美国医师协压疮指南.ppt

AMDA Clinical Practice Guideline(CPG) for Pressure Ulcers美国医师协会压疮临床实践指南 For Medical Directors and Attending Physicians 适合于卫生主管和主治医师 What is a Pressure Ulcer?压疮是什么? Any skin lesion – usually over a bony prominence – caused by unrelieved pressure resulting in damage to underlying tissue 皮肤损伤_通常发生在骨隆突处_是压力和/或剪力、摩擦力对皮下组织损伤的结果。 Pressure Ulcers May Not be Preventable有些压疮是难以避免的 Aggressive measures can reduce but not eliminate the incidence of pressure ulcers积极的预防措施能够降低压疮的发生率，但并不能彻底消灭压疮； Can develop despite best efforts of clinical team in high risk patients尽管临床小组作出最大的努力,但高风险的病人仍有压疮发生 Every effort should be made to prevent pressure ulcers要通过任何方式的努力来预防压疮； A systematic approach to recognize and manage pressure ulcers is needed需要用系统化的管理方法来识别和管理压疮。 Factors Affecting Pressure Ulcer Development促成压疮发生的四大直接因素 Pressure压力 Shearing剪切力 Friction摩擦力 Moisture潮湿 AMDA Pressure Ulcer CPG Steps压疮临床实践指南包括： Recognition识别 Assessment/Root Cause Analysis评估和分析根本原因 Treatment治疗 Monitoring监护 Pressure Ulcers CPGRecognition压疮识别 Document any history of pressure ulcers in the medical record在病历中记录压疮的全部历史资料； Thoroughly examine all skin surfaces on admission入院时仔细全面检查病人的皮肤； Identify all primary risk factors识别所有基本的风险因素 Pressure Ulcers CPG Recognition压疮识别 Distinguish types of ulcers辨别溃疡的类型 Vascular insufficiency/ischemia (venous stasis and arterial ischemic ulcers)血管机能不全/局部缺血（静脉淤滞和动脉缺血性溃疡） Neuropathic 神经性的 Pressure压力性的 Pressure Ulcers CPG Recognition压疮识别 Primary risk factors for development of pressure ulcers are:形成压疮的原发危险因素： Impaired/decreased mobility活动性受到限制或者减少 Co-morbid conditions, e.g., diabetes mellitus糖尿病等合并症 Urinary or fecal incontinence失禁 Undernutrition, malnutrition, hydration deficits营养不良、脱水 Impaired diffuse or localized blood flow血流灌注受限或者局部淤血 Drugs such as steroids that may affect wound healing类固淳药品的使用影响伤口康复； History of a healed pressure ulcer压疮痊愈的经历 Resident refusal of some aspects of care treatment居民拒绝给予局部的护理和治疗 Intrinsic risks due to aging老龄化为固有的危险因素 Pressure Ulcers CPG Recognition