bedsores
Introduction
Introduction to acne Hemorrhoids (also known as pressure sores, pressure ulcers) are caused by long-term compression of local tissues, which hinders blood circulation, and causes ischemia, hypoxia, and malnutrition, resulting in tissue ulceration and necrosis. The formation process is divided into three phases: the erythema phase, the vesicle phase and the ulcer phase. Skin acne is a common problem in rehabilitation and nursing. According to relevant literature reports, about 60,000 people die each year from acne. basic knowledge Probability ratio: the incidence of paralyzed patients can reach 10% Susceptible people: no special people Mode of infection: non-infectious Complications: osteomyelitis sepsis
Cause
Causes of acne
Nutritional status (30%):
Lack of systemic nutrition, muscle atrophy, and lack of protection from compression. Such as long-term fever and cachexia. Systemic dystrophies, inadequate nutrient intake, decreased protein synthesis, negative nitrogen balance, reduced subcutaneous fat, muscle atrophy, once compressed, the skin of the bone protuberance must withstand external pressure and the compression of the skin at the bony prominence. The pressure is lack of protection of muscle and adipose tissue, causing pressure sores in blood circulation disorders.
Stress factor (25%):
1 Vertical pressure: The main cause of acne is that the local tissue suffers from sustained vertical pressure, especially in the bulging of the body bones. 2 Friction: Friction acts on the skin and easily damages the stratum corneum of the skin. When the patient is active in a bed or in a wheelchair, the skin can be rubbed by the retrograde resistance of the surface of the bed sheet and the wheelchair cushion. If the skin is immersed by sweat, urine, stool, etc. after being scratched, it is prone to acne. 3 Shear force: The so-called shear force is a force applied to an object to cause a parallel sliding in the opposite direction. It is a combination of friction and vertical pressure. It is closely related to body position.
Reduced skin resistance (25%):
The skin is often subjected to physical stimuli such as moisture and friction (such as improper use of plaster bandages and splints, incontinence, inconspicuous sheets, and debris on the bed), which reduces skin resistance.
Pathogenesis
The long-term pressure caused by the above reasons and concentrated in a certain part of the body is enough to cause local blood circulation to be blocked and lead to tissue hypoxia, which may cause tissue damage and necrosis. If the pressure continues to cause full-thickness skin necrosis, the resulting ulcer may easily lead to Bacterial infection, due to the capillary and venous congestion at the base and edge of the ulcer, combined with the formation of a large number of granulation tissue, so that the ulcer or gangrene area can be quickly drilled and expanded under the skin, which can be 3 to 6 cm in diameter within a few days, and the range can be cut from the edge. 8 ~ 10cm, the development of deep into the periosteum and even bone, causing focal periostitis or osteomyelitis.
Prevention
Acne prevention
The method of prevention is to avoid local long-term compression. It is best to turn over regularly. It is best to turn over every 2 hours to 3 hours. Massage the compression part frequently. If necessary, use a steam cushion or a sponge pad to cushion the compression part, especially the tail. When moving the patient, the action should be brisk, avoid pushing and pulling the patient, always change the sheets, keep the sheets clean, smooth, dry, remove the urine and urine in time after defecation, scrub with warm water to avoid local irritation, to prevent hemorrhoids.
The key to preventing the occurrence of hemorrhoids should be as follows:
1. Medical staff should increase their sense of responsibility.
2. Avoid local long-term compression, reduce muscle tension, cerebral hemorrhage and deep coma should be turned over once every 30 to 60 minutes, normal muscle tension should be turned over every 2 hours, if conditions can use various medical devices to reduce local Tissue pressure or alternately compressed, such as pulsed air pressure pads, jet medical air cushions.
3. Keep your skin clean and dry.
4. Keep the bed flat, clean and soft.
5. Change the local blood circulation, such as frequent massage with 50% alcohol, and then apply talcum powder 2 to 4 times a day.
Complication
Acne complications Complications osteomyelitis sepsis
Development to the deep can involve periosteum and even bone, causing focal periostitis or osteomyelitis.
In severe cases, secondary infections can cause sepsis and life-threatening, and those with severe hemorrhoids turn into skin cancer, which is life-threatening.
Symptom
Acne symptoms Common symptoms Blister edema erythema (clear boundary
Clinical manifestations of more than 95% of acne occur in the lower body of the bone bulge, 67% of the ulcer occurs around the hip and buttocks, 29% occur in the lower limbs, the typical acne occurs in the humerus, the greater femur, the ischial trochanter, The heel and the external hemorrhoids, these anatomical parts are the most dangerous parts of the acne when the patient does not change position. Most of them occur in the compression part of the skeletal protrusion. According to the occurrence, the development process can be divided into three degrees: once: the local only shows erythema Edema, or pale, blue-gray, clear boundary, numbness or tenderness, if treated in time, can be improved within a few days, second degree: skin color is dark purple or purple black, blisters may appear, blister wall formation Superficial erosion surface, three degrees: ulcer formation, shallow subcutaneous tissue, deep to bone tissue, secondary pus after infection, and smell.
The clinical manifestations of acne can be regarded as a series of skin activities, the color depth changes from red to white, no tissue loss, deep damage extends to muscles, joint capsules and bones.
Early changes in the skin, white erythema is characterized by a strong change in erythema, from pink to bright red.
The stain shows the severity of the change in blood vessel state. The heavier the color, the more intense the skin changes, from black to blue to blue-violet.
Further deterioration of the tissue in the stain site is compressive dermatitis, rupture of the epidermis, and blisters under the epidermis. Large blisters, scars, scales may appear, and after appropriate treatment, it may heal in 2 to 4 weeks without persistent pathological changes. The lack of awareness and treatment of oppressive dermatitis are not timely, leading to the formation of real acne.
According to the development process of acne, the degree of severity can be divided into three phases:
(1) When the local skin is compressed or stimulated by moisture, there is redness, swelling, heat, numbness or tenderness, and some have no swollen heat reaction.
(2) If the redness and swelling continue to be compressed during the inflammatory infiltration period, the blood circulation will not be improved, the skin color of the pressed surface will turn purple, and the skin will become blisters due to edema and thinning. At this time, it is easily broken and reveals moist and rosy. Wounds.
(C) venous return of the ulcer is severely impaired, local congestion caused by thrombosis, tissue ischemia and hypoxia. Light superficial tissue infection, pus outflow, ulcer formation; severe necrotic tissue black, increased purulent secretion, odor. The infection spreads to the surrounding and deep, reaching the bones and even causing sepsis.
Examine
Hemorrhoids examination
1. Clinical skin examination
Because the elderly suffer from pain loss, dementia, etc., it is impossible to reflect the occurrence of hemorrhoids in time, and medical personnel need to closely observe the pressure-receiving parts in order to find them in time. Especially when acne causes systemic infection, early performance is more atypical. Anyone with fever, erythrocyte sedimentation rate, hypothermia, tremors, chills, sweating, and changes in consciousness should be alert to the possibility of hemorrhoids combined with infection.
2. Other inspections
White blood cells can be normal or elevated during secondary infection with acne. When the elderly suffer from pneumonia due to prolonged bed rest, the X-ray is abnormal.
Diagnosis
Hemorrhoid diagnosis
diagnosis
Diagnose based on
1. More common in long-term bedridden patients such as paraplegia, chronic wasting disease, extensive burns and deep coma.
2. More often in the humerus, ischial tuberosity and other bone protuberances.
3. Three-step pathological changes of erythema, blisters and ulcers occurred in the site of continuous compression.
Coma and paralyzed patients, bedridden, debilitated patients, patients with long-term fixation or bed rest after fractures, occur in the skeletal bulging compression site, local only erythema edema, or pale, gray-gray, clear boundary, numbness Feeling or tenderness, followed by skin color dark purple or purple-black, blisters may appear, and the blister wall will form a superficial erosion surface, three degrees: ulcer formation, shallow to subcutaneous tissue, deep to bone tissue, ie Can be diagnosed.
TCM pathogenesis and syndrome differentiation: Chinese medicine believes that due to long-term illness, blood loss, compression of blood stasis, blood circulation, meridian barrier, muscle and muscle dystrophy, it is ulcerated into sores.
TCM syndrome differentiation:
Main card: local skin color red, mild swelling or dark purple color, ulceration, weak body weakness, loss of appetite, pale tongue, white fur, fine pulse.
Dialectical: qi stagnation and blood stasis, skin dying.
Differential diagnosis
When acne-type ulcers occur, the ulceration of the early buccal mucosa cancer should be differentiated from erosive lichen planus and mucosal chronic ulcer.
