Pressure sores refer to soft tissue ulceration and necrosis caused by prolonged pressure on local tissues, impaired blood circulation, sustained ischemia, hypoxia, and malnutrition in the area; Ulcers caused by skin rupture caused by pressure, shear force, or friction. With the aging of the social population, the number of elderly hospitalized patients is increasing year by year, and the number of patients with chronic diseases is increasing, which significantly increases the risk of pressure ulcers. Currently, the incidence rate of pressure ulcers among hospitalized patients in China is about 3% to 14%. If a patient develops pressure ulcers, it not only prolongs hospitalization time and increases pain, but also increases treatment costs and the burden on family members, as well as the workload of nursing staff. Due to the fact that the prevention and treatment of pressure ulcers are long-term difficulties for clinical nursing staff, they are also one of the indicators reflecting nursing quality management.

Our department has been using hydrocolloid dressings (ultra-thin dressings, standard dressings, Duo'aifu ointment, hydrolyzed gel) produced by Shandong Sukang Medical Technology Co., Ltd. since January 2013 to prevent and treat high-risk and pressure ulcer patients, achieving satisfactory results. The current report is as follows.

1. Materials and Methods

1.1 General Information: From January to October 2013, our department admitted 60 high-risk patients with pressure ulcers (Braden scale score 8-12 points), including 26 females and 34 males, aged 62-91 (77.3 ± 5.8) years old. There were 40 patients with pressure ulcers, including 18 females and 22 males, aged 68-89 (76.7 ± 6.1) years old, with 34 stage I and II wounds; Four wounds in stage III and two wounds in stage IV; Location: 5 at the ankle, 5 at the back, 17 at the sacrococcygeal region, and 13 at the hip; Area 1cm × 1.5cm~7cm × 8.5cm.

1.2 Method

1.2.1 Prevention methods for pressure ulcers: Sixty high-risk patients with pressure ulcers were randomly divided into a prevention control group (control group) and a prevention observation group (observation group) using a random number table method, and different nursing methods were used to prevent pressure ulcers. Observation group of 30 people, first clean the skin at the compressed area, then scrub with physiological saline until it dries, apply hydrocolloid dressings, change positions every 5-7 days, and every 3-4 hours. A control group of 30 people were treated with traditional nursing methods to prevent pressure ulcers, including strengthening basic care, keeping the patient's skin clean and the bed unit tidy, massaging the compressed area with 50% safflower alcohol, and changing positions every 2-3 hours.

1.2.2 Treatment methods for pressure ulcers: 40 patients with pressure ulcers were randomly divided into a traditional treatment group (traditional group) and a dressing treatment group (dressing group), each with 20 cases. Different dressing methods were used to treat each stage of pressure ulcers.

1.2.2.1 Traditional treatment methods for stage I and II pressure ulcers: Rinse with physiological saline and apply 0.3% iodine externally. If there are blisters, first aspirate the liquid inside the blister, then apply iodine, and apply sterile gauze externally; Stage III pressure ulcers are first treated with hydrogen peroxide to remove the decayed tissue from the wound, followed by cleaning with physiological saline and applying 0.3% iodine externally. Infrared radiation is applied twice a day; Stage IV pressure ulcers are treated with surgical debridement to completely remove the decaying tissue from the wound, followed by traditional surgical dressing changes once per day. The size of the pressure ulcer needs to be measured and recorded for each dressing change (the measurement method should be consistent for each change).

1.2.2.2 Treatment method for stage I and II pressure ulcers in the dressing treatment group: After cleaning the wound with physiological saline, disinfect the surrounding skin with An'er iodine and wait for it to dry before applying the hydrogel dressing. The size of the dressing should be based on the principle that its edge is not less than 2cm away from the wound. If there are blisters, the liquid should be drawn first and then the dressing should be applied. Generally, it should be replaced every 5-7 days. If the exudate reaches two-thirds of the dressing area, it should be replaced. For stage III pressure ulcers, first clean the secretions and necrotic tissue with hydrogen peroxide, then clean with physiological saline, and apply hydrogel dressings externally. Change dressing once every 3-4 days. After observing the growth of fresh granulation tissue on the wound, only use physiological saline to clean the wound and apply a layer of Duoaifu ointment to promote granulation tissue growth. Stage IV pressure ulcers are treated with sterile procedures to remove necrotic tissue, filled with hydrolytic gel to promote necrotic tissue clearance, and externally applied with hydrogel dressings. Change the dressing according to the condition of the exudate, starting every 1-2 days, and changing the dressing every 3-4 days after the exudate decreases. Each dressing change requires measuring the size of the wound and recording it.

1.3 Evaluation criteria for effectiveness [3] Evaluation criteria for pressure ulcer prevention: Patients who have not developed pressure ulcers during hospitalization are considered effective, otherwise they are considered invalid. The evaluation criteria for pressure ulcer treatment are healing: complete wound healing, epithelial coverage, including wound healing>75%; Improvement: The wound is clean, exudate is reduced, granulation grows well, and the wound is gradually shrinking; Invalid: No fresh granulation tissue found on the wound, no reduction in wound size or wound healing<25%.

1.4 Statistical methods: SPSS 11.5 statistical software was used for statistics, t-test was used for quantitative data, and t-test was used for count data χ 2-test, P<0.05 indicates statistically significant difference.

2 Results

2.1 Comparison of the time required to prevent pressure ulcers between two groups of high-risk patients is shown in Table 1.

The comparison of the effectiveness of pressure ulcer prevention between two groups of high-risk patients is shown in Table 2.

2.3 Comparison of pressure ulcer care time between two groups of patients is shown in Table 3.

3 Discussion

The traditional dry healing theory suggests that wounds require a dry environment [4], but dry therapy can easily lead to dehydration and scabbing of the wound, and the gauze dressings used may adhere to the wound surface, making it difficult to remove them during dressing changes, resulting in secondary damage and increasing patient pain and prolonging healing time. In 1962, medical expert Winter GD confirmed through research that wound healing in a wet environment is twice as fast as in a dry environment, thus giving rise to a new healing theory called the wet healing theory [5]. The hydrocolloid dressing is composed of sodium carboxymethyl cellulose, animal glue, pectin and other components. It absorbs the exudate from the wound surface to form a semi-solid substance similar to gel, which attaches to the surface of the pressure sore to form a wet environment that can promote wound healing. It does not adhere to the new granulation tissue. When changing the dressing, the dressing can be removed without causing secondary damage and increasing the patient's pain; It can firmly adhere to the surface of the skin, forming a closed dressing barrier, thereby reducing the chance of infection and accelerating wound healing [6]. At the same time, hydrocolloid dressings have the effect of dissolving fibrin, maintaining normal metabolic function of local tissues, and avoiding the formation of pressure ulcers. In the study, the nursing time required for the preventive observation group and dressing treatment group was significantly less than that for the preventive control group and traditional treatment group; The effective rate of prevention in the observation group (100%) and the cure rate of pressure ulcers in the dressing treatment group (100%) were significantly higher than those in the control group (87%) and the traditional treatment group (65%). Therefore, the application of hydrocolloid dressings in the prevention and treatment of pressure ulcers significantly shortens the nursing time for pressure ulcers and reduces the workload of nursing staff; Its application is easy to operate, avoids secondary damage caused by frequent dressing changes, does not increase patient pain, promotes pressure ulcer healing, shortens hospitalization time, and has a definite effect on preventing and treating pressure ulcers. It is worth promoting and applying.

Reference:

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