供充足营养，包括补充蛋白质、维生素C和锌；针对败血症、蜂窝织炎、骨髓炎或预防细菌性心内膜炎使用全身性抗生素；以及局部伤口护理，清除坏死组织，减少细菌负荷，并提供一个生理的、无压力的环境以使伤口愈合。对于一些患者，尤其是溃疡较大的患者，可考虑使用专用床。对于适合手术的老年人，手术是一种选择。对于一些压疮患者，适当的治疗目标可能侧重于提供舒适感而非治愈溃疡。
