Fugazza G, Moroni S, Bona F
IRCCS, Centro di Riabilitazione di Montescano, Fondazione Clinica del Lavoro di Pavia, Italy.
Riv Eur Sci Med Farmacol. 1995 Sep-Oct;17(5):197-202.
The authors present a plan for pharmacological treatment of pressure sores in patients affected by neurological pathologies: cerebrovascular accidents, head injuries, spinal cord injuries. This plan is easily applicable to all pressure sores included between first and third degree of the Reuler and Cooney classification. Authors identified some drugs specifically usefull in different cutaneous lesion degrees. Skin lesions and employed medicines are described as follows: Erythema: semi occlusive bandage with porous adsorbing membrane. This dressing must be left in for five days at least. Excoriation: bactericidal or bacteriostatic medicines if it's situated in a non pressed area while the same dressing utilized for erythema if it's localized in a pressed area. Pressure sores: if there is local infection cleanse the wound from bacterial defilement using topic antibiotics apply compresses with vitamin C if the cutaneous lesion is larger than deeper, Cadexomero lodico if it's deeper than larger. Fistulas: wadding with tablets of collagen. Necrobiosis: complete or partial surgical removal of eschar preceded by the use of enzymatic drugs when eschar is firmly adherent to subcutaneous tissues. The first group collects 9 patients with stroke and head injury: 8 with sacral and 1 with heel pressure sores. First degree pressure sores heal within 45 days and third degree lesions within 160 days. The second group collects 10 spinal cord injury patients mostly with complete lesion among which: 7 sacral, 1 heel, 1 ischiatic and 1 malleolar lesions. First degree pressure sores heal within 30 days, third degree pressure sores heal within 200 days. Healing time are considered acceptable. Pressure sores recovery swiftness can be related to different factors such as pressure sores sterness, neurological pathology and arising of clinical complication (hyperthermia, infections, low serum albumin values, etc).
作者提出了一项针对患有神经病理学疾病(脑血管意外、头部损伤、脊髓损伤)患者压疮的药物治疗方案。该方案易于应用于Reuler和Cooney分类中一度至三度的所有压疮。作者确定了一些在不同皮肤损伤程度下特别有用的药物。皮肤损伤及所用药物描述如下:红斑:使用带有多孔吸附膜的半封闭绷带。这种敷料必须至少留置五天。擦伤:如果位于非受压区域,使用杀菌或抑菌药物;如果位于受压区域,则使用与红斑相同的敷料。压疮:如果存在局部感染,使用局部抗生素清除伤口的细菌污染;如果皮肤损伤面积大于深度,使用维生素C湿敷;如果深度大于面积,则使用碘络酮。瘘管:用胶原蛋白片填塞。坏疽:当焦痂牢固附着于皮下组织时,在使用酶类药物后,完全或部分手术切除焦痂。第一组有9例中风和头部损伤患者:8例骶骨压疮,1例足跟压疮。一度压疮在45天内愈合,三度损伤在160天内愈合。第二组有10例脊髓损伤患者,大多为完全性损伤,其中:7例骶骨损伤,1例足跟损伤,1例坐骨损伤,1例踝关节损伤。一度压疮在30天内愈合,三度压疮在200天内愈合。愈合时间被认为是可以接受的。压疮恢复速度可能与不同因素有关,如压疮的严重程度、神经病理学以及临床并发症(高热、感染、低血清白蛋白值等)的出现。