Mondragon Natalie, Zito Patrick M.
Texas A&M Health Science Center College of Medicine - Scott and White
University of Miami; Miller School of Medicine
Pressure injuries are localized damage to the skin and underlying soft tissue, usually occurring over a bony prominence or related to medical devices. They result from prolonged or severe pressure with contributions from shear and friction forces. These skin and soft tissue injuries remain a significant problem within hospitals and long-term care facilities and result in decreased quality of life, high costs for the patient and our health care system, and increased morbidity and mortality. As pressure injuries may be considered an indicator of the quality of care of a facility, inadequate steps in prevention or treatment can lead to litigation. Awareness of factors that may contribute to the pathogenesis of pressure injuries enables the identification of those patients at risk for their development, and preventive measures can be aimed toward these patients. As treatments for pressure injuries have been characterized and evaluated with variable degrees of completeness, there remains uncertainty regarding the best options for management. The superficial skin layer is less prone to be affected by pressure injury; the overall physical examination may underestimate the extent of the damage.[1] The underlying history of immobility (including but not limited to patients with bed-ridden status or chair-bound individuals) is usually present. However, poorly fitting casts, other medical equipment, devices, and implants also play a role. Medical devices may induce mucosal pressure injury. Skin and soft tissue pressure-induced injuries are identified as localized skin with and without underlying tissue involvement. However, they usually occur over a bony prominence. The inciting factors are pressure or pressure accompanied by shear stress. The sacrum, calcaneus, and ischium are the most common bony prominences. Significantly, superficial moisture-induced lesions, skin tears, tape burns, perineal dermatitis, or excoriation should be differentiated from pressure injury-induced lesions. According to the National Pressure Injury Advisory Panel system updates, the term "pressure injury" instead of "pressure ulcer" is preferred. The former recognizes that minimal skin damage due to pressure may not necessarily be associated with ulceration and is categorized as stage 1. Moreover, deep tissue pressure injury might occur without prominent overlying skin ulceration.
压力性损伤是皮肤和皮下软组织的局部损伤，通常发生在骨隆突处或与医疗设备相关。它们是由长时间或严重压力以及剪切力和摩擦力共同作用导致的。这些皮肤和软组织损伤在医院和长期护理机构中仍然是一个重大问题，会导致生活质量下降、患者和医疗保健系统成本高昂，以及发病率和死亡率上升。由于压力性损伤可能被视为一个机构护理质量的指标，预防或治疗措施不足可能导致诉讼。了解可能导致压力性损伤发病机制的因素，有助于识别那些有发生压力性损伤风险的患者，并针对这些患者采取预防措施。由于对压力性损伤的治疗已进行了不同程度的全面表征和评估，对于最佳管理方案仍存在不确定性。皮肤表层较少受到压力性损伤的影响；全面的体格检查可能会低估损伤的程度。[1]通常存在潜在的活动受限病史（包括但不限于卧床患者或久坐于轮椅的个体）。然而，不合适的石膏、其他医疗设备、器械和植入物也会起作用。医疗设备可能会导致黏膜压力性损伤。皮肤和软组织压力性损伤被定义为伴有或不伴有皮下组织受累的局部皮肤损伤。然而，它们通常发生在骨隆突处。诱发因素是压力或伴有剪切应力的压力。骶骨、跟骨和坐骨是最常见的骨隆突部位。重要的是，应将浅表性潮湿引起的损伤、皮肤撕裂、胶带灼伤、会阴皮炎或表皮脱落与压力性损伤引起的损伤区分开来。根据国家压力性损伤咨询小组的系统更新，更倾向使用“压力性损伤”而非“压疮”这一术语。前者认识到因压力导致的轻微皮肤损伤不一定与溃疡相关，并将其归类为1期。此外，深部组织压力性损伤可能在没有明显皮肤溃疡的情况下发生。
