美国医师协会压疮指南.pptVIP

AMDAClinicalPracticeGuideline(CPG)forPressureUlcers

美国医师协会压疮临床实践指南

ForMedicalDirectorsandAttendingPhysicians

适合于卫生主管和主治医师

WhatisaPressureUlcer?

压疮是什么?Anyskinlesion–usuallyoverabonyprominence–causedbyunrelievedpressureresultingindamagetounderlyingtissue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。

PressureUlcersMayNotbePreventable

有些压疮是难以避免的Aggressivemeasurescanreducebutnoteliminatetheincidenceofpressureulcers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；Candevelopdespitebesteffortsofclinicalteaminhighriskpatients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Everyeffortshouldbemadetopreventpressureulcers要通过任何方式的努力来预防压疮；Asystematicapproachtorecognizeandmanagepressureulcersisneeded需要用系统化的管理方法来识别和管理压疮。

FactorsAffectingPressureUlcerDevelopment

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

AMDAPressureUlcerCPGSteps压疮临床实践指南包括：Recognition识别Assessment/RootCauseAnalysis评估和分析根本原因Treatment治疗Monitoring监护

PressureUlcersCPG

Recognition压疮识别Documentanyhistoryofpressureulcersinthemedicalrecord在病历中记录压疮的全部历史资料；Thoroughlyexamineallskinsurfacesonadmission入院时仔细全面检查病人的皮肤；Identifyallprimaryriskfactors识别所有基本的风险因素

PressureUlcersCPGRecognition压疮识别Distinguishtypesofulcers辨别溃疡的类型Vascularinsufficiency/ischemia(venousstasisandarterialischemiculcers)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

PressureUlcersCPGRecognition压疮识别Primaryriskfactorsfordevelopmentofpressureulcersare:形成压疮的原发危险因素：Impaired/decreasedmobility活动性受到限制或者减少Co-morbidconditions,e.g.,diabetesmellitus糖尿病等合并症Urinaryorfecalincontinence失禁Undernutrition,malnutrition,hydrationdeficits营养不良、脱水Impaireddiffuseorlocalizedbloodflow血流灌注受限或者局部淤血Drugssuchassteroidsthatmayaffectwoundhealing类固淳药品的使用影响伤口康复；Historyofahealedpressureulcer压疮痊愈的经历Residentrefusalofsomeaspectsofcaretreatment居民拒绝给予局部的护理和治疗Intrinsicrisksduetoaging老龄化为固有的危险因素

PressureUlcersCPGRecognition压疮识别

PressureUlcersCPGRecognitio