Hokynková Alica, Paulová Hana, Šín Petr, Nováková Marie, Babula Petr, Pokorná Andrea
Department of Burns and Plastic Surgery, University Hospital, Brno, Czechia.
Faculty of Medicine, Masaryk University, Brno, Czechia.
Front Nutr. 2025 Apr 24;12:1564879. doi: 10.3389/fnut.2025.1564879. eCollection 2025.
This case report presents a unique study focused on relationship between nutritional parameters, C-reactive protein (CRP), and the marker of oxidative stress 8-hydroxy-2'-deoxyguanosine (8-OHdG), in 61-year-old male paraplegic patient with multiple pressure ulcers. A multidisciplinary approach was essential for the timing of the successful reconstruction process. The patient had a history of paraplegia since 1999 due to a skiing accident with fractures of thoracic vertebrae (Th6-Th9), requiring spinal surgery. His medical background includes acute pancreatitis with biliary tract revisions, partial pancreatic resection, acute respiratory failure with tracheostomy, renal failure treated with hemodialysis, bronchopneumonia, pseudomembranous colitis, and hyperuricemia. The patient also underwent multiple surgical interventions, including treatment for ulnar nerve paresis, cholecystectomy, and multiple pressure ulcer reconstructions. The study describes the relationship between selected biochemical parameters and overall clinical status in a paraplegic patient with three deep pressure ulcers located in the left-sided ischial, trochanteric, and sacral regions during their multistage surgical therapy. The reconstructive procedure and collection of biological samples for determination of selected biochemical parameters were performed according to the same schedule: debridement of pressure ulcers at the beginning of the particular hospitalization and on the day of surgical reconstruction. The patient's severe condition was accompanied by decreased levels of both 8-OHdG and selected nutritional parameters (albumin, prealbumin, and total protein) and increased CRP levels at the beginning of the treatment process. The evaluation of the dynamics of the measured parameters during the gradual improvement of the patient's condition and the multistage reconstruction of pressure ulcers in six hospitalizations over a period of 17 months was continued resulting in the healing of all pressure ulcers. This case highlights the crucial importance of investigating selected biochemical parameters, with emphasis on 8-OHdG, and nutritional parameters, for the timing of surgical strategy and comprehensive therapy in patients with multiple pressure ulcers and severe, complex medical histories.
本病例报告展示了一项独特的研究，该研究聚焦于一名61岁患有多处压疮的男性截瘫患者的营养参数、C反应蛋白（CRP）与氧化应激标志物8-羟基-2'-脱氧鸟苷（8-OHdG）之间的关系。多学科方法对于成功重建过程的时机选择至关重要。该患者自1999年起因滑雪事故导致胸椎骨折（Th6-Th9）而截瘫，需要进行脊柱手术。他的病史包括急性胰腺炎伴胆道修复、部分胰腺切除、急性呼吸衰竭伴气管切开、接受血液透析治疗的肾衰竭、支气管肺炎、伪膜性结肠炎和高尿酸血症。患者还接受了多次手术干预，包括尺神经麻痹治疗、胆囊切除术和多次压疮重建手术。该研究描述了一名截瘫患者在其多阶段手术治疗期间，位于左侧坐骨、转子和骶骨区域的三处深部压疮的选定生化参数与总体临床状况之间的关系。重建手术和用于测定选定生化参数的生物样本采集按照相同时间表进行：在特定住院开始时以及手术重建当天对压疮进行清创。在治疗过程开始时，患者的严重病情伴随着8-OHdG水平以及选定营养参数（白蛋白、前白蛋白和总蛋白）的降低和CRP水平的升高。在17个月的时间里，对患者病情逐渐改善以及压疮多阶段重建过程中所测参数的动态变化进行了持续评估，共进行了6次住院治疗，最终所有压疮均愈合。该病例凸显了研究选定生化参数（重点是8-OHdG）和营养参数对于患有多处压疮且有严重复杂病史患者手术策略时机选择和综合治疗的至关重要性。
