Bed sore (Decubitus)

Japanese: 床ずれ（褥瘡） - とこずれ（じょくそう）（英語表記）Bed sore (Decubitus)
Bed sore (Decubitus)

What is the disease?

Sustained pressure reduces or eliminates blood flow to tissues, Ischemia ( Excursion ) In a hypoxic state, tissue Necrosis ( Replying to @sarah_mcdonald ) This is what has happened.

This can be done for people who are bedridden or paralyzed and cannot change their position. Sacrum ( Senkotsubu ) or feet heel ( Heel ) These tend to appear in areas that are under pressure, such as the hips, bones, and other areas of the body that are under pressure. Create ( yes ) (Wounds) become harder to heal and more likely to become chronic.

How symptoms manifest

At first, the area that was compressed becomes red, Blisters ( Water ) or Purpura ( Shihan ) In shallow bedsores, only shallow erosions are seen, but in deep bedsores, the wound surface gradually darkens after the acute phase, and necrotic tissue becomes apparent.

In the black stage, such black necrosis is seen, and in the yellow stage, when these are removed, the necrotic subcutaneous fat and muscle turn a dirty yellow color. Granulation ( Hateful ) There is a red phase in which tissue regenerates and the wound surface turns red, and a white phase in which epithelium forms around the wound and skin covers it.

In chronic cases, the wound cave ( Caves ) In some cases, a pocket may form under the skin that expands like a blister. If there is an infection, it may be accompanied by a foul odor, and if your physical strength is weakened, infection of the ulcer may cause a systemic infection, so care must be taken.

Testing and diagnosis

D (depth), E ( Exudation ( Release ) The condition of the ulcer is assessed using the DESIGN tool, which evaluates the degree of S (fluid), S (size), I (inflammation), G (granulation tissue), N (necrotic tissue) and P (pocket).

If there is an infection, a bacterial culture may be performed to determine what type of bacteria is present.

Treatment methods

For deep bedsores, necrotic tissue is removed and the area is cleaned, and topical medication is applied according to the time. For those that form pockets, an incision may be made to expose the area. Disinfection is not necessary, and topical medication or dressings can be applied after cleaning the area with saline or tap water. Paste ( Chofu ) I will.

What to do if you notice an illness

Please consult a doctor immediately. It is important to take care not to put pressure on the affected area by changing the patient's position frequently, and to provide adequate nutrition.

Tatsuya Horikawa

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　持続的な圧迫によって、組織の血流が減少・消失し、虚血(きょけつ)状態、低酸素状態になって、組織の壊死(えし)が起こった状態です。

　寝たきりや麻痺などで体位を変えられない人にできます。腰の仙骨部(せんこつぶ)や足の踵(かかと)の部分、骨が突出している部分など、圧迫を受ける部分に現れます。栄養不良状態があると創(そう)（傷）が治りにくくなり、慢性化しやすくなります。

症状の現れ方

　初めは圧迫を受けた部位が赤くなり、水疱(すいほう)や紫斑(しはん)が現れます。浅い褥瘡では浅いびらんがみられるのにとどまりますが、深い褥瘡では急性期を過ぎたころに創面が徐々に黒ずんで、壊死組織が明らかになってきます。

　このような黒ずんだ壊死がみられる黒色期、さらにこれらが取り除かれると壊死に陥った皮下脂肪や筋肉が汚い黄色を示す黄色期、治癒機転がはたらいて肉芽(にくげ)組織が再生し創面が赤くなる赤色期、創の周囲から上皮が形成されて皮膚がおおわれる白色期の時期があります。

　慢性のものでは、創が洞穴(どうけつ)状に皮下に拡大するポケットを形成する場合もあります。感染があると悪臭を伴うことがあり、体力が衰えていると褥瘡の感染が全身的な感染を引き起こすこともあるので注意が必要です。

検査と診断

　D（深さ）、E（滲出(しんしゅつ)液）、S（大きさ）、I（炎症）、G（肉芽組織）、N（壊死組織）、P（ポケット）の程度を評価するDESIGNツールで褥瘡の状態を判定します。

　感染がある場合は細菌培養を行って、どのような菌の感染があるかを調べる場合があります。

治療の方法

　深い褥瘡では壊死組織の除去や洗浄を行い、時期に応じた外用薬の処置をします。ポケットを形成するものでは、切開をして露出させる場合があります。消毒は必要ではなく、生理食塩水や水道水で患部を洗浄したあとに外用薬や被覆剤を貼付(ちょうふ)します。

病気に気づいたらどうする

　すぐに医師に相談してください。病巣部に圧迫をかけないように体位交換をたびたび行うなどの注意だけでなく、栄養をつけることも重要です。

堀川　達弥

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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