senile bedsores
Introduction
Introduction to acne in the elderly Acne refers to short-term strong stress or long-term low pressure leading to ischemic necrosis and ulceration of muscles on the skin, subcutaneous tissue and bone bulge. Acne occurs in the tibia, the greater trochanter of the femur, the internal and external iliac crest, and the spine. Acne can be seen at any age, but it is most common in the elderly, especially in elderly patients over 70 years of age. basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of infection: non-infectious Complications: sepsis
Cause
Causes of acne in the elderly
Local factor (30%):
(1) Compression: the tissue of the protruding part of the bone is compressed, the regulation of microvascular circulation is weakened, the local capillaries are ischemic, the higher the tissue pressure is, the shorter the time of ulcer formation is formed, and if the human body continues to be subjected to 8.0 kPa pressure, the skin The internal blood flow rate drops to 33% of normal, and tissue damage occurs after being pressed for more than 3 hours. If the pressure is not relieved, it causes acne.
(2) Friction and shear force: the elderly have skin physiology, immune changes, their barrier ability, vascular dysfunction, such as pushing and dragging the patient's body, causing the patient's skin to be rubbed; or allowing the patient to lie down and partially suffer Increased shear force can easily cause acne.
(3) Humidity and temperature: high temperature sweating, incontinence, tissue infiltration, local skin softening, slight friction will increase skin tissue loss; in addition, such as hot water bottle, ice bag, etc. can affect local metabolism and tissue blood supply, if Improper use can lead to acne.
(4) Skin wrinkles: The skin of the wrinkles is poorly elastic, and the subcutaneous lacks a fat pad that protects the capillary blood flow in the dermis, so that the cushioning force against mechanical damage is weakened, and acne tends to form easily.
Systemic factors (30%):
(1) Malnutrition: The elderly have hypoproteinemia and anemia due to diabetes, multiple organ dysfunction, etc. In this case, hemorrhoids are prone to occur.
(2) Feeling low: due to senile dementia, cerebrovascular accident, paraplegia, neuritis and other reasons caused by low feelings, the pain sensitivity caused by compression is reduced, can not avoid the oppression, it is prone to hemorrhoids.
(3) Aging: due to the skin caused by old age, subcutaneous tissue, muscle atrophy and relaxation, so that the ability of the tissue to reduce the buffering pressure is reduced, so it is prone to hemorrhoids.
Social factors (20%):
Elderly people who have been in bed for a long time and elderly patients who are treated at home, because of the lack of medical knowledge of caregivers, lack of awareness of the risk of developing acne, care for care, and the occurrence of acne.
Pathogenesis
1. Ischemia: due to local pressure and shear stress, the tiny arteries are narrowed or occluded, blood supply is reduced or ischemic, resulting in ischemic necrosis of skin and subcutaneous tissue. The elderly often have increased skin wrinkles and are more prone to local small blood vessels. Occlusion.
2. Injury: Due to local shear stress, infection, tearing, friction and other effects, the skin and subcutaneous tissue are damaged, and the formation of hemorrhoids is caused by ischemia.
3. Impregnation: large, urinary incontinence, sweating and other local moist impregnation, which affects blood supply, local skin is easy to break, accelerate the occurrence of hemorrhoids.
Prevention
Elderly acne prevention
Because the skin is aging, the body's resistance is reduced. Once hemorrhoids are difficult to cure, prevention is extremely important. Take appropriate precautions against the causes of hemorrhoids.
1, eliminate local factors
(1) Remove local pressure:
1 Exchange position: Turn over once every 2 to 3 hours to avoid prolonged compression of the bone protrusion.
2 use prevention tools: local use of ring cotton pads, sponge pads, pillows, polymer artificial fat pads, etc., to alleviate the pressure of the bone protuberance, in addition, there are more types of body appliances, such as pressure point moving air cushion, is the use of black and white charging The airbag alternately expands and contracts to move the pressure of the pressure point dispersion. In addition, the irrigation pad and the electric air cushion can all exert the effect of dispersing the pressure, but they cannot rely on the appliance completely. Pressure.
(2) Keep dry and prevent abrasions: The skin of the elderly is more folds, plus sweat, incontinence leads to softening of the skin. Special care should be taken to prevent abrasions and tears. The sheets should be kept flat and wrinkle-free. The underwear that is in direct contact should be soft. To help the patient turn over, force it up, not tow, push, so as not to cause scratches. In addition, take a bath, change clothes, keep the skin dry and smooth, and apply a thin layer of talcum powder to reduce friction. Force and absorb moisture.
(3) Observing the skin condition: The elderly are unresponsive, so it is necessary to observe the skin condition in a strict and meticulous manner. Pay special attention to the skin condition of the acne-prone area. For patients in bed, passive exercise, massage, etc. should be carried out to promote blood circulation.
2, improve the general condition
Active treatment of primary disease, improvement of malnutrition, correction of hypoproteinemia, use of methods such as parenteral nutrition and deep vein nutrition, high protein, high energy diet, central venous nutrition, blood transfusion, etc., due to nerve palsy Low measures should also be taken to treat them.
3. Health education
For patients who are treated at home, the caregiver and the patient should be educated about the causes of acne and the prevention knowledge to achieve prevention.
Complication
Senile acne complications Complications sepsis
Severe cases can be complicated by sepsis or multiple organ failure.
Symptom
Old acne symptoms Common symptoms Immunity drops severe pain Trembling hypothermia Stress vascular sclerosis Dementia chill
Clinical manifestation
(1) Symptoms are not typical: due to the loss of pain in the elderly, dementia, etc., can not reflect the occurrence of hemorrhoids in a timely manner, medical personnel need to closely observe the compression site, in order to find out in time, especially when hemorrhoids cause systemic infection, early performance is not typical. Anyone with fever, erythrocyte sedimentation rate, hypothermia, tremors, chills, sweating, changes in consciousness, etc. should be alert to the possibility of hemorrhoids combined with infection.
(2) Easy secondary infection: due to the substantial cell shrinkage and the decrease of the number of organs in the elderly, the storage capacity of the organs is reduced, the adaptability is reduced, the immunity of the body is reduced, and the infected local and surrounding infections are prone to occur. Can cause sepsis.
(3) difficulty in healing: the elderly are mostly mixed hemorrhoids, and the factors affecting the healing of hemorrhoids are complex, such as old age, poor nutritional status; decreased immune system function, resulting in decreased phagocytic formation, weakened phagocytosis; emotional stress, microvascular contraction, The microcirculation is reduced to deliver nutrients to the wound bed, so the repair ability is poor and the healing is extremely difficult, which is an important reason for prolonging the hospital stay, slowing down the recovery speed and increasing the mortality rate.
2. Classification
(1) Ordinary compression acne: due to local compression ischemia, local blood supply before compression, normal temperature difference between acne and surrounding skin, and shorter healing time (<6 weeks).
(2) arteriosclerotic acne: due to hardening of the arteries, stenosis affects the local blood supply, such acne skin temperature difference is more obvious, not easy to heal, prone to ulcers and gangrene, providing more suitable conditions for secondary infection.
(3) Acne before dying: It often occurs in patients with multiple organ failure and advanced cancer. At this time, the body is depleted, and once hemorrhoids occur, it is extremely difficult to heal.
(4) mixed acne: often caused by pressure, arteriosclerosis, failure, malnutrition, infection, local infiltration and other reasons, is the most common type of acne in the clinic.
Examine
Elderly acne examination
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
Diagnosis and diagnosis of acne in the elderly
Diagnostic criteria
According to the history, symptoms, signs, hemorrhoids can be diagnosed, in order to timely detect and prevent hemorrhoids, clinically divided into 4 or 4:
1I degree (sudden rosity period): the epidermis is not damaged, but the skin is red, but the redness is not improved after 30 minutes of compression.
2 II degree (inflammatory infiltration period): redness of the epidermis, shallow ulcer, erosion, blisters, tissue defects, but not the dermis, the wound infiltration is pink, accompanied by pain, no necrotic tissue.
3III degree (superficial ulcer period): The ulcer is subcutaneously subcutaneous, which is a sickle-like tissue defect, accompanied by exudate and infection, and has necrotic tissue, but does not involve nearby tissues and joints.
4 IV degree (necrotic ulcer phase): extensive destruction of the entire layer of the skin, necrosis and involving the tendon, bone and its supporting tissue, may be accompanied by fistula, if there is nerve damage accompanied by severe pain.
Differential diagnosis
Clinical should be differentiated from simple sore or drug allergy skin diagnosis, suppurative sore rash.
