Bliss M R, Schofield M
Homerton Hospital, London.
Age Ageing. 1993 Jul;22(4):279-84. doi: 10.1093/ageing/22.4.279.
Twenty-six patients with leg ulcers with a mean age of 80 years were assessed at a day hospital to determine the aetiology and to carry out a trial of four-layer compression bandaging for those suitable. Ten had ankle brachial pressure indices (ABIs) < 0.8. Of nine patients with venous disease who received compression bandaging, only two ulcers healed and have remained healed with fitted below-knee elastic stockings. The remaining patients were unable to tolerate compression or developed deterioration of their ulcers. Nine patients had unhealing arterial ulcers all unsuitable for reconstructive surgery. Five patients presented with pressure sores due to bandages, shoes or heel pressure in bed. All healed slowly with leg elevation and pressure relief. Four patients had extensive non-venous, non-arterial ulceration associated with fluid retention and dependent oedema exacerbated by spending their nights in chairs. Varicose eczema was healed in 12 patients. All the patients had multiple pathology and poorly controlled pain. Although complete healing was achieved in only six patients, the importance of ABI measurement and the gross mixed pathology suggests that every elderly patient with a leg ulcer needs medical assessment and management and that this could form a valuable service of a geriatric day hospital.
26名平均年龄为80岁的腿部溃疡患者在日间医院接受了评估，以确定病因，并对适合的患者进行四层加压绷带治疗试验。其中10人的踝肱压力指数（ABI）<0.8。在9名接受加压绷带治疗的静脉疾病患者中，只有2例溃疡愈合，并且在佩戴膝下弹力袜后一直保持愈合状态。其余患者无法耐受加压治疗或溃疡病情恶化。9名患者患有无法愈合的动脉溃疡，均不适合进行重建手术。5名患者因绷带、鞋子或床上的足跟压力出现压疮。通过抬高腿部和减轻压力，所有压疮均缓慢愈合。4名患者出现广泛的非静脉、非动脉溃疡，伴有液体潴留，因夜间坐在椅子上而导致依赖性水肿加重。12名患者的静脉曲张性湿疹愈合。所有患者都存在多种病理状况且疼痛控制不佳。尽管只有6名患者实现了完全愈合，但ABI测量的重要性以及严重的混合病理状况表明，每一位患有腿部溃疡的老年患者都需要医学评估和管理，这可以成为老年日间医院的一项有价值的服务。
