Posted by: happyangelclub | 十二月 26, 2012

Article (1) : Class C Ward daily charges of $35 Vs Bed Sore Mattress rental cost of $10 per day

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A friend’s late father passed away in KTPH on 23/10/2012. After settling the funeral matters, the son Mr F handed me a Bed Sore Mattress (for preventing Bed Sores) used by his late father, to be given to any needy persons.

Mr F told me that during the period when his late father was warded, the hospital rented a Bed Sore Mattress to him. The daily rental fees were $10. Mr F asked the hospital if he could buy one such mattress so that he would not need to pay for the rental fees, and it could be used at home even after the patient was discharged. The hospital replied that he would not because these were only for rental, and the price per set was costly (over $1000 each) and there was only one known supplier in Singapore.

Mr F made a lot of enquiries and finally found a vendor. He bought a set of Bed Sore Mattress which was ten times cheaper for his late father to use in place of the one rented from the hospital. Mr F happily approached the hospital but they declined his request. The reason given was that if the next of kin were to use their own Bed Sore Mattress, the hospital’s electricity would be over-loaded. However, Mr F has the knowledge and rebutted the excuses given by the hospital. Eventually, the hospital had softened the tone, but gave a condition that the vendor MUST send a technician to conduct a demo before they were allowed to install it. This had puzzled the vendor and requested a recall and refund as it was so troublesome to make this sale.

After much negotiation, the hospital finally gave way and Mr F was able to let his late father use the Bed Sore Mattress he bought in the hospital ward without having to summon for the technician.

I handed over Mr F’s Bed Sore Mattress to a Mr Tan (78 years old), was has been bed-ridden for 3 years. I confirmed with Mrs Tan that the hospital in which Mr Tan is warded (St. Luke Hospital) allows patients to use their own Bed Sore Mattresses in the ward. Renting one from the hospital would also cost $10 daily.

I did some research on the internet, and got the following information hoping to help patients and family members lighten the medical expenses:-

myHome-n-Health.Com
http://www.myhome-n-health.com/servlet/StoreFront

Medical Anti Bed Sore Mattress Pad System , Changing air pressure improves circulation…
Sells for $165
Season Sale  Price: $135.00

Today is 25/12/2012 Christmas Day.  Perhaps for many of us it is holiday mood. However, some patients who are warded and their family members are worrying about medical fees. Perhaps…. MOH and KTPH could give us an answer: Why are they not putting patient’s well-being as top concerns, but instead mislead patient’s family members and cooperate with vendors of expensive medical equipment?

(By Jane Lim 25-12-2012  https://happyangelclub.wordpress.com/

C级病房每天费用35元/ 防褥疮床褥每天租金10

23-10-2012,朋友的爸爸在邱德拔医院过世了,家人为他办好后事之后,其儿子小黑Mr F将他爸爸用过的Bed Sore Mattress(预防褥疮之床褥)交给我,请我转交给其他有需要的人使用。

小黑告诉我,爸爸住院期间,院方出租Bed Sore Mattress给他使用,租费是每天十元。小黑问院方,可否让家属自己买来用?就不必每天支付租费而且待病人出院后在家里也可以使用。院方说不行,他们只出租不卖,院方强调,这种产品很贵,一个要价一千多元,全新加坡就只有院方这个代理商有售卖。

小黑多方打听,终于找到了一家售卖此产品的商家,他以便宜十倍的价钱买了一个Bed Sore Mattress要给爸爸使用。小黑兴高采烈向医院表明用意,院方断然拒绝小黑的请求,理由是,如果家属用自己的Bed Sore Mattress,会让医院的电力不甚负荷。小黑也算是有这方面的知识,他驳斥了院方不成理的理由。后来,院方的态度软化了,可是,却提出了一个附带条 件,要小黑请那个售卖产品给他的商家,务必派一个技术人员到医院来作示范,才准许使用。结果搞到商家莫名其妙,啼笑皆非,责问小黑:“怎么卖一个小产品给 你,还搞到那么麻烦,需要派技术人员上门示范才被核准,那就干脆不卖了。”

几经抖旋,院方终于让步了,小黑终于可以将自己购买的Bed Sore Mattress,让爸爸在邱德拔医院使用,也无须派技术人员到来。

我 将小黑的Bed Sore Mattress交给另一个卧病在床三年的陈老伯(78岁),同时向陈太太查证,得知陈老伯所住的 St. LUKE Hospital 是允许病人带自己的Bed Sore Mattress来使用的,如果向院方租借,同样得支付每天十元的费用。

我在网上搜寻,得到以下讯息,希望能够给病人和家属减轻医疗开销:

myHome-n-Health.Com
http://www.myhome-n-health.com/servlet/StoreFront

Medical Anti Bed Sore Mattress Pad System
Changing air pressure improves circulation…
Sells for $165
Season Sale  Price: $135.00

今天是25-12-2012圣诞节,也许,佳节的喜庆气氛,感染着许多人;也许,一些趟在病床的病患和家属,正为着高昂的医药费而发愁;也许。。。。。。卫生部和邱德拔医院会给我们一个答案:为何没以病人的福祉为重,误导病人家属并和售卖昂贵医药器材的商家合作?

(文:林宝珠 Jane Lim 25-12-2012  https://happyangelclub.wordpress.com/

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Responses

  1. […] Class C Ward daily charges of $35 Vs Bed Sore Mattress rental cost of $10 per day Share| Intel Q6600@3600 | Scythe Infinity | ASUS P5K3 Deluxe | 8GB Kingston […]

    • Thanks for linking for further discussion.

  2. There are a range of special mattresses and cushions that can relieve the pressure on parts of the body that are vulnerable. Care teams will discuss the types of mattresses and cushions that are most suitable for you.

    People with pressure ulcers will require different types of mattresses the higher the grade the more sophisticated mattress or bed system will be needed. For example, there are mattresses which are connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required.

    http://www.mayflower-medical.co.uk/pressure-ulcer-bed-sore-treatment.html

    The $165 mattress is likely to be a prophylactic med sore mattress vs a therapeutic bed sore mattress…. the cheaper version is unlikely to treat the higher grade sore. It is a pity the hospital failed to explain this in the correct light

    • Thanks Chicken Pie for your sharing.

  3. Khoo Teck Puat Hospital (KTPH) has in place protocols for patients who wish to use their own medical equipment during their stay in our hospital.

    Pressure-relieving mattresses are considered medical equipment as they are powered by electricity and used to prevent patients from developing bed sores when they lie prone for long periods of time.
    Patients and their next-of-kin (NOK) are advised to rent a pressure-relieving mattress from our approved vendor for $10 daily.

    Our mattresses are of medical grade, clinically-tested and meant for high usage in a hospital environment versus those purchased off the shelf for individual use. The vendor also takes care of the maintenance of the mattresses.

    Patients and their NOK who do not wish to rent from our vendor are allowed to use their own pressure-relieving mattresses. They have to sign a Hospital Indemnity Form and have their mattress commissioned jointly by the product vendor/manufacturer and our Bio-Medical Engineering staff.

    Commissioning is required to ensure all medical equipment is compatible. Equipment that is not commissioned may short-circuit and result in a fire risk and/or power supply shutdown in the room/ward. This may compromise staff and patient’s safety, especially for patients who are hooked up to other medical equipment such as life support systems.

    In the case of Mr F’s father, our staff had explained to his immediate family the reason for the commissioning of their own pressure-relieving mattress. The family was satisfied with our explanation and also agreed to bear the cost of the commissioning.

    • Reply to KTPH 回复邱德拔医院

      Greetings from Jane Lim.
      Thank you for your reply.
      After posting my first article, it received attention from the mass media (Shin Min Daily, Today Paper and Capital 95.8 FM) and was reported separately. Some Shin Min Daily readers called SPH to find out where to buy the bedsore mattress mentioned in the article. Those readers may be caregivers and if we can openly discuss this matter, it will benefit many others in need and caregivers. This will be what I glad to see.
      Over the past few years, I had the opportunities to take part in the Senior Citizens classes and seminars organized by MCYS and NCSS. From 24 to 27 May 2005, I was in Perth, Western Australia to participate in the Regional Training Programme on Community Care in an Ageing Population [Sustaining and Supporting Family Carers and Family Care]. The centre of discussion was about the physical and mental health of caregivers. Researches showed that half of the caregivers would have depression. MCYS is also very concern about caregivers’ health. Singapore established a Caregivers’ Centre after that event.
      I have often reminded myself to benefit others in need with what I have learnt, and also not to forget the teachings of instructors: The priority is the well-beings of the cases.
      Mr F, a caregiver mentioned in my article, not only had to take care of his Father who was warded in the hospital, but also had an elderly Mother at home who was sick and young children to take care of. Choosing Class-C ward would lighten his expenses but the rental fees of $10 a day was an additional burden.
      Ward C $35 day was already a burden for many. An additional $10 per day would add load, especially to those who need to stay in for a long period of time.
      The hospital should provide medical services that are truly affordable and transparent, without such optional “side dishes”. For example, someone who is poor but need to be bed-ridden — 3 weeks of stay with mattress rental would cost him / her $210 more.
      KTPH should look into how to make it affordable rather than charging additional optional charges for such equipment, as hospital should and must have such equipment for their patients’ need and not extra charges.
      Shin Min Daily published the matter on 02/01/2013. I noticed you hospital replied that the retail shop in the hospital was also selling similar mattresses for $200-$400. I checked with the sister of Mr F. She confirmed that she did approach the retail shops in the hospital about it but was told they did not sell such products. That was why she had to resort to external sources. If these products are available for $200-$400 in your hospital, why didn’t your hospital staff recommend them to the patient’s family members? In stead, your staff told them the products used in your hospital would cost more than $1000, and there was only one supplier?
      From the reply I got from your hospital, I understood that the quality of the mattresses used in your hospital was different from cheaper ones. BUT the fact was Mr F’s Father did not suffer from Bedsore ulcers. May I know if all patients lying in bed MUST USE such expensive mattresses from the beginning? I have checked with other hospitals and confirmed that some have allowed own bedsore mattresses, and even encourage family members to bring their own ones to use in the hospital.
      The following is the subject Mr F’s account on your reply to the newspapers:
      [We were unaware of any such “commissioning fees” as stated in reply to newspapers reports otherwise we would NEVER had agreed.
      A further check on the bills (2 interim & 1 final) also did NOT reveal such charges.
      During the discussion with the PR & the Nurse Manager, they DID NOT MENTION any such charges. I was also NOT SATISFIED with their explanation about the shock circuiting. I only stopped probing when they agreed to let us use our mattress.]
      I would like to ask your hospital, HOW MUCH WOULD such COMMISSIONING FEES be for “commissioning” those own mattresses? I also learnt from the patient’s family members that the rental fees of $10 for the bedsore mattresses could only be paid in Cash and not with CPF. Is it correct?
      I have compiled some articles about bedsore ulcers and posted on my blog https://happyangelclub.wordpress.com/ under the comments session of my first article, for your reference.
      Next, I have enclosed herewith my second article for your reference. The focus of the article, also my hope was not to have another Mr F who had to take so much trouble before he was able to let his Father use his own bedsore mattress in the hospital.
      (Note: Having “The priority is the well-beings of the cases” in mind, I humbly hope to bring this issue to the various departments, hoping to lighten the medical costs of patients and their family members. I therefore sent carbon-copy of this article to the following for in-depth study and research: REACH, The Prime Minister of Singapore, Ministry Of Health, Shin Min Daily, Capital 95.8 FM, Today Paper)
      Thank you!
      Jane Lim
      13-1-2013
      Volunteer of Elderly Services
      https://happyangelclub.wordpress.com/

      回复邱德拔医院 :

      感谢您的回复.
      在我的第一篇文章发表之后,引起媒体(新明日 报,TODAY, Radio 95.8)的关注和报导,也有新明日报的读者致电报馆想知道何处可以买到我文中所提到褥疮床垫? 那些读者,也许是看护者.如果我们的公开无私的讨论,能够惠及其他有需要者和看护者,那是我所乐见的.
      过去几年,我有机会参与由MCYS和 NCSS主办的乐龄课程和研讨会, 24-27 May 2005, 我到 Perth, Western Australia 参与 Regional Training Pogramme on Community Care in an Ageing Population [ Sustaining and Supporting Family Carers and Family Care]. 讨论的重点,非常关注看护者的身心灵健康。因为有研究显示,有一半的看护者,会患上忧郁症。 MCYS也非常关注看护者的健康,那次研讨会之后,新加坡也成立了看护者中心。
      我常常提醒自己,务必将所学,惠及有需要者,更不忘导师的教导:以个案的福祉为重。这也是为什么我在第一篇文章中,点出了这个重点。期盼身为各方的医疗前线工作者,给于所有病患和看护者适当的建议,指引和支持,让大家更有力量对抗病魔。
      我的文章中所提到的看护者Mr.F, 除了需要照顾在贵院留医的父亲,家里还有一个患病的老妈妈,还有年幼的孩童需要照顾。选择C级病房,有助减轻他的经济负担,然而,每天10元的褥疮租费,却是他的经济负担。

      新 明日报于2-1-2013报导此事,我注意到了贵院答复说医院的零售店也有售卖200-400元的褥疮床垫。我向Mr.F的妹妹查证过,她之前到了该院的 零售店想购买,被告知没有售卖。所以,她才到外面去购买。既然贵院有售卖200-400元的床垫,那么,为何院方没有早点介绍给家属?反而告诉家属,贵院 所使用的床垫是一千多元,而且只有贵院的这家商家有售卖。

      从贵院给我的答复中,我了解到也许贵院提及的床垫的确是和其他便宜的有所不同。但是,Mr.F 的爸爸并没有罹患褥疮,请问是否所有卧病在床的病患,一开始都需要用这么昂贵的防褥疮床垫才行?其他一些医院是被允许使用的,也有医院鼓励家属带自己的防褥疮床垫到医院使用。

      以下是当事人Mr.F 针对贵院答复报章的回复:
      [We were unaware of any such “commissioning fees” as stated in reply to newspapers reports otherwise we would NEVER had agreed.
      A further check on the bills (2 interim & 1 final) also did NOT reveal such charges.
      During the discussion with the PR & the Nurse Manager, they DID NOT MENTION any such charges. I was also NOT SATISFIED with their explanation about the shock circuiting. I only stopped probing when they agreed to let us use our mattress.]

      我想请问贵院,HOW MUCH WOULD such COMMISSIONING FEES be for “commissioning” those own mattresses? 我也从病患家属那里得知,这个每天10元的褥疮床垫租费,只能用现金来支付,是不能够用CPF来扣除的,对吗?

      我在我的网站https://happyangelclub.wordpress.com/ 的第一篇文章内的Comment 栏目,转贴了一些和褥疮相关的资料,供大家参考和讨论。

      另,以下是我之前写的第二篇文章,也附上让你参考,文章的重点,也是我的期盼,希望不会再有下一个Mr.F,需要几经波折才能够让爸爸在医院使用自己购买的褥疮床垫。

      (注:本着以个案福祉为重的目标,期盼各个相关部门,为所有病患和家属减轻医药负担。是故,本文同时传给以下各方供深入探讨和研究:民情组,李总理,卫生部,新明日报,电台95.8,今日报。)

      谢谢!
      林宝珠Jane Lim
      13-1-2013
      Volunteer of Elderly Services
      https://happyangelclub.wordpress.com/

  4. 百度的解释: From http://baike.baidu.com/view/162376.htm#18_6 :

    褥疮(又称压疮,压力性溃疡)是由于局部组织长期受压,发生持续缺血、缺氧、营养不良而致组织溃烂坏死。据有关文献报道每年约有6万人死于褥疮合并症。已成为卧床病人头号“杀手”,应引起足够的重视,并结合医师建议使用褥疮药褥疮宁等及时治疗,同时在健管家指导下及时进行康复训练。

  5. From http://baike.baidu.com/view/162376.htm#18_6 :

    危害
      
    褥疮易发部位 褥疮药【褥疮宁】提供

    褥疮易发部位 褥疮药【褥疮宁】提供
    褥疮,是临床最常见的并发症之一,发病率高达1-4.7%,病程发展迅 速,难以治愈,治愈后极易复发。 久治不愈的褥疮可并发骨髓炎、败血症和低蛋白血症等老年病人致死性病症,成为典型的卧床病人头号“杀手”。

  6. From http://baike.baidu.com/view/162376.htm#18_6 :

    常见原因

    1、压力因素
      (1)垂直压力:
      引起褥疮最主要的原因是局部组织遭受持续性垂直压力,特别在身体骨头粗隆凸出处。如长期卧床或坐轮椅、夹板内衬垫放置不当,石膏内不平整或有渣屑等,局部长时间承受超过正常毛细血管的压迫,均可造成褥疮。(一般而言皮肤层下的血管可承受的压力约为32mmHg左右,假若超过以上的压力局部血管便可能扭曲、变形而影响到血流的通过而有缺血的现象。)

      (2)摩擦力:
      摩擦力作用于皮肤,易损害皮肤的角质层。当病人在床上活动或坐轮椅时,皮肤可受到床单和轮椅垫表面的逆行阻力摩擦,如皮肤被擦伤后受到汗、尿、大便等的浸渍时,易发生褥疮。

      (3)剪力:
      所谓剪力是一个作用力施于物体上后导致产生一平行反方向的平面滑动,是由摩擦力与垂直压力相加而成。它与体位关系密切,例如:平卧抬高床头时身体下滑,皮肤与床铺出现平行的摩擦力,加上皮肤垂直方向的重力,从而导致剪力的产生,引起局部皮肤血液循环障碍而发生褥疮。

    2、营养状况
      全身营养缺乏,肌肉萎缩,受压处缺乏保护。如长期发热及恶病质等。
      全身营养障碍,营养摄入不足,出现蛋白质合成减少、负氮平衡、皮下脂肪减少、肌肉萎缩,一旦受压,骨隆突处皮肤要承受外界压力和骨隆突处对皮肤的挤压力,受压处缺乏肌肉和脂肪组织的保护,引起血液循环障碍出现压疮。

    3、皮肤抵抗力降低
      皮肤经常受潮湿、摩擦等物理性刺激(如石膏绷带和夹板使用不当、大小便失禁、床单皱褶不平、床上有碎屑等),使皮肤抵抗力降低。

    4、易发人群
      老年人皮肤松弛干燥,缺乏弹性,皮下脂肪萎缩、变薄,皮肤易损性增加。
    易发部位
      多发生于无肌肉包裹或肌肉层较薄、缺乏脂肪组织保护又经常受压的骨隆突处。

    褥疮症状及其护理
    褥疮症状及其护理(6张)
      仰卧位好发于:枕骨粗隆、肩胛部、肘、脊椎体隆突处、骶尾部、足跟。
      侧卧位好发于:耳部、肩峰、肘部、肋骨、髋部,膝关节的内、外侧及、内外踝。
      俯卧位好发于:耳、颊部、肩部、女性乳房、男性生殖器、髂嵴、膝部、脚趾。

  7. From http://baike.baidu.com/view/162376.htm#18_6 :

    别称: 压疮、压力性溃疡

    病发原因: 压力大、营养缺乏等
    易发人群: 老年人

    目录

    危害
    常见原因
    易发部位
    临床分期
    临床表现
    疾病诊断
    1.药物治疗
    展开

    危害
    常见原因
    易发部位
    临床分期
    临床表现
    疾病诊断
    1.药物治疗
    展开

    危害
      
    褥疮易发部位 褥疮药【褥疮宁】提供

    褥疮易发部位 褥疮药【褥疮宁】提供
    褥疮,是临床最常见的并发症之一,发病率高达1-4.7%,病程发展迅 速,难以治愈,治愈后极易复发。 久治不愈的褥疮可并发骨髓炎、败血症和低蛋白血症等老年病人致死性病症,成为典型的卧床病人头号“杀手”。
    常见原因
    1、压力因素
      (1)垂直压力:
      引起褥疮最主要的原因是局部组织遭受持续性垂直压力,特别在身体骨头粗隆凸出处。如长期卧床或坐轮椅、夹板内衬垫放置不当,石膏内不平整或有渣屑等,局部长时间承受超过正常毛细血管的压迫,均可造成褥疮。(一般而言皮肤层下的血管可承受的压力约为32mmHg左右,假若超过以上的压力局部血管便可能扭曲、变形而影响到血流的通过而有缺血的现象。)
      (2)摩擦力:
      摩擦力作用于皮肤,易损害皮肤的角质层。当病人在床上活动或坐轮椅时,皮肤可受到床单和轮椅垫表面的逆行阻力摩擦,如皮肤被擦伤后受到汗、尿、大便等的浸渍时,易发生褥疮。
      (3)剪力:
      所谓剪力是一个作用力施于物体上后导致产生一平行反方向的平面滑动,是由摩擦力与垂直压力相加而成。它与体位关系密切,例如:平卧抬高床头时身体下滑,皮肤与床铺出现平行的摩擦力,加上皮肤垂直方向的重力,从而导致剪力的产生,引起局部皮肤血液循环障碍而发生褥疮。
    2、营养状况
      全身营养缺乏,肌肉萎缩,受压处缺乏保护。如长期发热及恶病质等。
      全身营养障碍,营养摄入不足,出现蛋白质合成减少、负氮平衡、皮下脂肪减少、肌肉萎缩,一旦受压,骨隆突处皮肤要承受外界压力和骨隆突处对皮肤的挤压力,受压处缺乏肌肉和脂肪组织的保护,引起血液循环障碍出现压疮。
    3、皮肤抵抗力降低
      皮肤经常受潮湿、摩擦等物理性刺激(如石膏绷带和夹板使用不当、大小便失禁、床单皱褶不平、床上有碎屑等),使皮肤抵抗力降低。
    4、易发人群
      老年人皮肤松弛干燥,缺乏弹性,皮下脂肪萎缩、变薄,皮肤易损性增加。
    易发部位
      多发生于无肌肉包裹或肌肉层较薄、缺乏脂肪组织保护又经常受压的骨隆突处。

    褥疮症状及其护理
    褥疮症状及其护理(6张)
      仰卧位好发于:枕骨粗隆、肩胛部、肘、脊椎体隆突处、骶尾部、足跟。
      侧卧位好发于:耳部、肩峰、肘部、肋骨、髋部,膝关节的内、外侧及、内外踝。
      俯卧位好发于:耳、颊部、肩部、女性乳房、男性生殖器、髂嵴、膝部、脚趾。
    临床分期
    按成过程分为三期
      其形成过程分为红斑期、水泡期和溃疡期三期。褥疮的预防极为重要,主要以精心护理为基础。不同分期的症状说明:
      褥疮I度(红斑期):全身的受压部位表现为局部瘀血,皮肤呈现红斑。若在此期除去压力此改变在48小时内消失。
      褥疮II度(水疱期):受压部位出现大小不等的水泡,皮肤发红充血,用手指压时不消退。
      褥疮III度(浅溃疡):溃疡不超过皮肤全层,因溃疡基底部缺乏血液供应,呈苍白色,肉芽水肿,流水不止。
      褥疮IV度(深溃疡):涉及了深筋膜和肌肉,受累组织因缺血而坏死呈黑色,因细胞的感染,病变常侵犯骨质,形成骨膜炎或骨髓炎。
    依其病理过程分为4级
      1级-皮肤完整出现指压不会变白的红印
      2级-表皮或真皮受损,但尚未穿透真皮层;
      3级-表皮或真皮全部受损,穿入皮下组织,但尚未穿透筋膜及肌肉层;
      4级-全皮层损害;涉及肌肉,骨头。
      根据伤口的颜色分为:
      ① 红色伤口:伤口基底部为健康的红色肉芽组织,清洁或正在愈合的伤口属于此类
      ② 黄色伤口:伤口基底部为脱落细胞和死亡细菌,一般黄色伤口又指感染伤口;
      ③ 黑色伤口:伤口有黑色的坏死组织和黑痂,如糖尿病足干性坏疽、深度褥疮表面的坏死痂皮
      ④ 粉色伤口:有新生的上皮组织覆盖。
    临床表现
      褥疮的临床表现可视为皮肤一系列的活动,颜色深度变化范围由红转白,无组织损失,深度破坏延伸到肌肉、关节囊及骨骼。
      皮肤的早期改变,白红斑的特征是红斑变化强烈,从粉红色变为亮红色。用手指压迫时变白,放开手指后迅速再现红斑。发红区域常伴有皮肤的轻微水肿,知觉正常的患者可感觉疼痛。解除压力后24小时内皮肤恢复正常无后遗症。
      色斑体现出血管状态变化的严重性,色越重,皮肤的变化更剧烈,可由黑红色变化为青紫色。用手指压迫时无颜色改变,皮温有下降的表现,病损灶可感到柔软或硬化。
      色斑部位组织进一步恶化反应便形成压缩性皮炎。表皮破裂,以及表皮下出现水疱。可出现大水疱、结痂、鳞屑。如缺乏认识以及处理压迫性皮炎不及时,而导致真正的褥疮形成。
      早期褥疮为色斑或压迫性皮炎糜烂,表皮组织受到损坏,水疱破裂或者被擦掉,使真皮暴露。早期溃疡为表面边界不清,底部反光,常由非白红斑区域包绕。如果不进程处理可发展成慢性褥疮。
      慢性褥疮的周边呈红斑时,其特点是手指压迫时无变白改变,邻近的皮组织产生变硬,呈温热或变成花斑状。平均溃疡的基底测量在5~12cm的直径以内,呈暗红色或黑红色,触之不易出血。

  8. From http://baike.baidu.com/view/162376.htm#18_6 :

    疾病诊断
      一般来说,创面周围伴有红、肿、热、痛局部炎症,如果还有化脓、恶臭症状者即可认定为局部感染征兆,伴发热则说明具有全身反应。
      1.多见于截瘫、慢性消耗性疾患、大面积烧伤及深度昏迷等长期卧床患者。
      2.多发于骶骨、坐骨结节等骨隆突处。
      3.在持续受压部位出现红斑、水泡、溃疡三步曲病理改变。
    1.药物治疗
      发现和确诊为褥疮后,可针对症状使用褥疮药科学治疗:
      (1)碘酊具有使组织脱水促进创面干燥、软化硬结构的作用。将碘酊涂于创面,每日2次。
      (2)多抗甲素 它能刺激机体的免疫细胞增强免疫功能,促进创面组织修复。对创面较大者,先用生理盐水清创,然后用红外线灯照射20分钟,创面干燥后用多抗甲素液湿敷,再用红外线灯照射10分钟,最后用灭菌紫草油纱布覆盖,对渗出液多者,每日换药3次。
      (3)灭滴灵对杀灭厌氧菌有特效,并能扩张血管,增强血液循环。用此药冲洗后,湿敷创面,加红外线灯照射20分钟,每日3-4次。
      (4)传统中药 对于II和IV期褥疮,中药膏的应用十分重要。可以先用生理盐水清洗创面,去除坏死组织,再采用中药涂于褥疮创面进行治疗,伴有空洞可配合使用化腐生肌油纱条,能将化腐溶解物引流排出,促使新生肉芽加速生长.中药治疗褥疮的重要性越来越得到认可。
    2.分期治疗
      一期的临床表现以局部皮肤暗红色、肿胀、灼热、疼痛为主症,皮肤的完整性尚未破坏,及时治疗,有望完全恢复正常而不溃烂,这就是褥疮一期的表现。治疗应首先应增加患者的翻身次数,以改善局部血液循环,纠正缺血缺氧,还要尽可能去除导致褥疮的病变因素。其次用过氧化氢液擦拭创面,再用生理盐水清洗创面,用75%酒精消毒褥疮周围皮肤,再用无菌纱布覆盖。
      二期的临床表现是以局部皮肤紫红色、水肿为主症。瘀血久滞可成瘕,所以也每见皮下硬结;水肿甚时可使皮肤变薄,故又常见出现水疱,水疱不小心极易破溃,从而又可引发感染。此期治疗应注意保持皮肤洁净,严防引起感染。未溃破的水疱要尽量减少摩擦,以防破裂;大水疱可用注射器抽取疱内液体,以保护皮肤不受损伤。此期又称炎性浸润期,说明最易引起感染,如有感染,可静脉滴注有效抗生素。先用生理盐水清洗创面,有水泡未破者,则用无菌注射针头将水泡刺破,再将消毒纱布浸入新液中,取两层纱布敷于创面,每3—4小时用注射器抽取药液滴于敷料之上,以保持覆盖伤口的纱布湿润。提示:尽量保护好表皮,所用纱布应采用无菌医用纱布;使用新液之前先用生理盐水将创面洗干净;采用软枕或垫圈将患处腾空,避免纱布覆盖处拖拉、受压。再次换敷料时可用生理盐水将纱布再次湿润后揭下,防止敷料与创面发生粘连。
      治疗炎性浸润期压疮患者,临床多用0.5%碘伏消毒,使创面干燥,但此法容易使伤口脱水,不利于上皮细胞生长,易使生物活性物质丢失,减慢愈合速度。不覆盖纱布则容易造成皮肤与床铺等形成擦伤,覆盖纱布又容易导致敷料与创面粘连,再换药时易导致机械损伤,增加患者疼痛感,甚至会扩大创面。目前认为,在无菌条件下持续湿润,有利于创面上皮细胞生成,加速坏死组织脱落,显著促进肉芽组织生长和创面的愈合。所以持续湿敷的方法适合用于治疗炎性浸润期压疮。
      三期又称浅度溃疡期,是褥疮比较严重的阶段,治护均较困难。由于褥疮早期失于发现,加之以后又治不如法,致使病变局部表皮水疱逐渐扩大,以致破溃暴露出真皮,真皮极易感染,感染后原有的黄色渗出液表面可有脓液覆盖,并逐渐形成溃疡,开始出现疼痛。治疗首先应用防褥疮气垫床并2h翻身1次,避免受压,保持皮肤干燥、清洁,床单清洁、平整无皱褶。再有效地抗感染,以防病情继续发展。使用足量有效的抗生素的同时,局部每天换药2次,换药时遵循无菌技术操作规程。上午先用双氧水、0.2‰呋喃西林溶液清洗褥疮创面,若有坏死组织先剪去后再清洗,局部均匀涂碘伏,用频谱治疗仪局部照射20min,最后覆盖无菌纱块。下午常规清刨及频谱照射后,用浸有新液的纱块贴在创面上,再覆盖无菌纱块。当创面逐渐缩小,不宜再用纱块时,直接将新液滴于创面。碘伏溶液由碘和载体结合而成,对细菌、芽孢、病毒、真菌、霉菌孢子及原虫均有较强的杀灭作用,对皮肤黏膜无刺激性。新液则具有通利血脉,养阴生肌的作用,能促进血管新生,促进肉芽组织生长,改善创面微循环,加速病损组织修复及增强机体免疫功能.临床土主要用于各类溃疡创面的愈合。用频谱仪照射有利于血液循环,消炎镇痛。此法污疗褥疮治愈率高,疗程短,促进肉茅组织生长,使用方便,无副作用,促进愈合,是治疗褥疮的较好方法。
      四期处理原则是清洁创面,去除坏死组织和促进肉芽组织的生长,先用生理盐水清洗创口,再用络合碘对创口消毒。适当清创清除坏死组织,可用外科法、机械法及化学酶法、自溶法等。外科扩创是最有效的方法,锐物清创最迅速,可用手术刀或剪子除去腐肉及痂直至暴露健康组织后使用新液。主要是快速促进创口的修复。当使用了康复新湿敷后,渗液逐渐减少,周围红肿消退后结痂形成。随着治疗次数的增加,局部症状改善明显。
    3.物理疗法
      ① 氧疗利用纯氧抑制创面厌氧菌的生长,提高创面组织中氧的供应量,改善局部组织代谢。氧气流吹干创面后,形成薄痂,利于愈合。方法:用塑料袋罩住创面,固定牢靠,通过一小孔向袋内吹氧,氧流量为5-6L/分钟, 每次15分钟,每日2次。治疗完毕,创面盖以无菌纱布或暴露均可。对分泌物较多的创面,可在湿化瓶内放75%酒精,使氧气通过湿化瓶时带出一部分酒精,起到抑制细菌生长,减少分泌物,加速创面愈合的作用。
      ② 气垫床疗法:随着经济发展、国民生活日益改善 买一张中高档防褥疮气垫床来预防褥疮已经不是什么大问题了,如今科技发展,褥疮垫生产工艺也不逊色,现在各厂家生产出来的褥疮床垫不像以前那么笨重了,气垫床其实就一个气床垫和气泵,所以携带很方便(褥疮患者也经不起经常移动)。但褥疮主要还是起到预防效果,以及中早期褥疮辅助治疗作用。
      ③ 人工护理 :每1~2小时定时对病人进行翻身,按摩受压皮肤,劳动量大,需要护理人员有高度责任心;定期为病人清洁皮肤,实际护理中,由于病人行动不便,很难保证皮肤清洁。
      ④ 紫外线光疗法: 理疗目的:小剂量紫外线通过直接杀菌作用,刺激损伤部分细胞释放出刺激生长因子及加强正常细胞的代谢功能,从而达到促进创面愈合的目的.大剂量紫外线照射可通过强红斑量反应控制感染,促进坏死组织蛋白质分解脱落,从而达到创面清洁,有利愈合的目的.
    4.外科手术
      对大面积、深达骨质的褥疮,上述保守治疗不理想时,可采用外科治疗加速愈合,如手术修刮引流,清除坏死组织,植皮修补缺损等。外科手术修复亦适用于战伤并发大面积褥疮,因战伤病人失血多,机体抵抗 力差,褥疮迁延不愈,易造成全身感染。采用手术修复可缩短褥疮的病程,减轻痛苦,提高治愈率。

  9. From http://baike.baidu.com/view/162376.htm#18_6 :

    皮瓣转移手术治疗褥疮
      1、清创:病人均采用全麻下浮卧位手术,先彻底切除溃疡及周围的瘢痕组织,凿除突出及感染的部分骨组织,并将骨面修平整。
      2、皮瓣设计:标明髂后上棘与股骨大转子连线中上1/3交点,该点为皮瓣的旋转轴。在连线上方根据骶尾部创面大小及形状设计皮瓣,注意从轴点至皮瓣最远端距离要大于至创面最远端距离,并标明皮瓣与创面间切口线。
      3、肌皮瓣切取:先作皮瓣蒂部及上部切口,寻找臀大肌与臀中肌间隙,将两者钝性分离,掀起臀大肌显露走行于肌肉深面的臀上动脉浅支或臀下动脉皮支血管,确认血管进入皮瓣去后,切去肌皮瓣。处理蒂部时,在肌皮瓣的营养血管周围需保留少量臀大肌纤维,形成窄小肌肉蒂,既保护血管蒂,又方便转移。
      4、肌皮瓣转移:肌皮瓣切取以后向内旋转,即可完全覆盖创面且到达无张力缝合骶尾部创面,供应创面也可一期缝合,皮瓣下置放负压引流管。[1]
    5.紫外线光疗法
      其作用机理如下:
      ① 紫外线有抑制杀菌生长作用,能破坏细菌的核酸代谢,使细菌死亡,因此能有效的杀死繁殖在褥疮表面的细菌,消除感染,促进创面恢复。
      ② 紫外线有消炎作用,紫外线红斑是皮肤对紫外线的一种特殊反应。在照射局部由于组胺和类组胺物质的作用,使血液及淋巴循环加强,网状内皮系统功能增强,细胞吞噬能力增强,局部皮肤温度升高,酸碱度趋向碱性,新陈代谢旺盛,这些类炎症的反应加强了人体的防御能力。上皮组织在人体内释放的刺激生长因子的作用下生长加速,角化层增厚,色素沉着。提高了皮肤防御能力。紫外线治疗组愈合时间较对照组短,主要是有效的抗菌作用,使创面炎症反应减轻,分泌物减少,从而促进创面愈合。使用仪器:例如锦兴牌ZZ-II型紫外线治疗仪。

  10. From http://baike.baidu.com/view/162376.htm#18_6 :

    验方治疗
    一、十一方酒
      1.药物组成:田七 血竭琥珀 生大黄桃仁 红花泽兰 归尾乳香 川断骨碎补土鳖杜仲 制马钱子 苏木秦艽 自然铜没药 七叶一枝花无名异
      2.功能主治:活血化瘀、消肿止痛、收敛防腐生肌。
      3.用法用量:外用:药酒纱布填塞伤口,每日滴药酒一次。也可内服。当发现皮肤潮红时,将十一方酒l0ml倒人手中用手掌按摩患处,每日二三次,局部有水疱形成者,用无菌注射器抽吸水疱内液后再涂擦十一方酒,每日二三次。如皮肤有溃疡、渗液,应立即用十一方酒纱布湿敷,每日三四次。
      4.制备方法:上药各适量放人米三花酒7500ml,浸泡三至六个月后备用。
    二、复方红花酒
      1.药物组成:红花50g黄芪30g 白蔹20g 75%乙醇(酒精)500ml
      2.功能主治:褥疮,扭伤血肿,皮肤灼伤等。
      3.药物组成:干红花30g 70%的乙醇(酒精)100ml
      4.功能主治:活血化瘀,消结止痛。主治:①因注射而致局部硬结肿块。②外伤肿痛。③褥疮形成。
      5.用法用量:用纱布或脱脂棉蘸30%的红花消结酒,局部涂擦患部,日二三次,每次5分钟。
      6.制备方法:每lOOml70%的乙醇(酒精)中,放人干红花驸s,浸泡密封一星期,滤去药渣,即可使用。
      按:药酒密封浸泡时间越长效果越佳。
    三、芎参花酒
      1.药物组成:川芎10g 丹参10g 红花10g
      2.功能主治:祛瘀活血、行气通络。主治褥疮。
      3、用法用量:预防褥疮组:在骨骼隆起受压处,每2-4小时翻身涂擦药液一次,3-5分钟后用滑石粉外敷。治疗褥疮组:早期(即淤血红润期)每日涂擦药液四至六次。对水疱或者局部皮肤已溃烂(即褥疮期),在其周围每日涂擦药液六至八次,保持疮面清洁,同时用棉圈保护疮面,防止局部再次受压。
      4.制备方法:上药共研末置50%乙醇(酒精)500ml中密羽浸泡一个月以上,滤出药液备用。
    四、红当酒
      1.药物组成:红花30g 当归尾30g
      2.功能主治:活血祛瘀,通络止痛,消散瘀肿。主治褥疮。
      3.用法用量:用红花酒少许涂于受压部位,用大小鱼际肌在受压部位由轻至重环形按摩3-5分钟,再用滑石粉或爽身粉,每日4-6次。
      4.制备方法:上两药浸人50%乙醇(酒精)1000ml中,浸泡一个月滤取清液备用。
    五、白杨叶水
      白杨叶一把,洗净加水(水没叶子两指)熬开十分钟即可。待温热时,反复用布沾药水敷于患处,至水将凉,用温热的叶子贴在患处,十几分钟后拿下。一日四次。几日即可痊愈!
    六、碘伏
      在治疗褥疮时,褥疮局部也可用碘伏换药。碘伏可保持较长时间的杀菌作用,对细菌、病毒、霉菌及其孢子均有较强的杀菌作用,且对皮肤黏膜无刺激性,毒性低。褥疮局部用碘伏,能有效预防和控制感染,促进肉芽组织生长,达到清创、祛腐生肌的目的。
    七、芦荟
      芦荟治疗褥疮的方法很简单。首先取家庭种植的新鲜芦荟的叶子,用一把干净的小刀刮去表皮并将芦荟叶肉捣碎。把患部清洗干净后将捣碎的芦荟敷在患处即可,芦荟的多糖类可增强人体对疾病的抵抗力,治愈褥疮。
    八、中药治疗
      [2]1.滑石粉100克,冰片5克,炉甘石5克,共研末,混匀。洗患处,撒粉,敷消毒布(不用胶布),3~5天见效。
      2.红花20克,白酒250毫升。将红花在白酒中浸泡24小时后,用棉签蘸药液涂擦患处,每天2~3次。

  11. From http://baike.baidu.com/view/162376.htm#18_6 :

    防止感染
      首先要控制好患者的房间的适度,经常通风,保持患者床铺的整洁和干燥,定时的为患者进行翻身,每次翻完身要注意观察局部皮肤的情况,对于一些大小便失禁的患者,来及时的清理排泄物,保证患者身体的清洁干燥,避免排泄物对皮肤产生刺激,引发褥疮的感染。另外要增加患者的营养,患者营养跟上去了,相应的自身的抵抗力也就上去了,发生感染的情况也会相应的少一点
      在对褥疮创口进行换药的时候要严格的执行无菌操作,创口渗血多或是受到污染的时候要及时的更换敷料,在换药的时候要注意观察患者的伤口,如果有发生感染的迹象的话,要及时的进行处理,并加强抗感染的措施,一旦发生感染的话,要对染灶的分泌物做药敏试验和细菌培养实验,根据实验的结果选择合理的抗生素[3]
    疾病护理
    翻身护理
      (一)目的 使病人安全、舒适,预防并发症。适用于不能自理的病人。
      (二)操作方法
      要领:托重心、用合力,不抓不捏找空隙:防撞碰、不擦皮,既轻又稳亦省力。
      1.一人节力翻身法(平卧翻左侧卧位)
      (1)护士立于病人右侧,两腿距离10-15cm 以维持平衡,重心恒定。将病人左右手交叉置腹部。
    翻身

    翻身
      (2)移上身(上身重心在肩背部)。右手将病人右肩稍托起,左手伸入肩部,用手掌及手指扶托颈项部;右手移至对侧左肩背部用合力抬起病人上身移向近侧。
      (3)移下身(下身重心在臀部)。左手伸入病人腘窝,右手扶于足背,屈膝双下肢;右手沿腿下伸入达尾骶部,左手移至对侧左臀部用合力抬起病人下身移向近侧。
      (4)调整体位。左手扶背,右手扶双膝,轻翻转病人,抬起病人右腿,拉平裤子,托膝使病人屈髋膝置于床旁;抬左腿拉平裤子放于床中。平整衣服,以软垫支持病人背部和双腿,取舒适卧位。侧卧翻平卧,护士立于病人左侧,步骤同上,两手动作相互调整。
    一人巧翻身法
      2.两人节力翻身法(平卧翻侧卧位)对于身体胖重且不能活动者,如截瘫、偏瘫、昏迷等病人则宜采用两人协助翻身。
      两位护士站在病床的同侧,一个托病人两手放于腹部,托其颈肩和腰部,另一人托臀和腘窝部,两人同时将病人抬起移向床缘,分别扶托肩、背、腰、膝部位,轻推,使病人转向对侧。
    两人扶助患者翻身法
      对有导管者,应先将导管安置妥当,翻身后检查导管,保持通畅。严重烧伤者可采用翻身床。颈椎和颅骨牵引者,须使头、颈、躯干保持在同一水平翻动。
    心理护理
      长期卧床的病人,由于疾病的折磨,会产生各种不良情绪,心理压力大,甚至沮丧厌世,家属应多体贴、多理解,劝慰和开导病人,使其建立起战胜疾病的信心,培养稳定、乐观的情绪。通过听音乐、戏曲,看电视,读报纸,陪患者聊天等方式分散患者对自身疾病的注意力,以调整患者的情绪。

  12. From http://baike.baidu.com/view/162376.htm#18_6 :

    护理
      (1)主要原则是定期翻身、减压,强调体位及翻身,经常更换体位,每2~3h翻身一次,局部可使用气垫、气圈等。对长期卧床的患者,最好使用翻身床、褥疮防治气垫床。翻身床可帮助护理人员对患者进行左右翻身,三折板翻身床翻身时减少了对病人皮肤的摩擦,可以有效减轻病人受压迫皮肤的损伤,对恢复褥疮病有显著效果。变换体位。褥疮防治气垫床系由双气囊构成,通过交替充气和排气,帮助患者缓慢翻身,从而避免局部长时间受压,起到有效改善受压部位血液循环,防止褥疮发生或发展的目的。临床上,我院对长期卧床的患者(尚未发生褥疮),使用翻身床和褥疮防治气垫床,尚无一例发生褥疮。
      (2)保持床铺平整、清洁、干燥、无碎屑也是防治褥疮的重要环节,同时也要保持患者的皮肤清洁和干燥。一般情况下,定时采用50%酒精按摩骨骼凸出部位的皮肤,如骶尾部、髋部、枕部、肩胛部、肘部、足跟等,以促进局部血液循环,避免或减少褥疮的发生。
      (3)补充营养、保持高蛋白饮食,防止机体分解大于合成,以促进伤口愈合,收到比较理想的康复疗效。
      (4)除局部换药外,配合红外线照射。照射距离离患处约30cm,每日1~2次,每次30min,也能取得显著效果。照射时应随时观察局部情况,以防烫伤
    健康饮食
      ① 给予高蛋白食品
      ② 多食用植物油,如花生油、芝麻油、豆油、菜籽油等,有润肠功效,利于缓解便秘。
      ③ 选用富含植物纤维的食物,如粗粮、蔬菜、水果、豆类等。
      ④ 食用富含维生素b1的食物,如粗粮、豆类、瘦肉、动物内脏、新鲜蔬菜等。
      ⑤ 食果汁、新鲜水果、果酱、蜂蜜等刺激肠蠕动。
      ⑥ 多喝水、饮料,以免大便干燥。
      ⑦ 要时少食多餐,以利消化吸收。
      ⑧ 凡伴有消化不良、肠炎、腹泻、便秘的病人,宜多食用酸奶。

  13. From http://baike.baidu.com/view/162376.htm#18_6 :

    疾病预防
    1、勤翻身
      实施有效到位的翻身来间歇性地解除局部压迫,是预防褥疮最为有效、关键的措施。一般卧床病人每1—2小时翻身一次,发现皮肤变红,则应每小时翻身一次,左、右侧卧、平卧、俯卧位交替进行,并用软枕、气枕、水枕、气垫圈、海绵圈等垫在骨突出部位,可起到局部悬空、减轻压力作用。坐轮椅的病人可在足底放一个海绵垫,臀下软枕(垫)或创生源防褥疮垫,每15—20分钟变换重心1次,应阻止病人长时间坐轮椅(2小时以上),在可能的情况下,让病人站立,行走10分钟。
    勤翻身

    勤翻身
    2、正确实施按摩
      平卧时,将手放入臀下,掌心向下向上均可。充分感受皮肤温度和受压力情况,并上按摩皮肤5分钟,每20分钟重复一次。左、右侧卧时,侧身要侧到位,半平半侧(斜侧)应用软枕支撑腰背部,对皮肤颜色、温度、质地正常的受压部位可用50%红花酒精倒入掌心,两侧由轻→重→轻按摩5—10分钟;发现皮肤变红,则不宜进行皮肤按摩,可悬空压红部位,一般解除压力30—40分钟后皮肤颜色可恢复正常。皮肤持续发红、发绀、更不宜按摩、以免加重损伤。
    3、床褥、床单的要求
      卧床病人的床褥要透气,软硬适中、吸水性好,可用气垫床(卵窝形为佳)、高密度海绵床垫,床单应为纯棉,另外在床单上可铺一条纯棉浴巾,便于更换。
      床单保持平整、干燥、清洁、无皱折、无渣屑、无杂物;气垫床充气软硬要适度,过度充气反而可使皮肤受压增加。为病人更换床单时应防止拖、拉、拽,以防损坏皮肤。
    4、保持皮肤清洁
      预防褥疮的方法多种多样,我们通常使用的方法是温水擦浴每天1—2次,擦洗时不可用刺激性强的清洁剂,不可用力擦拭,以防损伤皮肤。对易出汗的腋窝、腹肌沟部位,可用小毛巾随时擦拭。为防止皮肤损伤可在局部扑“强生”婴儿护臀粉或痱子粉。大便失禁者,及时洗净肛周皮肤,涂上强生婴儿护臀粉或护臀霜,即可有效防治肛周和会阴縻烂、湿疹;小便失禁者可使用bt型高颈透气接尿器;应用热水袋热敷,水温应在50℃,并用毛巾包好,热敷时间30分钟,应经常观察热敷部位皮肤情况,不能长时间在一个部位热敷,以防烫伤。用冰袋降温时,冰袋应放在颈部两侧、腋窝、腹股沟处。冰敷时间以10—30分钟为宜,放置时间不可过长,以防冻伤。
    5、加强营养
      ①给予高蛋白、豆类。
      ②多食用植物油,如花生油、芝麻油、豆油、菜籽油等,有润肠功效,利于缓解便秘。
      ③选用富含植物纤维的食物,如粗粮、蔬菜、水果、豆类等。
      ④食用富含维生素b1的食物,如粗粮、豆类、瘦肉、动物内脏、新鲜蔬菜等。
      ⑤多食果汁、新鲜水果、果酱、蜂蜜等刺激肠蠕动。
      ⑥多喝水、饮料,以免大便干燥。
      ⑦必要时少食多餐,以利消化吸收。
      ⑧凡伴有消化不良、肠炎、腹泻、便秘的病人,宜多食用酸奶。
    6、早发现,早治疗
      褥疮早期皮肤发红,采取翻身、减压等措施后可好转。当皮肤出现浅表溃烂、溃疡、渗出液多时就应及时到医院接受治疗

  14. From http://baike.baidu.com/view/162376.htm#18_6 :

    褥疮治疗4原则
      褥疮早期皮肤发红,采取翻身、减压等措施后可好转。当皮肤出现浅表溃烂、溃疡、渗出液多时就应及时到医院接受治疗。褥疮治疗4原则要谨记:
      1、重度褥疮的患者在发现病症后,最好立即选用冰石愈伤软膏进行治疗:首先将创面用生理盐水消毒清洗后,将药膏直接涂在创面上, 15分钟左右立即止痛,同时有分泌物出现(开始是水点、水珠、脓血、腐肉等异物)并会自动脱落,观察创面发白,此时均是正常现象。
      2、患者用药前,要清洗并注意将坏死组织清除干净,尤其是褥疮和糖尿足患者更应该仔细检查创面情况,必要时要将坏死的肌键进行处理,以免后患。
      3、对于严重的褥疮、糖尿足患者,最好在清疮期时间内每天换两次药,目的是要随时将创面里的渗出液清除干净,条件允许的情况下最好暴露治疗,这样能有效的缩短治疗时间。
      4、一般情况下,治愈浅Ⅱ度烧烫伤需要7天左右时间,治愈深Ⅱ度以上需要12-15天左右时间。治疗5-8公分左右的褥疮、糖尿足需用10-15支左右,时间大约需要20-30天左右。
    中医解析
      古称褥疮为“腐肉”,《内经》称为恶肉,《咚天奥旨》称为死肉,《灵枢》谓:“热盛则肉腐”,凡腐肉最多的疮疡为发烂疔之类。中医认为褥疮多因气血虚弱,气滞血瘀所引起,久病白卧床,受压部位气血瘀滞,血脉不通,经络阻隔,气血亏损,毒邪内侵,肌肉筋骨失养则溃腐成疮,缠绵难愈。
      夫疮疡生于外,皆由积热蕴于内。《内经》谓血热肉败,荣卫不行,必将为脓,留于节腠,必将为败。盖疮疽脓溃之时,头小未破,疮口未开,始出古方消褥化腐散,立追蚀腐溃之法,使毒脓外泄而不内攻,恶肉易去,好肉易生也。若其疮而痛应心根者,亦不可强之;误触其疮,痛必倍,变证不测,不可不慎也。若疮疖脓成未破,于上薄皮剥起者,即用消褥化腐散当破头代针之剂安其上,以纱包之。脓出之后,继用方药搜脓化毒之,取效如神矣。若脓血未尽,持之用药,方则化作生肌敛疮之剂,恶肉尽,疮合即愈。


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