home Audience 12 Bedsores are pathological changes in tissues as a result of their compression while lying in one position. Bedsores. Causes, symptoms, signs, diagnosis and treatment of pathology

Bedsores are pathological changes in tissues as a result of their compression while lying in one position. Bedsores. Causes, symptoms, signs, diagnosis and treatment of pathology

Bedsores are one of the most difficult problems in caring for bedridden patients. They are a consequence of being forced to remain in the same position for a long time. Bedsores often form in patients in intensive care units, in comatose states, with spinal paralysis, during the period of post-infarction and post-stroke rehabilitation.

Bedsores are called neurotrophic changes fabrics that are in prolonged contact with a hard bed or other surface. This phenomenon is expressed in denervation, impaired lymph circulation, poor blood supply to areas of the skin, muscles, and subcutaneous tissue. After just 2 hours of being completely immobile, problems with blood flow begin in the “sitting” and “lying” areas of the body due to compression small vessels. Bedridden patients are in a stationary state much longer, and some permanently, so their disorders become persistently pathological.

The second reason why tissues occur destructive processes– vascular microtraumas from friction that occur when a patient moves by crawling to change position and as a result of forceful pulling from under a lying person wet laundry.

Factors contributing to the development of bedsores are divided into 2 groups:

Additional factors significantly increase the likelihood:

How to identify bedsores

In young patients who do not have severe chronic diseases and are conscious, bedsores are rare and develop slowly. With proper care, their occurrence can be prevented. Weakened patients are susceptible to rapid progression of pathology.

The algorithm for the prevention of bedsores in bedridden patients provides for mandatory inspection of all risk areas, taking into account the forced position (sitting, on the side, on the back, on the stomach):

Upon examination, the incipient pathology is characterized by stagnation of fluid, pronounced cyanotic erythema without certain limits, similar to a bruise, as well as desquamation of the epidermal layer with or without vesicular elements.

Manifestations of venous erythema are:

normal temperature of the affected area, as opposed to inflammatory hyperthermia;
When pressed with a finger, the skin on the hyperemic area turns pale, while the hematoma does not change color.

Subjectively, patients who are in themselves present the following complaints:

Tingling caused by lymphatic congestion and compression of the capillaries supplying the peripheral endings in the area of a potential bedsore.
A feeling of numbness that occurs after a couple of hours of immobility.

Bedsores develop in stages, starting with stagnation of blood circulation and ending with necrotic processes in tissues. In weakened patients with congestive lesions due to cardiovascular pathology, the transition from one stage to another can occur in a matter of hours.

Consequences

The main danger of bedsores is necrotic processes with the addition of infection. For the patient this may end:

leg amputation;
excision of large areas of soft tissue, resulting in denervation and poor blood supply to adjacent areas;
development of periostitis, osteomyelitis with the spread of necrosis to bone tissue and periosteum;
depletion of immunity;
complication of treatment of the underlying disease.

The severity of the consequences of bedsores largely depends on the type of pathological changes in the tissues:

Dry necrosis has a protracted course with a long period of restoration of the wound surface.
Weeping necrosis occurs with infection of the cavity by pathogenic microbes (staphylococci, streptococci and others). Purulent inflammation leads to the formation of phlegmon, erysipelas, and gas gangrene. These processes are characterized by symptoms of intoxication of the body, high fever, and the formation of fistulas. The focus of suppuration is local or diffuse, glossy, hyperemic, hotter or colder than the surrounding skin. When a wound is infested with clostridium, the inflammation increases in a putrefactive manner with the development of gas gangrene. With this pathology, the skin acquires a bluish tint, the wound does not look moist and emits a strong odor. If you pass over the affected area, a characteristic crunching sound occurs.

A logical continuation of a purulent bedsore is sepsis: infected exudate from the wound cavity penetrates into the blood. Blood poisoning with the modern level of medicine is a fairly rare occurrence. But it is likely late start antibiotic therapy, resistance of the patient’s body to the drugs used, in the patient’s immunodeficiency state.

At the initial stage of development of bedsores, specific treatment is not required. Measures are being taken to eliminate congestion: massage without aggressive influence on the affected areas, the use of anti-decubitus devices, careful hygiene, and the use of preventive and therapeutic external agents.

The first stage of bedsore treatment

The appearance of wound cavities, especially infected ones, requires the patient to be admitted to a hospital with an appointment antibacterial therapy and surgical treatment:

Emptying the wound from purulent contents.
Ensuring the outflow of accumulating exudate.
Relieving swelling and inflammation.
Suppression of microbial activity.

Cleaning of bedsores from purulent cells and dead tissue is carried out in a surgical hospital, then drainage is installed. Further treatment can be done at home. It is important to regularly fill the cavities with napkins or high-quality bandages (dense, not crumbling into threads) with medicinal impregnations, and change them in a timely manner.

How to treat bedsores in bedridden patients:

The use of new generation antiseptics has been approved for washing wounds:

iodopirone solution at a concentration of 0.5%;
dioxidine solution 1%

In their absence, irrigation with hydrogen peroxide, furatsilin, and boric acid solution is allowed.

Enzyme therapy is also used to absorb pus. Pure proteolytic enzymes (chymotrypsin, trypsin, ribonuclease) or as part of an ointment (Iruksol, Iruksovetin) are injected into the wound.

In addition, physiotherapeutic methods are used:

Ultrasound cavitation;
laser irradiation;
exposure to a vibraphone;
pressure chamber, etc.

Second stage of therapy

After cleaning the wound, it is necessary to ensure the growth of healthy tissue. At this stage, a scab should appear - a thin crust granulation tissue. Young connective tissues It is important to protect against inflammation, damage and stimulate development. How to treat bedsores in bedridden patients at the beginning of healing:

anti-inflammatory drugs Levomekol, Methyluracil, Troxevasin ointments, Bepanten and other external agents;

for protection, softening and regeneration - oils from the fruits of sea buckthorn, rose hips, juice of fresh aloe leaves, Kalanchoe extract;
for active epithelization of tissues - laser exposure.

Third stage of treatment

The last phase of bedsore therapy consists of complete regeneration and scarring of the wound surface. The main task is to maintain the active process of epithelization, for which they use complex vitamins, immunostimulants, wound healing ointment EDAS 201M. The administration of antibiotics is indicated at all stages of treatment of purulent bedsores.

The patient’s nutrition is of no small importance in the treatment of bedsores. The diet must be saturated with a rich vitamin and microelement composition with an emphasis on sources of iron, zinc, vitamin C:

Skin treatment for bedsores

Treating the skin is an important part of treating and preventing congestion. It consists of three stages:

Hygiene: cleansing the skin of dirt, physiological secretions, maintaining normal moisture, softening. Exist special means care for bedridden patients: lotions, emulsions, creams.
Prevention: care that prevents the formation of cracks, stimulates local blood circulation, and restores sensitivity. To prevent bedsores, use a solution of ammonia (0.5%), alcohol solution tannin (1%), diluted camphor alcohol (2%), 1% salicylic alcohol. The skin in areas in contact with the surface of the bed and chair must be wiped 2 – 3 times a day.
Treatment: use of drugs in pharmaceutical forms for external use (ointments, powders, solutions, etc.).

magnesium sulfate at 25% concentration;
sodium chloride solution with chymotrypsin;
chlorhexidine diluted with water;
Multiferm napkins that create a therapeutic wound covering from a polymer material and an enzyme complex.

Solutions of potassium permanganate, iodine, and brilliant green should not be applied to bedsores, since they have a drying effect.

Regular proper care for inpatients is the key to successful prevention of bedsores. It is errors in hygiene that are main reason congestion and tissue damage.

The algorithm for the prevention of bedsores in bedridden patients includes the systematic implementation of a number of measures:

The patient's position must be changed every 2 hours;
to support the limbs and create gaps between the body and the bed, the use of special bolsters is recommended;
the head of the bed should be below or at the level of the surface of the bed;
Hygienic procedures and skin moisturizing should be carried out at least 2 times a day;
to care for the patient, it is better to use specially developed pharmaceutical cosmetics;
You can bathe immobilized patients in a warm bath, hot water is prohibited;
remove the consequences of uncontrolled bowel movements and urination as soon as possible;
You can’t use oilcloth or polyethylene as linings; for this there are absorbent “breathable” diapers, pads, diapers, disposable panties;
You regularly need to blot moisture from the surface and in the folds of the skin (sweat, water, other liquids) using absorbent wipes or soft cotton rags;
bed linen must be changed frequently as it gets dirty;
remake the bed at least twice a day, straightening out all folds and unevenness;
carefully place and remove the vessel;
do not pull wet laundry out from under it;
Intense massage is prohibited; it is allowed to “disperse the blood” with light stroking movements without pressure or friction;
for bedridden patients, it is advisable to purchase an anti-decubitus mattress with pumps to correct the density and level of various zones;
Wheelchair users should change position hourly;
to support the body and limbs of those sitting, there are special pillows with air, gel and foam filler;
to protect cracked skin lower limbs, the sacrum can be covered with a hydrocolloid dressing Comfil Plus;
caregivers should use latex gloves without powder.

To facilitate care and prevent bedsores in bedridden patients, you can purchase specialized products from the Seni and Menalind brands at the pharmacy: diapers, absorbent panties, diapers and napkins, detergents for the body, including water-free washes, protective creams with zinc oxide, moisturizing oils and lotions, shampoo-free hair wash caps, etc.

Bedsores occur when blood circulation in the tissues is impaired, which occurs when staying in one position for a long time, which causes poor circulation in certain areas of the body. They form in bedridden patients or seriously ill people who practically do not move. Especially dangerous and difficult to treat are purulent bedsores that cause deep necrotic lesions.

Main characteristics of the pathology

In most cases, bedsores occur in people of retirement age. It is these patients who most often find themselves in an immobilized position; in addition, with age, the layer of subcutaneous tissue decreases, which reduces protective properties deeper layers. And in the place where the greatest pressure occurs, microcirculation is disrupted, which leads to inflammation and the formation of ulcers.

Formation

The skin of older people loses its elasticity, and when left immobilized for a long time, it even further loses its protective properties. Therefore, when caring for a bedridden patient, care should be taken: carefully turn the patient over, do not pull the sheets out from under him, and carry out hygienic procedures in a timely manner.

Initially, you can see that the part of the body that is subjected to mechanical stress begins to turn red. And if measures are not taken in a timely manner, the integrity of the skin is compromised. The development of bedsores can be divided into 4 degrees:

Types of lesions

Suppuration of a bedsore begins with the proliferation of pyogenic bacteria: staphylococci, streptococci, Proteus, Escherichia coli and Pseudomonas aeruginosa. It is customary to distinguish four types of purulent bedsores:

For purulent bedsores, treatment should begin in a hospital, since this condition is fraught with complications and can lead to blood poisoning, degeneration of skin cells into malignant form and death.

And only after improvement is treatment prescribed at home.

Principles of treatment

Deep bedsores form if treatment in the first stages of the disease is absent or carried out incorrectly. Relatives of bedridden patients need to know what and how to treat bedsores. Purulent and deep wounds require a particularly careful approach.

Treatment of purulent bedsores consists of three stages:

For purulent bedsores, antibiotics are required to prevent sepsis. Prescribed:

oral administration (Cefixime, Amoxicillin);
local agents with antibacterial action (Fusicutan).

Effective products for external use

Modern medicine offers big choice remedies that help cure bedsores even stage 4. In order not to aggravate the condition, you should familiarize yourself with the rules for applying external products:

Other therapies

In addition to those described above local funds, other methods of treating bedsores are also used. Each of them has its own indications and contraindications and is characterized by varying degrees of effectiveness. Let's consider the most effective methods therapy.

Physiotherapy

Deep ulcers can be treated with physiotherapy. For each patient, depending on the stage, size and condition of the bedsore, the most appropriate method is selected:

Operations

Surgical intervention for stage 4 bedsores is carried out only according to strict indications, since any intervention can provoke wound growth.

Surgery on bedsores is plastic surgery, that is, removal of necrotic areas and application of a skin flap with other tissues to the wound: subcutaneous tissue and muscles.

Statistics show that only 50-70% of patients experience complete healing after surgery. In some cases, a second operation is performed, as suppuration and graft rejection begin. In most cases, complications begin with improper care of the patient, osteomyelitis of adjacent bones and improper preparation to intervention.

Unconventional methods

Bedsores should be treated at home like open wounds. All accessories must be sterile; damage must not be touched with hands - only with napkins. What tools can be used:

It should be remembered that these tools are only auxiliary. Patients with bedsores must be regularly seen by specialists. If within 3 weeks after using folk or traditional means If there is no improvement, then the treatment tactics are completely changed.

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Bedsores are areas of tissue necrosis that occur as a result of impaired blood circulation in them. Usually this problem appears as a result of prolonged contact of the human body with a hard surface.

Almost all people with limited activity are susceptible to developing bedsores, but they most often appear in severe exhaustion, overweight body, diabetes.

What are bedsores?

Bedsores are a dangerous complication various diseases caused by tissue malnutrition or external compression with displacement. In medicine, bedsores are often called ulcers.

bedsores photo - development of the necrosis process

This disorder usually occurs when tissue innervation is disrupted due to pathology or damage spinal cord. Bedsores often affect the buttocks, heels, and other areas that receive the most pressure.

In bedridden patients, blood vessels and skin are compressed, which leads to stagnation. As a result, the tissues die. Constant pressure, which can disrupt the natural blood flow of the skin capillaries for 2 hours, provokes the appearance of initial signs of necrosis. The likelihood of developing bedsores increases with increased dryness or excessive moisture of the skin.

Dry epithelium provokes exfoliation of the stratum corneum, and excessive humidity leads to infection. The situation worsens due to poor circulation in the compressed areas. That is why the treatment and prevention of bedsores of a bedridden patient is a very pressing problem.

Classification of bedsores, stages and photos

Doctors distinguish several stages in the development of bedsores. Each of them has certain features:

Stage 1. In this case, certain areas of the skin become red. However, they do not turn white when pressed with a finger. Sometimes swelling appears in these areas. The first stage is considered the simplest form of the disease. In this case, treat bedsores bedridden at home sick people are the easiest. If measures are taken in time, necrosis can be avoided.
Stage 2. At this stage, bedsores are accompanied by the appearance of small blisters or ulcers. It is very important to prevent the occurrence of inflammation or purulent process. To solve this problem, you need to use medicated dressings.
Stage 3. Bedsores resemble a deep wound because the skin is affected by a necrotic process. As a result, a person has visible adipose tissue and muscles. There is also purulent content in the affected area.
Stage 4. The pathology affects tendons and bone tissue. At this stage, the inflammatory process progresses, and the wounds are filled with purulent contents.

Treatment of bedsores in bedridden patients at home

For bedsore therapy to bring results, it must be comprehensive. Essentially, therapy should include several components:

preventing constant pressure;
local treatment;
elimination of the underlying pathology.

Medicines for the treatment of bedsores

Treatment of bedsores in bedridden patients at home is carried out only with initial stages, for this purpose local treatment is used - drugs and ointments. It is best if the doctor selects an ointment or cream for bedsores for a bedridden patient, based on the specific situation, and evaluates whether hospitalization is required.

Let's look at the drugs used. However, before applying these products, you need to treat the affected area with disinfectants and antiseptic drugs. These include the following:

Hexicon. Active component this tool is chlorhexidine. With its help, it is possible to disinfect the wound and cope with pathogenic bacteria. Good results can be achieved in case of infection with fungal microorganisms and some viruses. However, the drug does not produce negative impact on the body.
Solutions with silver compounds. Thanks to the effect of silver ions, it is possible to stop the growth and reproduction of bacterial microorganisms. In addition, these drugs increase the effectiveness of antibiotics, cope with pain and local discomfort - itching or burning sensation.
Furacilin. Active substance This product is nitrofural. It binds to proteins pathogenic microorganisms and changes their configuration. As a result, bacterial cells lose the ability to use their own proteins for life and die.

Ointments for bedsores, list

Currently there are quite a few medicines For local application. To cope with bedsores in the treating patient, ointments are often used to treat the affected areas. To the most effective drugs include the following:

Argosulfan. The effect of this product is due to the presence of silver ions in the composition. Thanks to the use of this ointment, it is possible to relieve pain, eliminate burning and tingling sensations. To get the desired results, before applying the ointment, the affected area should be treated with an antiseptic and dried.
Iruksol. The active component of the product is the enzyme collagenase. It also contains antibacterial components. Due to the presence of a proteolytic enzyme in the composition, it is possible to achieve a gentle and high-quality cleansing of the affected area without damaging healthy cells.

Antibacterial ingredients provide additional wound cleansing, which helps accelerate tissue regeneration.
It is recommended to apply the product in the form of a bandage, and then carefully fix it on the area where the bedsore is located.

Zinc ointment. This remedy has a pronounced anti-inflammatory and antiseptic effect. Thanks to its use, it is possible to achieve a drying effect and protect the affected area from external factors.

Levosin. This medicine includes several components. Antibacterial substances, such as sulfadimethoxine and chloramphenicol, produce a disinfecting effect and stimulate healing processes. Trimecaine is an anesthetic and perfectly relieves pain syndrome. Methyluracil starts skin regeneration processes.

A useful property of the ointment is the ability to absorb excess moisture, which speeds up the cleansing of dead cells and pus. To get the desired result, it is recommended to use the product daily. After applying the ointment, the treated surface should be covered with a bandage or a clean napkin.

Solcoseryl. The effectiveness of the product is due to the presence of the blood of dairy calves in its composition. When applied to the affected area, the ointment starts the process of tissue restoration.

An important feature of the product is its protective effect. This helps prevent the negative effects of external factors on the skin. It is important to take into account that the ointment should not be used if there is copious discharge of pus from the wound.

When bedsores form additional method therapy often becomes the use of folk remedies. With their help, it is possible to clean wounds and start the process of regenerating new tissue. Before using any folk remedy You should consult a doctor as they can provoke allergic reactions.

The most effective recipes include the following:

Squeeze juice from lungwort leaves and treat the area of the bedsore several times a day.
Cut the leaves of medicinal Kalanchoe into 2 parts and apply the cut side to the affected area. Secured with a bandage, it is recommended to leave them overnight.
Scald black elderberry leaves with hot milk and apply to the affected area twice a day.
Grind a tablespoon of calendula flowers and mix with 50 g of Vaseline. Treat bedsores twice a day.
Chop fresh potatoes and mix with honey in equal parts. Apply to an area prone to bedsores.
Treat diseased areas of the skin with sea buckthorn oil or tea tree. It is recommended to do this several times a day.
Combine aloe and celandine juice with honey in a ratio of 2:2:1. Apply the resulting mixture to the affected area twice a day.

Doctors' advice helps treat bedsores in bedridden patients at home:

It is important to control the cleanliness of the skin. At the same time, it should not be wet or dry, therefore it is necessary to periodically use air baths.
For hygiene purposes, you should not use antibacterial soap as it kills beneficial bacteria. To wash the patient you need to choose regular soap, natural sponge and water. It is not recommended to rub the skin. After washing, you need to gently pat it dry with a towel.
It is necessary to monitor the condition of the skin. If it is dry, moisturizers should be used. If the skin has high humidity, you should use powders or ointments with a drying effect.
If redness appears, do not massage this area. However, it is permissible to massage around the affected area.

To prevent such problems from occurring, you should use an anti-bedsore mattress. Doctors say that this device helps eliminate the main cause of such problems - compression of certain areas of the body.

Complications of bedsores

Main danger this state lies in the development of necrotic processes and the subsequent addition of infection. This leads to the following complications:

lower limb amputation;
excision of large areas of soft tissue;
development of periostitis or osteomyelitis;
weakening immune system;
problems in treating the underlying pathology.

Preventing bedsores

Bedsores are much easier to prevent than to try to cure them. To do this you need to carry out preventive actions to prevent bedsores in a bedridden patient:

Every two hours the patient must be turned, changing the position of his body.
Several times a day you should massage the skin in areas high blood pressure. However, it is prohibited to treat reddened skin.
It is best to buy a special bed for the patient that can be adjusted. Thanks to this, it will be possible to significantly facilitate hygiene procedures.
All bedridden patients definitely need a special mattress with a compressor. It allows for constant tissue massage, which improves blood circulation and speeds up healing.
Bed linen should be made from natural materials with a smooth texture.
It is important to follow the rules of hygiene - regularly change underwear, use absorbent diapers, use urine bags and diapers.

The development of bedsores on the body complicates the treatment of patients in intensive care wards, geriatric departments, as well as during the period of rehabilitation at home, after spinal, complex, spinal injuries, comatose states, and other pathologies, with a person being forced to remain in a monotonous position.

What are bedsores?

is a pathological change in the skin, subcutaneous tissue, muscles, bones, and other tissues of the body, developing as a neurotrophic disorder, the causes of which are disturbances in the innervation, blood and lymph circulation of a local area of the body, with prolonged contact with a hard surface.

Brief description of pathological changes on the body:

develop on the side of the body adjacent to the hard surface;

are characterized by stages of pathogenesis, begin with stagnation of blood circulation, in the absence of treatment, end with neurotrophic wet or dry type, sepsis or gas gangrene;

develop most quickly, within 24 hours, in exhausted patients with congestion in cardiovascular failure;

localized on protruding areas of the body, the most typical areas of damage are:

when the patient is positioned on his back, the area is affected (sacrum and coccyx, buttocks, spinous processes of the spine, area of the shoulder blades, heels);

when the patient is positioned on his stomach, the area (knees, iliac crests, protruding surface of the chest) is affected;

when the patient is positioned on his side or half-sitting, the area (ischial tuberosities) is affected;

rarely localized on the back of the head and folds of the mammary glands.

Specific localization of bedsores on the skin: under plaster casts, in places where there is a tight fit of materials that do not penetrate moisture (oilcloth diapers, rubber tubes), folds of bed linen, bandages, etc.

Specific localization of bedsores on mucous membranes: under dentures, with long-term drainage urethra– on the urethra, with long-term catheterization of blood vessels – on the mucous membrane of blood vessels.

Bedsores rarely develop in people at a young age conscious, without a history of chronic diseases. Typically, in this category of patients, if bedsores occur and develop gradually, there is a high probability of missing the impending pathology.

The first signs of bedsores

Subjective sensations that the patient can communicate to caregivers while conscious and with preserved pain sensitivity body parts:

tingling on the skin in places probable development bedsores, associated with stagnation of biological fluids (blood, lymph) feeding the nerve endings;

loss of sensation (numbness) after about 2-3 hours in this area of the body.

Visible signs incipient bedsores, which persons caring for the patient must know:

stagnation of peripheral blood and lymph, initially in the form of venous bluish-red color, without clear boundaries, with localization at the point of contact of bone and muscle protrusions of the body with the bed of the bed, intensity of skin coloring: from barely noticeable to rich;

desquamation of the skin epidermis with or without preliminary formation of purulent blisters.

These are signs of a developing bedsore. It is urgent to take measures to prevent further deterioration of the pathology.

What to do to eliminate the first symptoms of a bedsore?

To do this you need:

change the patient’s position every two hours; if there are no contraindications, it is recommended to use special pillows to change the position of the limbs and body relative to the surface of the bed, forming gaps between the skin and the bed;

monitor the level of the head of the patient’s bed; the head of the bed should be lower or level with it;

regulate the humidity of the patient’s skin with hygiene products (washing cream, foam, solution, spray, you can warm baths (it is forbidden to use hot water), do these procedures at least twice a day, in case of uncontrolled bowel movements, remove contaminants as quickly as possible;

remove excess moisture from the skin and skin folds(water, remains of liquid food, urine, wound exudate, sweat) using special absorbent pads, diapers, napkins, towels, films;

regularly remake the bed or change bed linen at least once a day;

do not perform intense massage; light stroking of skin areas with signs of stagnation is allowed; carry out this procedure carefully, without friction, especially in areas with close bones;

use anti-decubitus mattresses balloon or cellular type, equipped with special silent compressors to maintain and change the rigidity of its base, with adjustable and programmable inflation of different areas.

use, for patients in wheelchairs, pillows filled with gel foam, air, monitor changes in body position in the chair at least once an hour.

Why are bedsores dangerous?

Bedsores are pathologies whose treatment is best avoided. If this could not be done, then when foci of skin maceration form, pathogenesis develops very quickly, with the formation of foci of tissue necrosis and is characterized by long-term treatment of a purulent wound. The outcomes of bedsores are dangerous. In some cases, bedsores are caused by:

extensive excisions of soft tissues and the formation of defects with impaired innervation and blood circulation of the underlying areas of the body,

lower limb amputations;

necrotic lesions of the periosteum and bone tissue in the form of periostitis;

depletion of the body's defenses, complicating the treatment of the underlying disease;

With the development of bedsores of the type of dry necrosis, a protracted pathogenesis develops with long periods of healing of the defect.

The cause of bedsores is as follows. Our body is completely riddled with small blood vessels. Through these vessels - capillaries - blood flows to various bodies bodies. If blood vessels are compressed, blood stops flowing to the tissues, as a result of which the tissues become necrosis.

If a person remains motionless for two hours, his blood vessels are compressed and blood stops flowing to certain areas of the body tissue. Therefore, bedsores form. Remember that it is very dangerous to sit or lie still for a long time.

Bedsores also form if a wet sheet is often pulled out from under a sick person. In this case, blood vessels rupture. This is completely invisible to the human eye. But after the blood vessels rupture, blood stops flowing to the tissues. Bedsores form.

Also, blood vessels can rupture if a person cannot, for example, walk and constantly slides down to take a different position.

Risk factors for developing pressure ulcers

It has been observed that bedsores develop in bedridden patients at different times. IN medical institutions, to systematize the assessment of risk factors for the development of pressure ulcers, the Norton, Braden or Waterlow scales are used. At home they don't matter. Based on these criteria, risk factors associated with care errors and individual characteristics of the patient, suitable for home use, have been formulated.

1. Factors associated with errors in organizing patient care:

untidy bed, changed less than once a day;

rare change of underwear to dry and clean ones;

neglect hygiene procedures(treatment of the body with special solutions, drying, massage of areas of the body where possible without additional trauma to the bedsore);

hard, uneven bed surface.

2. Factors associated with the individual characteristics of the patient’s condition:

elderly age;

exhaustion or, conversely, obesity of the patient;

diseases of cardio-vascular system;

diseases associated with impaired innervation of the body (including strokes);

disturbances associated with change metabolic processes in the body (violation of water-salt metabolism or normal restriction in drinking);

unbalanced diet or lack of protein in the diet, protein dystrophies(protein metabolism disorders);

the patient's condition (coma, dementia, etc.) in which he does not control bowel movements or urination.

In addition, factors that provoke the occurrence of bedsores include smoking, diabetes, lack of water and little nutrition, excess or, on the contrary, very low weight, urinary and fecal incontinence, dirty skin, crumbs and small objects in the bed, allergic reaction for skin care products, folds, seams, buttons on underwear, as well as injuries and diseases of the spinal cord and brain, sweating during.

Stages and degrees of bedsores

The pathogenesis of bedsores is characterized by stages of development. There are four stages of pathogenesis.

Stage I bedsores

Visually determined by venous erythema at the site of skin contact with a foreign surface. Venous erythema is the result of obstructed blood outflow from a local area.

How to distinguish venous erythema from arterial hyperemia and bruise?

Difference from arterial hyperemia:

the color of venous erythema is red-bluish, the color of arterial erythema is bright red;

the local temperature of venous erythema corresponds to the skin temperature or slightly lower, the local temperature of arterial hyperemia is a warm area of the skin at the site where the temperature is determined.

Difference from a bruise:

the red-bluish color of the skin at the site of finger pressure does not change (bruise)

the same color of the skin at the site of pressure turns pale (venous hyperemia).

Venous hyperemia (erythema) of protruding bone areas of the human body adjacent to foreign surfaces, without compromising the integrity of the skin, is the most important sign bedsore of the first stage.

Stage II bedsores

Visually determined by thinning of the epidermis - the upper layer of the skin, followed by peeling and the formation of blisters. Pathogenesis develops as follows: venous congestion provokes disruption of tissue nutrition, innervation of a body area, excess fluid in the skin, causes swelling (maceration) and rupture of epidermal cells.

Superficial damage to the skin in the form of thinning and peeling of the epidermis, loss of integrity, maceration (moistening) is the most important sign of the second stage of a bedsore.

Stage III bedsores

Visually defined as a wound with suppuration (contamination with microflora) or without suppuration.

Involvement in the pathogenesis of deep layers of skin tissue, subcutaneous tissue, muscles with a purulent type of inflammation and the beginning processes of necrosis (tissue death) is the most important sign of the third stage of a bedsore.

Stage IV bedsores

Visually it is defined as a local cavity or defect formed as a result of decay (necrosis), along the edges of the cavity there are walls of the defect on which purulent inflammation continues.

A necrotic cavity and its expansion due to inflammation of the walls is the most important sign of the fourth stage of a bedsore.

On different parts of the body, there may be different stages bedsores.

Suppuration of the bedsore area begins in the second stage, develops in the third and fourth, after the wound is contaminated with streptococci and other pyogenic microorganisms of the area.

Frequent path the development of a purulent bedsore is erysipelas and phlegmon. In severe cases, a bedsore develops into sepsis or gas gangrene.

1. Development of purulent bedsores like erysipelas

suppress microbial contamination of the wound.

Inspection of the wound and cleaning of the edges from necrotic tissue is performed in a surgical department. To drain the pus, drainage tubes are made and they are regularly inspected.

Passive drainage can be done at home:

To do this, the wound is filled with special napkins soaked in compounds that promote the outflow of pus. The napkins are changed periodically. You can use regular bandages as napkins, the edges of which do not fall apart into threads. Solutions and ointments are used to impregnate napkins.

Outdated medicines: hypertonic solutions 10% sodium chloride, 3-5% boric acid solution and others. Currently, the use of such solutions is limited due to the low suction force from 4 to 8 hours.

Hydrophobic ointments (liniments, emulsions) on a petroleum jelly basis (Liniment according to Vishnevsky, synthomycin emulsion, tetracycline, neomycin and others). Their disadvantage is that they do not absorb pus; the antibiotics in their composition do not work at full strength.

Modern medicines: hydrophilic (water-soluble ointments) - Levomekol, Levosin and other water-soluble compounds. They remove pus from the wound well, within about 20-24 hours. Attention! Use hydrophilic ointments only if there is pus in the wound; in another situation (no pus), these ointments are not effective.

Enzyme therapy is the next method of surgical treatment purulent wounds(therapy with pus-removing enzymes).

Proteolytic enzymes (trypsin, chymotrypsin, others). To enhance their action, use a combination of these or other enzymes with ointments, for example, a combination of enzymes and Iruksol ointment.

Antiseptic solutions for external use. furatsilin, hydrogen peroxide, boric acid (currently used to a limited extent). Modern formulations are indicated for use - 0.5% solution of iodopyrone, 1% solution of dioxidine.

Physical methods of treatment. Use traditional methods(UHF, ultrasonic cavitation, oxygenation, vibraphonation, laser therapy and other similar methods)

II. In the second phase

In the second phase, after cleaning the bedsore from pus, healthy tissue appears. A healthy scab is a thin layer of dried granulations. A purulent scab is a thick crust consisting of dried pus. Recovery under a purulent scab is impossible!

When healthy granulations appear, treatment is prescribed:

relieving inflammation;

protecting healthy granulations (healthy tissues) from accidental damage;

stimulating tissue repair processes.

To relieve inflammation use:

ointments (hydrophobic ointments - methyluracil, troxevasin, hydrophilic ointments - bepanten and others);

herbal preparations – juice, oil (,);

laser therapy with the therapeutic effect of stimulating tissue epithelization.

III. Into the third phase

In the third phase, regeneration and scarring of the wound process are achieved. Use modern drugs stimulating epithelization and scarring of tissues, for example: EDAS-201M, vitamins, immunostimulants. At all phases of pathogenesis, use is allowed antibacterial agents, intravenous is recommended drip administration Metrogyl solution, antibiotics.

The resulting defects and consequences of bedsores are treated in a hospital setting.

Education: Moscow State Medical and Dental University (1996). In 2003, he received a diploma from the educational and scientific medical center for the administration of the President of the Russian Federation.

A bedsore is open wound on the surface of the skin. In particular advanced cases it reaches the deep muscle layers and is characterized by abundant necrotic tissue lesions, often accompanied by bacterial infections. Bedsores are formed due to mechanical compression local network small blood vessels when the patient remains in one position for a long time. Such disorders, as a rule, occur in bedridden or sedentary patients who cannot or for some reason do not want to regularly change the position of their body.

Stages of bedsores and reasons contributing to their appearance

Mobility impairment is one of the most common reasons, causing the development of bedsores as a result of the compressive effect on the blood vessels of the subcutaneous tissue. Most often, bedsores are observed in visually impaired patients under anesthesia, suffering from severe psychopathological conditions, with a history of severe pathologies of the musculoskeletal system or central nervous system. nervous system recovering from major surgery or injury. Patients, for a number of reasons, cannot change the position of their body often enough, and the influence of their own body weight puts serious pressure especially on those areas of the skin that protrude above the general surface.

The second most important cause of the development of bedsores is the rupture of small blood vessels that supply a certain area of tissue due to dragging the patient across the bed, pulling out wet underwear or sheets from under him, or pushing up the bedpan.

There are several complicating factors that, among other things, contribute to the development of pressure ulcers.

Limitation of joint mobility (contractures) and increased tone skeletal muscles (spasticity)

Prevents normal movement of the patient's body. Joint contractures most often occur with tendon injuries, arthritis, scar formations on the surface of the skin or disorders nervous regulation central genesis. Severe damage to the cerebral or spinal apparatus often leads to a spastic state muscle mass in the area of the extremities and abdominal cavity.

One of the most important stimuli for changing body position is pain.

Various neurological disorders or long-term use painkillers can significantly reduce pain threshold, thereby not informing consciousness about the need to reposition the body.

Increased pain sensitivity due to surgical or traumatic wounds

This may force the patient maintain a static position at all times.

A significant role in counteracting pathological processes as a result of squeezing blood vessels and nerve endings plays a role in the physiological state of the skin

Strong, elastic skin is sufficiently resistant to the development of bedsores. On the contrary, a thinned, atrophied epithelium, due to a reduced ability to regenerate, is quickly destroyed with an increasing deficiency of nutrients supplied by the blood. Such phenomena often occur when taking certain medications that affect water-salt metabolism in the body and hormonal drugs.

Decreased regenerative functions of the skin epithelium

Thinning of the skin-epidermal junction and organic destruction of the capillaries of the subcutaneous tissue are typical for elderly patients. That's why The development of bedsores in older people always occurs faster and is fraught with complications.

The skin becomes more susceptible to even minor traumatic forces as a result of de-epithelialization, which usually occurs due to friction and shear forces when the patient is pulled

Worn areas on the skin have a reduced barrier of protection against bacterial contamination, and are also characterized by a low content of transepidermal water, which leads to maceration of the skin with its subsequent stratification.

Constant exposure to high humidity on the skin

May occur as a result of insufficient patient care also lead to damage to the outer skin. The situation is aggravated by the aggressive effects of substances contained in the patient’s feces and urine.

Dirty laundry

This is one of the main reasons for the development pathogenic microflora in the formed ulcerative lesions on the skin. The temperature and humidity of the ulcer creates the most favorable conditions for the development of pathogenic microorganisms that are sufficiently resistant to local antibiotic therapy. The neglect of such processes often leads to a transition from a localized purulent-infectious process to a generalized form. In weakened patients Bacteremia, sepsis, myonecrosis or... often develop.

Malnutrition, insufficient protein intake, and anemia

They reflect the patient’s general condition of resistance against infectious and non-infectious types of skin lesions. Poor nutrition inhibits the body's immune system against pathogens. In addition, anemia results in poor oxygen carrying capacity of red blood cells. The situation worsens even more with the development of cardiovascular pathologies and hypovolemia.

Reperfusion

Restoring normal blood flow in the ischemic area, according to many experts, also contributes to the prolongation of necrotic processes. The metabolic products accumulated during the period of venous stagnation spread throughout the area of influence, thereby increasing the toxicity in this area.

In patients with normal sensitivity, mobility and the absence of psychopathological abnormalities, bedsores are extremely rare. Feedback from subcutaneous receptors, signaling to the brain about the onset of ischemic processes in the area of compressive effects on blood vessels, forces a person to change body position at a conscious or unconscious level.

The development of bedsores occurs in stages, and the further the stage, the more difficult it is to provide a therapeutic effect on ulcerative-necrotic formations.

First stage characterized by the integrity of the skin in the area of compression and the presence of persistent hyperemia long time after releasing the pressure.
Second stage - hyperemia of the subcutaneous tissue against the background early stages physical damage to the epithelial surface layers. Observe keratinization and detachment of the skin epithelium at the site of compression.
Third stage - the formation of a deep, weeping ulcer with complete disruption of all layers of the skin and transition pathological processes necrosis in subcutaneous tissue and muscle tissue.
Fourth stage characterized by a very deep spread of pathological processes, right down to the bones and muscle fascia.

Pathophysiological basis of pressure ulcer formation

For the first time, the pathological processes of the formation of bedsores were described in 1873 by D. Paget, who quite accurately determined the development of necrotic processes as a result of compression of the local subnetwork of small blood vessels. The development of bedsores is influenced by many factors, but the process is always based on ischemic phenomena, leading to the destruction of the cell membrane, and subsequently to cell death as a result of insufficient tissue trophism.

From this point of view, bedsores develop from prolonged, constant pressure on the same area, which impairs the blood circulation of the same area of tissue.

For the development of ischemia it is necessary compression effect for arterial capillaries no less than 32 mm Hg and from 12 mm for venous capillaries.
Squeezing of arterioles contributes to a lack of influx of fresh blood saturated with oxygen and nutrients, and compression of venules significantly impedes blood outflow, rich in tissue metabolism products.
Accordingly, in addition to ischemic manifestations, they also observe stagnant processes in compressed tissues, which significantly complicates the pathological process.

Typically, the tissues of a living organism are normally able to withstand much greater pressure than the indicators indicated above. This is facilitated by sufficient elasticity and strength of the cell walls. However, compression effects on the area for more than 2 hours overlap the tissue capabilities with trophic deficiency.

The development of bedsores most often occurs in areas of the skin that come into most close contact with surfaces. Pressure indicators on specific anatomical areas of the patient, depending on body position, are documented. Thus, when lying down, those most at risk of developing bedsores are:

sacrum;
heels;
back of the head

They are exposed to a pressure of about 40-60 mmHg. The chest and knees account for about 50 mm if the patient is lying on his stomach. IN sitting position The ischial tuberosities are most subject to compression - about 100 mm Hg. It should be noted that the human constitution does not play a significant role in the development of bedsores - than bigger man, the more developed its cellular stroma is. The exception is overweight patients, but in them the pressure on the blood vessels is compensated using the additional shock-absorbing qualities of the fat layer.

Upon reaching the third stage, the pathological process accelerates, it is characterized by more severe damage muscle tissue, which is more demanding in providing oxygen and removing metabolic products. For this reason, the “point of no return” period is set at 2 hours, after which irreversible changes in muscle tissue begin. As for individual skins, they can withstand compression for up to 12 hours.

It is worth noting that, in addition to the immediate lack of blood supply, the processes of regulation of tissue activity in the compressed area are disrupted due to compression of the nerve endings.

Features of the localization of bedsores, symptoms and diagnosis

Pressure ulcers are usually described in terms of the location of the pathological area and the depth of involvement of the underlying tissue.

About 70% of all places where bedsores most often form are in areas of the ischial tuberosities, greater trochanters of the femur.
On heels, iliac crests, shoulder blades and elbow joints accounts for about 15-25%.
The remaining percentage is distributed to any parts of the patient’s body that come into contact with any surfaces for a long time, for example, when plaster casts are applied incorrectly.

It is worth noting that the formation of pressure sores in the oral cavity is common in the field of dentistry. The areas most often occur at pressure points of dentures, as well as in the interdental crevice space on the gum, which is facilitated by the packing of dense formations from food masses.

Usually, diagnosing a bedsore is not particularly difficult - visually and organoleptically it is possible to determine with a sufficient degree of confidence the development of ischemic processes in the area subject to compression. However, in cases where there is no improvement with correct treatment of pressure ulcers, it may be necessary additional diagnostics in order to identify third-party pathologies, including oncological ones. Besides, osteomyelitis must be excluded , especially in cases of deep pressure ulcers.

Complete blood count with differentiation can show increased content white blood cells, which allows us to judge the possible generalization of the pathological process beyond the bedsore, as well as the development of an invasive infection. The erythrocyte sedimentation rate is higher than 120 mm/h and the leukocyte count is more than 15,000 cells/µl, forcing a series additional research for osteomyelitis.

Food quality, as an integral factor in favorable pressure ulcer therapy, is determined by the presence of albumin, prealbumin, transferrin and the amount of total protein in the blood serum.

A biopsy of wound tissue is performed if there is no improvement despite proper care of pressure ulcers. This examination is carried out to determine the species of bacterial flora that populate the wound surface, as well as to exclude malignant cell growth. Whenever there is an exacerbation of a pressure ulcer that has been in remission for several months or years, a biopsy must be performed. This effect is most often observed during the development malignant processes in old wounds.

Briefly about the treatment and prevention of bedsores

It is worth noting that there is no panacea for treating bedsores. A series of consistent measures is required to facilitate rapid disposal of the developing pathological area.

The need for maximum restoration of blood circulation and innervation at the site of compression.
Removal formed necrotic masses in the pathological focus.
Promoting speedy healing formed wounds.

You should always remember that the appearance of a bedsore is an indicator of the patient’s neglect in terms of proper care and the correctness of the therapy used. Therefore, if the patient is unable to independently change the position of the body, it is necessary to assign service personnel to him, preferably in the person of the same person, who will always be aware individual characteristics development of possible pathological processes. Unfortunately, in the conditions of a modern Russian hospital, functioning with state support, this is an almost impossible task.

Absolutely all patients whose movement is limited by a wheelchair, bedridden patients suffering from paresis or paralysis of certain parts of the body, as well as diseases that reduce the level of brain activity. Special attention required for people with the following pathologies:

urinary and fecal incontinence;
are at the stage of exhaustion;
obese;
people with diabetes;
with a history of stroke complications.

What are the basic principles for preventing the development of bedsores?

Reduced compression, friction or lateral shear effects of the body.