中风全身瘫痪致脑萎缩17处压疮分阶段干预

The intervention of 17 stage pressure sore in the whole body paralysis to brain atrophy

目的：探讨既不增加应激反应又能使多发性多层次压疮愈合的方法。方法：对87岁中风全身瘫痪致脑萎缩患者多部位、多期17处压疮采取分阶段干预。前期：治疗基础疾病,稳定血压、血糖,改善营养,补充能量,彻底清创,保护压疮疮面和各骨隆突处皮肤,预防压疮疮面感染、防止创面扩大、程度加深、部位增加。中期：病情稳定后,对17处压疮进行分组,采用干性创面促进愈合（A组）和湿性创面促进愈合（B组）。A组对Ⅱ度以下创面清创后,使用艾条灸加TDP治疗Bid,艾灸30min/次,结束后无菌纱布覆盖,TDP熏烤30min,直至结痂、脱落。B组对Ⅱ度以下创面清洁消毒后采用湿性创面（使用康乐惠水胶体敷料和泡沫敷料处理创面）,直至愈合,对Ⅲ度及以上创面,先使用康乐惠清创胶＋藻酸盐填充条填充,外覆银离子抗菌敷料,表面仍以艾条灸加TDP熏烤以活血化瘀,保持创面清洁干燥,2~3d更换敷料1次,直至疮面愈合。后期：压疮创面全部愈合后,出院仍采用艾条熏灸骨隆突处,按时翻身、做好皮肤护理,增加营养等治疗措施,预防压疮的再发,每1个月随访1次,连续观察6个月,观察记录2组压疮疮面皮肤完整性和血运。结果：该患者的17处压疮全部愈合。平均愈合时间（20.46±5.84）d。2组愈合时间分别为A组（15.8l±5.33）d、B组（25.10±6.35）d,差异有统计学意义（P〈0.05）;随访6个月时患者皮肤完整性和血运明显优于3个月时。结论：分阶段干预促进了多部位、多期压疮的愈合,艾灸在压疮治疗和预防压疮的发生中疗效确切、明显、稳定。

Objective：To explore a method for the healing of multiple levels of pressure ulcers,which can not only increase the stress response but also cause multiple levels of pressure ulcers. Methods：87- year- old patients with 17- stage pressure sore were divided into different stages,and the patients were divided into different stages. Early：to treatment of the underlying disease,stable blood pressure,blood glucose,improve nutrition,energy,thorough debridement,pressure sore surface and the bone protuberance skin protection,prevention of pressure sore surface infection,prevented the increase in expansion of the wound,the degree deepens,location. Middle term：after the disease was stable,17 pressure ulcers were divided into groups,the use of dry wounds to promote healing（A group） and wet wound healing（B group）. A group of the II degree following after wound debridement,use moxa stick moxibustion ＋TDP treatment bid and moxibustion 30 minutes each time,after the end of the sterile gauze to cover,TDP smoked for 30 minutes,until the scab,shedding. Group B to sub second degree wound clean after disinfection by wet wound（use and the foam dressing Kang Lehui hydrocolloid dressings to treat the wound） until healing,III degree and above the wound,to use Qing Kang Lehui a glue and alginate filled bar fill,coated with silver ion antimicrobial dressings,surface still to moxa stick moxibustion ＋TDP smoked grilled by promoting blood circulation to remove blood stasis,to keep the wound clean and dry,2-3 days dressing change once,until the wound surface healing. Later：pressure ulcers healed after discharge still use moxa stick smoked moxibustion bone protuberance,on time to stand up,good skin care,increase nutrition treatment,recurrence of the prevention of pressure sores,1 per 1 month follow-up,continuous observation of 6 months,observed and recorded two groups of pressure sore skin surface finish whole and blood supply. Results：all the patients were healed by 17 pressure ulcers. Average healing time（20.46 ＋ 5.84） days. The healing time of the two groups were A（＋ 5.33） days,B group（25.10 ＋ 6.35） days,the difference was statistically significant（P〈0.05）. The patients were followed up for 6 months. The skin integrity and blood circulation were significantly better than 3 months. Conclusion：the staged intervention can promote the healing of multiple parts and multi stage pressure ulcers. The effect of Moxibustion in the treatment and prevention of pressure ulcers is accurate,obvious and stable.