Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int Wound J. 2018 Aug;15(4):623-632. doi: 10.1111/iwj.12906. Epub 2018 Jun 6.
One of the most common complications in patients with incontinence is incontinence-associated dermatitis. This study aimed to examine the influences of lipidolytic enzymes and/or proteases on skin barrier and tissue structure on the development of incontinence-associated dermatitis. Two animal experiments, ex vivo and in vivo, were performed using rats to examine the influences of 3 factors (maceration, proteases, and lipidolytic enzymes) alone or in various combinations on the barrier function and histology of the skin. As a result, skin treatments, including both of the skin maceration and proteases application, caused erythrocyte leakage from the blood vessels in the dermis. The erythrocyte leakage was observed in a larger area in the skin treated with proteases and lipidolytic enzymes with maceration than in the skin treated with proteases with maceration, that is, the addition of lipidolytic enzymes to skin maceration with proteases enhanced erythrocyte leakage. Lipidolytic enzymes in macerated skin are factors that accelerate tissue damage via skin barrier impairment, and proteases are the factors that trigger the development of incontinence-associated dermatitis via tissue damage. Advanced nursing care of perineal skin in patients with faecal incontinence is required because of the deleterious influence of lipidolytic enzymes and proteases.
失禁患者最常见的并发症之一是失禁相关性皮炎。本研究旨在探讨脂解酶和/或蛋白酶对皮肤屏障和组织结构的影响，以及它们在失禁相关性皮炎发展中的作用。本研究使用大鼠进行了两项动物实验，即离体和体内实验，以研究 3 种因素（浸软、蛋白酶和脂解酶）单独或组合使用对皮肤屏障功能和组织学的影响。结果表明，包括皮肤浸软和蛋白酶应用在内的皮肤处理会导致真皮血管中的红细胞漏出。与仅用蛋白酶处理的皮肤相比，用蛋白酶和脂解酶处理并浸软的皮肤中观察到更大面积的红细胞漏出，即蛋白酶和脂解酶联合处理皮肤浸软会增强红细胞漏出。浸软皮肤中的脂解酶是通过破坏皮肤屏障加速组织损伤的因素，而蛋白酶是通过组织损伤引发失禁相关性皮炎发展的因素。由于脂解酶和蛋白酶具有有害影响，因此需要对粪便失禁患者的会阴皮肤进行高级护理。
