1. Principles of bedsore treatment
(1) Patients with severe bedsore should be treated with BingShi Yu ointment immediately after finding symptoms. First, after the wound is disinfected and cleaned with normal saline, the ointment is directly applied to the wound, and the pain is immediately relieved in about 15 minutes. At the same time, secretions (such as water spots, water drops, purulent blood, carrion and other foreign bodies at first) appeared and fell off automatically. Observe that the wound turned white and normal.
(2) Before taking the medicine, patients should clean and pay attention to remove necrotic tissue, especially patients with bedsore and diabetic foot should carefully check the wound surface, and deal with necrotic muscle bonds when necessary to avoid future troubles.
(3) For patients with severe bedsore and diabetic foot, it is best to change the dressing twice a day during the period of clearing the sore, so as to clean the wound exudate at any time, and it is best to expose the treatment if possible, which can effectively shorten the treatment time.
(4) Generally, it takes about 7 days to cure superficial second-degree bedsore, and about 12 ~ 15 days to cure deep second-degree bedsore. It takes about 10 ~ 15 to treat bedsore and diabetes with a length of 5 ~ 8 cm for about 20 ~ 30 days.
2. Drug therapy
(1) tincture of iodine can dehydrate tissues, promote wound drying and soften hard structures. Apply iodine to the wound twice a day.
(2) Polyantigen A can stimulate immune cells, enhance immune function and promote wound tissue repair. For patients with large wounds, we should first debride them with normal saline, then irradiate them with infrared light for 20 minutes, wet compress them with polyoxin A solution after the wounds are dry, then irradiate them with infrared light for 65,438+00 minutes, and finally cover them with sterilized purple clover oil gauze. For patients with excessive exudate, the dressing should be changed three times a day.
(3) Metronidazole has special effects on killing anaerobic bacteria, dilating blood vessels and enhancing blood circulation. After washing with this medicine, wet compress the wound and irradiate it with infrared lamp for 20 minutes, 3 ~ 4 times a day.
(4) Chinese medicine is very important for stage II and IV bedsores. We can first clean the wound with normal saline to remove necrotic tissue, and then apply Chinese medicine to the bedsore wound for treatment. If there is a cavity, it can be combined with oil gauze to promote granulation growth, which can drain and discharge decomposed substances and accelerate the growth of new granulation. The importance of treating bedsore with traditional Chinese medicine is increasingly recognized by people.
(5) The modified chitin extracted from squid cartilage has the functions of stopping bleeding, promoting wound healing and reducing scars, and is non-irritating, non-allergic, non-toxic and biocompatible, so it is an excellent biological dressing.
Staged treatment
(1) Phase I clinical manifestations are mainly dark red, swelling and burning pain of local skin, and the skin integrity has not been destroyed. If treated in time, it is expected to return to normal completely without ulceration, which is the first stage of bedsore .. Treatment should first increase the number of patients turning over, improve local blood circulation, correct ischemia and hypoxia, and try to remove the pathological factors leading to bedsore. Secondly, wipe the wound with hydrogen peroxide, then rinse the wound with normal saline, disinfect the skin around the bedsore with 75% alcohol, and then cover it with sterile gauze.
(2) The clinical manifestations in the second phase are mainly purplish red and edema of local skin. Stagnation of blood stasis can lead to hysteria, so every time I see subcutaneous induration. Edema can make the skin thinner, so blisters often appear. If you are not careful, blisters will easily break and lead to infection. During this treatment, attention should be paid to keeping the skin clean to prevent infection. Try to reduce friction and prevent the blister from breaking. The liquid in the blister can be pumped out with a syringe to protect the skin from damage. This period, also known as inflammatory infiltration period, indicates that infection is most likely to occur. If there is infection, effective antibiotics can be injected intravenously. First, wash the wound with normal saline. If there are blisters, puncture them with a sterile needle. Then, soak the sterilized gauze in new liquid and apply two layers of gauze to the wound. Every 3-4 hours, the liquid medicine is pumped out by a syringe and dripped on the dressing, and the gauze covering the wound is kept moist. Tip: Try to protect the epidermis, and the gauze used should be sterile medical gauze. Before using the new solution, wash the wound with normal saline. Empty the affected area with a soft pillow or washer to avoid dragging the gauze-covered area. When changing the dressing again, the gauze can be soaked with normal saline again and then removed to prevent the dressing from sticking to the wound. In the treatment of patients with pressure ulcers in inflammatory infiltration period, 0.5% iodophor is often used for disinfection to dry the wound. However, this method is easy to dehydrate the wound, which is not conducive to the growth of epithelial cells, and it is easy to lose bioactive substances and slow down the healing speed. If gauze is not covered, it is easy to scratch the skin and bed, and if gauze is covered, it is easy to cause the dressing to stick to the wound. When dressing changes again, it is easy to cause mechanical injury, increase the pain of patients and even expand the wound. At present, it is believed that continuous humidification under aseptic conditions is beneficial to the formation of wound epithelial cells, accelerating the shedding of necrotic tissue, and significantly promoting the growth of granulation tissue and wound healing. Therefore, the continuous wet compress method is suitable for the treatment of pressure ulcers in inflammatory infiltration period.
(3) The third stage, also known as superficial ulcer stage, is a serious stage of bedsore, and it is difficult to treat and nurse. Because bedsore was not found in the early stage, the treatment was not as good as that in the future, and the local epidermal blisters gradually expanded, so that the dermis was exposed after rupture. Skin infection is very easy. After infection, the original yellow exudate surface can be covered with pus, which gradually forms an ulcer and begins to hurt. In the treatment, the bedsore-preventing air cushion bed should be used first, and the bedsore-preventing air cushion bed should be turned over within 2 hours 1 time to avoid pressure, keep the skin dry and clean, and keep the sheets clean, flat and wrinkle-free. Then effectively resist infection and prevent the disease from continuing to develop. While using enough effective antibiotics, local dressing changes should be made twice a day, and aseptic technical operation procedures should be followed when dressing changes. Wash the bedsore wound with hydrogen peroxide and 0.2‰ furacilin solution in the morning. If there is necrotic tissue, cut it off before cleaning it. Apply iodophor evenly locally, and irradiate it locally for 20min minutes with spectral therapeutic instrument. Finally, cover it with sterile gauze. In the afternoon, after routine debridement and spectral irradiation, a piece of gauze soaked in new liquid was put on the wound surface, and then covered with sterile gauze. When the wound surface gradually shrinks and it is not suitable to use gauze again, drop new liquid directly on the wound surface. Iodophor solution is composed of iodine and carrier, which has strong killing effect on bacteria, spores, viruses, fungi, mold spores and protozoa, and has no irritation to skin and mucosa. The new liquid has the functions of dredging blood vessels, nourishing yin and promoting granulation, promoting angiogenesis, promoting granulation tissue growth, improving wound microcirculation, accelerating the repair of damaged tissues and enhancing immune function. Clinically, it is mainly used for the healing of various ulcer wounds. Irradiation with spectrometer is beneficial to blood circulation, anti-inflammatory and analgesic. The method has the advantages of high cure rate, short course of treatment, promoting the growth of sarcophagus tissue, convenient use, no side effects and promoting healing. It is a better method to treat bedsore.
(4) The principle of four-stage treatment is to clean the wound, remove necrotic tissue and promote the growth of granulation tissue. Wash the wound with normal saline first, and then disinfect the wound with complex iodine.
Proper debridement and removal of necrotic tissue can be accomplished by surgical methods, mechanical methods, chemical enzyme methods and autolysis methods. Surgical debridement is the most effective method, and sharp wound debridement is the fastest. The carrion and scab can be removed by scalpel or scissors until the healthy tissue is exposed, and new liquid is used, mainly to quickly promote wound repair. When using Kangfuxin wet compress, the exudation gradually decreased, and the surrounding redness subsided and scabbed. With the increase of treatment times, local symptoms improved obviously.
4. Physical therapy
(1) Oxygen therapy uses pure oxygen to inhibit the growth of anaerobic bacteria on the wound surface, improve the oxygen supply to the wound tissue and improve the local tissue metabolism. After the oxygen flow dries the wound, it forms a thin scab, which is beneficial to healing. Methods: Cover the wound with plastic bag and fix it firmly. Blow oxygen into the bag through a small hole. Oxygen flow rate is 5 ~ 6L/min, each time 15 min, twice a day. After treatment, the wound can be covered or exposed with sterile gauze. For wounds with a lot of secretions, 75% alcohol can be put in the humidification bottle, so that some alcohol can be taken out when oxygen passes through the humidification bottle, which can inhibit the growth of bacteria, reduce secretions and accelerate wound healing.
(2) Air-cushion therapy: The use of air-cushion bed has a low popularization rate, which cannot fundamentally solve the problem. Moreover, air-cushion bed is inconvenient to move and use, expensive, and has poor air permeability, which easily leads to wet and sticky skin of patients due to sweating, discomfort in patients' back, long-term power consumption and noise, which makes patients fidgety and affects their rest. Most air-cushion beds have no therapeutic effect on bedsores.
(3) Manual nursing: Turn over the patient regularly every 1 ~ 2 hours and massage the pressed skin. Because of the heavy workload, nurses need to have a high sense of responsibility. Clean the patient's skin regularly. In practical nursing, it is difficult to keep the skin clean because of the inconvenience of patients.
(4) Ultraviolet phototherapy: Through direct sterilization, low-dose ultraviolet rays stimulate some damaged cells to release stimulating growth factors, and strengthen the metabolic function of normal cells, thus achieving the purpose of promoting wound healing. High-dose ultraviolet irradiation can control infection through strong erythema dose response, promote protein decomposition and necrosis tissue shedding, and thus achieve the purpose of wound cleaning and healing.
5. Surgery
For bedsores with large area and deep bone, when the above conservative treatment is not ideal, surgical treatment can be used to accelerate healing, such as surgical scraping and drainage, removal of necrotic tissue and skin grafting to repair defects. Surgical repair is also suitable for war injury complicated with large area bedsore. Because of war injury, people lose a lot of blood, their body resistance is poor, and bedsore persists, which is easy to cause systemic infection. Surgical repair can shorten the course of bedsore, relieve pain and improve the cure rate.
6. Ultraviolet therapy
The mechanism of ultraviolet phototherapy instrument is as follows: ① Ultraviolet rays can inhibit the growth of sterilized bacteria, destroy the nucleic acid metabolism of bacteria and kill them. Therefore, it can effectively kill bacteria propagating on the surface of bedsore, eliminate infection and promote wound healing; ② Ultraviolet rays have anti-inflammatory effect, and ultraviolet erythema is a special reaction of skin to ultraviolet rays. In the irradiated area, due to the action of histamine and histamine-like substances, the blood and lymphatic circulation are strengthened, the function of reticuloendothelial system is enhanced, the phagocytosis of cells is enhanced, the local skin temperature is increased, the pH tends to be alkaline, and the metabolism is vigorous. These inflammatory reactions enhance the body's defense ability. Epithelial tissue grows faster under the action of stimulating growth factors released by human body, and the keratinized layer is thickened and pigmented, which improves the skin defense ability. The healing time of ultraviolet treatment group is shorter than that of control group, mainly because of effective antibacterial effect, which can reduce the inflammatory reaction and secretion of wound surface, thus promoting wound healing.