Bedsores appear on a bedridden person, what should you do? Caring for a bedridden patient: at home or in a boarding house? Limiting skin irritants

From this article you will learn:

Why do older people get bedsores?

What are the different stages and degrees of bedsores?

Who is at risk of disease

What are the first signs of bedsores?

How to treat bedsores in the elderly

Will surgical treatment of bedsores have any effect in older people?

What anti-bedsore mattresses and pillows to buy for the elderly

Due to prolonged forced lying down, weakened body functions and insufficient skin care, bedsores appear in older people. Typically, the problem occurs in those who are bedridden due to a stroke or bone fractures. Treating bedsores in older people is not an easy task. In this article we will look at how this is done and what methods are used.

Why do bedsores occur in older people?

Bedsores are pathological changes in the skin, muscle and bone tissue. Bedsores in an elderly person are caused by a violation of innervation, blood circulation, and lymph circulation in a separate area of ​​the body. As a rule, they appear due to prolonged contact with a hard surface.

We list the main characteristics of bedsores:

appear on areas of the body that have been in contact with a hard surface;

bedsores in older people have gradual development. First, blood circulation is disrupted in a separate area of ​​the body. If bedsores in an elderly person are not treated, then wet or dry neurotrophic necrosis, sepsis or gas gangrene will occur;

if a pensioner suffers from illnesses of cardio-vascular system, then bedsores of an elderly person develop very quickly;

Bedsores in older people affect protruding areas of the body.

Let's look at the areas where wounds most often appear:

if we are talking about patients who constantly lie on their backs, then bedsores in older people affect the sacrum, coccyx, buttocks, spinous processes of the spine, shoulder blades, heels;

if the patient lies on his stomach, then bedsores affect knee joints, iliac crests, protruding surface of the chest;

if the patient lies on his side, then bedsores appear on the ischial tuberosities;

In rare cases, bedsores in older people occur in the area of ​​the back of the head and folds of the mammary glands.

Sometimes bedsores in older people appear under a plaster cast, in a place where waterproof material fits tightly to the body, under a bandage, etc.

Sometimes bedsores in older people affect the area under the dentures. A wound may occur in the urethral area due to prolonged drainage urethra. Bedsores in older people can also appear on the mucous membrane of blood vessels. As a rule, the cause is their prolonged catheterization.

What are the different stages and degrees of bedsores?

Bedsores in older people develop in stages. Let's consider 4 stages of disease development:

Stage I bedsores

Venous erythema occurs in the area adjacent to the hard material. Its appearance is caused by obstructed blood flow. How venous erythema differs from a bruise and arterial hyperemia, we will consider below.

Difference from arterial hyperemia:

Venous erythema is characterized by a red-bluish color, and arterial erythema is bright red;

With venous erythema, the temperature in the affected area of ​​the body does not increase, and arterial hyperemia suggests that the area is becoming warm.

Difference from a bruise:

If you press your finger on a bruise, its color will not change;

With venous hyperemia, the same action will cause the skin area to turn pale.

Venous erythema of a protruding area of ​​the human body adjacent to a foreign surface is the most important sign of pressure ulcers.

Stage II bedsores

Bedsores in older people are characterized by a thinning top layer of skin that begins to peel off and blisters appear on the affected area. Tissue nutrition is disrupted due to venous stagnation, excess fluid appears in the skin, and epidermal cells swell and rupture.

Thinning and peeling of the skin, violation of its integrity are the most important signs of stage 2 bedsores.

Stage III bedsores

Bedsores in older people are wounds that may contain suppuration.

Damage to the deep layers of skin and muscles, the appearance of suppuration, and beginning necrosis are important signs of the third stage.

Stage IV bedsores

Bedsores in older people are local cavities, defects that are formed as a result of tissue necrosis and at this stage are accompanied by the release of pus and the inflammatory process.

Necrosis and expansion of its zone, inflammatory process- signs of the fourth stage.

Who is at risk of disease

Bedsores can develop in different ways in older people. Medical institutions use the Norton, Braden or Waterlow scales to systematize the assessment of risk factors for the development of wounds on the body. Let's look at the factors that contribute to the development of bedsores below.

1. Factors associated with errors in organizing patient care:

irregular change of bed;

underwear is changed irregularly to clean and dry ones;

hygiene procedures are carried out irregularly or completely ignored;

the bed has a hard, uneven surface.

2. Factors associated with individual characteristics patient's condition:

old age;

the patient's obesity or exhaustion;

problems with the cardiovascular system;

disruption of the innervation of the body;

impaired metabolic processes;

unhealthy diet, protein dystrophy;

uncontrolled defecation, urination.

Bedsores in older people can be provoked smoking, diabetes, lack of water, being overweight or underweight, fecal/urinary incontinence, the presence of crumbs and small objects in the bed, an allergic reaction to one of the cosmetics, buttons on underwear, injuries, increased sweating.

The first signs of bedsores in an elderly person

As a rule, a patient who has developed bedsores will inform those caring for him about the following:

He is bothered by a “tingling” sensation that occurs in some parts of the body;

He noticed that the skin became numb or numb for 2-3 hours;

It is necessary to begin treating bedsores in a bedridden elderly person in a timely manner. Therefore, it is important for caregivers to know what the signs of a developing wound are.

Blood and lymph stagnate, venous erythema appears, which has a bluish-red color. Bedsores in older people, as a rule, have blurred boundaries and appear in areas where bone and muscle protrusions come into contact with the bed;

The skin becomes thinner, peels, and purulent blisters form on it.

If you notice something like this, then treatment cannot be delayed. How to treat bedsores in older people? Let's consider what needs to be done to prevent further development of wounds.

It is necessary that the patient changes position every 2 hours. It is recommended to use special pillows that change the position of the arms, legs and the whole body. Their use is possible if the patient has no contraindications.

Pay attention to the level of the head of the bed;

Use hygiene products to regulate the patient's skin moisture. Carry out procedures aimed at cleansing and moisturizing skin, at least twice a day. If bedsores in older people are caused by uncontrolled bowel movements, then the skin should be cleaned of feces immediately after they appear;

If the patient has excess moisture on the skin, it must be removed regularly. Absorbent pads, diapers, napkins, towels, films are suitable for this;

Bed linen should be changed regularly;

Performing intensive massage is contraindicated. You can lightly stroke areas of the skin that show signs of congestion. The procedure should be carried out with great care;

Bedsores in older people can be prevented by using an anti-bedsore mattress. It is better to give preference to a model with a silent compressor that maintains and changes the hardness of the bed, with the ability to regulate and program the inflation of different zones of the mattress.

It is useful to use pillows filled with gel foam. If we are talking about a patient in a wheelchair, then it is important to change the position of the patient’s body every hour.

Why are bedsores dangerous for older people?

Bedsores in older people are a problem that it is better not to face. If it was still not possible to prevent their appearance, then, alas, it will be necessary long-term treatment. As a rule, the reasons for the development of bedsores are:

extensive excision of soft tissues, disruption of innervation and blood circulation;

limb amputation;

necrotic damage to periosteal and bone tissues;

weakened immunity.

If bedsores in older people are accompanied by infection of the affected areas, then the situation gets worse, because purulent processes are very dangerous.

With dry necrosis, bedsores in older people heal very slowly.

How to treat bedsores in an elderly person

Bedsores in older people can be treated with various ointments. Let's look at the most effective ones:

1) Argosulfan- a cream based on the antibiotic sulfathiazole, which effectively fights growth and reproduction pathogenic microflora. The drug allows you to remove painful sensations, moisturize the wound, speed up its healing. The cream is applied to the previously cleaned surface of the bedsores in a layer of 2-3 mm 2-3 times a day. The drug can be used in conjunction with an occlusive dressing. Treatment lasts no more than two months. Analogues of the drug are sulfargin (50 grams/200 rubles) and dermazin (50 grams/200 rubles, 250 grams/530 rubles). Prices for argosulfan: 15 grams/200 rubles, 40 grams/350 rubles.

2) Ointment “Iruksol”. With this drug you can clean bedsores and remove dead tissue. The ointment has a bacteriostatic effect. How to treat bedsores in elderly bedridden people? Apply the drug to pressure wounds, previously cleaned with saline, 2 times a day. The cost of the medicine is 1300 rubles. for 30 grams.

3) Levosin ointment. The drug contains sulfadimethoxin and chloramphenicol, which have an antimicrobial effect, methyluracil, which promotes healing, and trimecaine, which relieves pain. The ointment helps eliminate bedsores in older people short time. Pressure wounds are cleared of purulent accumulations and dead tissue and gradually heal. The ointment should be applied every day to previously cleansed skin, and then cover the treated area with a dressing. The ointment can be administered into purulent cavity by means of a syringe. The cost of the drug is 80 rubles/40 grams.

4) Levomekol. The ointment contains methyluracil and chloramphenicol. Thanks to the use of the drug, tissue regeneration improves. The ointment also has an antibacterial effect. It is used if bedsores in older people are purulent-necrotic in nature. The cost of the drug is about 80-100 rubles.

5) Metronidazole gel 0.75%. The drug contains metronidazole, which has a powerful antimicrobial effect. The gel is used with dressings. It inhibits the growth of microbes, eliminates unpleasant smell from bedsores. If bedsores in older people are accompanied by heavy discharge, it is recommended to use a foam bandage with metronidazole. If we are talking about dry bedsores, then hydrogel dressings with metronidazole are better suited. The cost of the drug is 100-120 rubles.

6) Hydrogel “Intrasite” allows you to cleanse the skin of dead skin. The drug is used with an external dressing. Its choice and frequency of change depend on the condition of bedsores in older people. The drug gently and quickly cleanses the wound of necrotic tissue due to the adsorption of excess exudate. The gel costs 2100 rubles.

Treating bedsores in older people at home is not so easy. However, thanks to the achievements of modern medicine, this is possible. Regular cleansing is necessary purulent wounds, providing conditions for bedsores in older people to dry out and gradually heal.

It is recommended to use disposable dressings with an antiseptic effect, the choice of which is very wide. As a rule, such materials have a narrow focus and recommendations for their use at a certain stage of pathology development.

7) Proteox-TM. This remedy is used to treat infected bedsores in older people. The drug is suitable for treating pressure wounds at the last stage. It allows you to clean bedsores from pus and dead tissue, prevents the development of the inflammatory process, and promotes healing. The cost of the drug is 180 rubles.

8) Multifarm- a drug for the treatment of bedsores of the first and second degree. The bandage is applied for a day or two. The cost of the medicine is 180 rubles.

9) Biaten AG. The drug allows you to treat weeping bedsores in older people, including infected ones. Treatment requires the use of 1-10 dressings, each of which is applied for 1-7 days. The dressings are changed as they become saturated. The cost of the medicine is 950 rubles.

10) Comfil plus Suitable for the treatment of non-infected pressure wounds. The cost of the drug is 140 rubles.

Does surgical treatment of pressure ulcers in older people make sense?

Surgical treatment should be used only as a last resort. Incorrect and inappropriate intervention can only increase the area of ​​damage and lead to worsening of the skin condition.

Surgery involves free skin grafting, excision of bedsores and subsequent comparison of wound edges, plastic surgery. Unfortunately, treating bedsores in older people in this way is not always effective. The fact is that transplanted tissues do not take root well in an area where blood circulation is impaired. In addition, the reason is the non-sterility of the pressure ulcer.

Surgery can have unpleasant consequences. There is a high probability of marginal necrosis, wound necrosis, bleeding, suture dehiscence, etc. In addition, the formation of fistulas is possible in the future, leading to bedsores appearing again in older people.

How to treat bedsores in a bedridden elderly person using folk remedies

When it comes to a problem such as bedsores in older people, folk remedies can act as an auxiliary measure. However, their use allows wounds to be cleaned and new tissue to form. It is important to remember that everyone folk method involves the use medicinal plant, which is fraught with the appearance of allergic reactions. If you plan to treat bedsores in older people using such remedies, we recommend that you first consult with your doctor.

Let's look at recipes that can treat bedsores in older people:

Lubricate bedsores in older people several times a day with juice prepared from lungwort leaves;

Apply bandages with Kalanchoe leaves, cut in half, to bedsores;

Apply black elderberry leaves to bedsores twice a day. They must first be scalded with boiling milk;

Prepare an ointment from calendula flowers and petroleum jelly. Apply it to bedsores in older people twice a day;

Mix fresh crushed potatoes half and half with honey and apply to bedsores in the elderly;

Mix sea ​​buckthorn oil and tea tree oil, lubricate bedsores in elderly people with the mixture several times a day;

Mix celandine juice, aloe juice, honey in a ratio of 2:2:1 and apply to bedsores in the elderly twice a day;

Sprinkle starch on bedsores in older people.

Prevention of bedsores in older people

Bedsores in older people form very quickly, and cells can begin to die after just a few days. Treatment of the disease causes many difficulties and is not always effective. For this reason, the prevention of pressure sores should be given Special attention.

Prevention of bedsores:

Turn the patient several times a day;

Make sure that no folds or foreign objects (crumbs, buttons, etc.) appear on bed linen and underwear;

Take care of the cleanliness of bed linen;

Places of the skin that are constantly in contact with the surface of the bed are wiped with a disinfectant solution;

The place where bedsores may appear in older people is washed with cold water, wiped with alcohol, and powdered.

What anti-bedsore mattresses and pillows to buy for the elderly

Caring for a bedridden patient- difficult task. If we are talking about a disabled person who is unable to even roll over, then caring for him requires serious physical activity. An anti-decubitus mattress makes the work of a caregiver easier. It can be purchased at a pharmacy by pre-order or in one of the online stores. By the way, such a mattress not only prevents the occurrence of bedsores, but is also comfortable for a sick person.

Thanks to the opposite mattress, blood circulation is activated in the area prone to bedsores. The pressure points alternately change, which provides a massage effect. Mattresses come in balloon and cellular types.

A cellular mattress is suitable for a patient weighing no more than 120 kg. It is suitable for the prevention and treatment of stage 1 and 2 bedsores. If we are talking about a patient whose weight exceeds 100-120 kg, then it is better to give preference to a balloon mattress. It is also suitable for the treatment of grade 3 and 4 pressure ulcers. Unique laser micro-perforations provide additional air flow and prevent sweating.

The cost of a balloon mattress is higher than that of a cellular mattress. However, treating bedsores with medication or surgery will cost you much more.

A special pillow will help prevent bedsores in older people. It comes in three types:

A foam pillow is the most economical option. However, it gradually loses its elasticity, and its effect becomes less effective after a short period of time;

The gel pillow prevents bedsores in older people. It hardens if the temperature in the room drops significantly;

The air cushion is used to treat bedsores in older people, but can also be used for preventive purposes.

In our boarding houses we are ready to offer only the best:

24-hour care for the elderly by professional nurses (all staff are citizens of the Russian Federation).

5 full and dietary meals a day.

1-2-3-bed occupancy (specialized comfortable beds for bedridden people).

Daily leisure (games, books, crosswords, walks).




Bedsores are damage to the skin and tissues that form due to poor circulation in the soft tissues covering protruding bones.

Bedsores form in patients who have to stay in the same position long time. Bedsores can be the result of stroke, heart attack, spinal palsy, spinal injury and other complex conditions.

The most susceptible to bedsores are the back, buttocks, tailbone, and heels. Bedsores form in patients who are bedridden and hardly change their body position. Bedsores cause death not only of the skin, but, in severe cases, also of bone tissue, so bedsores develop quickly and are difficult to treat.

What are bedsores?

A bedsore is a change in the skin, muscles, bones and other tissues that is pathological in nature. With prolonged contact with a hard surface, blood circulation and lymph circulation are impaired, and then the death of certain parts of the body occurs.

Features of pathological changes on the body:

• bedsores form on the side of the body that comes into contact with a hard surface;
• the disease goes through several stages, starting from blood stagnation and ending with wet or dry neurotrophic necrosis, or gas gangrene;
• in exhausted patients with cardiovascular insufficiency, bedsores form very quickly, literally within a day;
• Bedsores mainly affect protruding areas of the body;
• if the patient is immobilized on his back, then bedsores form on the buttocks, sacrum, coccyx, shoulder blades, spinous processes of the spine, heels);
• if the patient is immobilized on his stomach, then bedsores form on the knees, protruding areas of the chest, and the iliac crests;
• if the patient is immobilized on his side (or in a semi-sitting position), then bedsores form on the ischial tuberosities;
• Bedsores almost never appear on the folds of the mammary glands and the back of the head.

Specific localization of pressure sores on the skin: under a cast, a bandage, where waterproof materials (rubber tubes, oilcloths) fit tightly to the body, folds in bed linen, etc.

Specific localization of bedsores on mucous membranes: under dentures, on the urethra (due to long-term drainage of the urethra), on the mucous membrane of blood vessels (due to the long-term presence of catheters in blood vessels).

For conscious young patients, bedsores are not typical, and if they develop, it is gradually, so it is quite difficult to identify the impending danger. Still, bedsores are the lot of, for the most part, exhausted elderly people.

The first signs of bedsores

If the patient is conscious and has retained sensitivity of parts of the body to pain, then he may complain to the people caring for him about:

• tingling sensations that occur on the skin in places where bedsores are more likely to form. Such sensations are due to the fact that biological fluids (blood and lymph) stagnate and cease to nourish the nerve endings;
• numbness, that is, loss of sensitivity in an area of ​​the skin. This sensation appears literally a couple of hours after the tingling sensation.

Signs of a developing bedsore that caregivers should know:

• stagnation of peripheral blood, lymph. It first appears as red-bluish venous erythema, which does not have clear boundaries. It is localized at the points of contact of bodily protrusions (both bone and muscle) with the surface of the bed. Such venous erythema can have different intensity in coloring, which means it can be either almost invisible or very bright;
• the appearance of pustules (but they do not always occur) on the skin, and then desquamation of the epidermis.

If you notice such signs of a bedsore in a patient, you must urgently take all possible measures so that the situation does not worsen.

How to eliminate a bedsore when the first symptoms appear?

There are a number of measures that can prevent the patient’s condition from worsening:

• regularly (every 2 hours) change the patient’s position in the absence of contraindications for such actions. It is recommended to use pillows specifically designed to vary the position of the limbs and the whole body on the bed. Such pillows form a space between the skin and the surface of the bed;
• the headboard, if possible, should be at the level of the entire bed, or lower;
• monitor the hygiene and moisture of the patient’s skin, using various means (warm, but not hot baths, washing cream, foam, spray, solution). Such procedures need to be done at least 2 times a day. If the patient has uncontrollable bowel movements, then it is worth removing dirt from the skin as quickly as possible;
• excess moisture from the skin and folds (sweat, urine, wound exudate, water, perspiration, food debris) should be removed with special absorbent pads, towels, etc.;
• change bed linen or remake the bed at least once a day;
• Avoid intensive massage on skin areas with developing bedsores. You can only lightly stroke the skin, doing it carefully and without friction, especially near the bones;
• can be used anti-decubitus mattresses(balloon or cellular). Such mattresses are equipped with silent compressors to provide and change rigidity; the inflation of different areas is regulated or programmed;
• You can use pillows filled with gel, foam, or air. Such pillows are relevant for people in wheelchairs. Every hour it is necessary to pay attention to the patient’s body in the chair, changing its position.

Why are bedsores dangerous?

Treating bedsores is not an easy task, so it is much easier to prevent the occurrence of such a pathology than to treat it. When foci of skin maceration appear, the disease develops instantly, foci of tissue necrosis form, and long-term treatment of the purulent wound is necessary.

The final outcomes of bedsores are very dangerous, sometimes they can be caused by:

• excision of soft tissues, formation of defects in which the blood circulation of lower areas of the body is impaired;
• amputation lower limbs;
• defeats bone tissue, periosteum (osteomyelitis, periostitis);
• suppression protective functions the patient’s body, which complicate the treatment of the underlying disease.

If bedsores develop as a type of wet necrosis, then an infection can get into the wound and purulent processes such as sepsis, phlegmon, and gas gangrene can develop.

If bedsores develop as dry necrosis, then there is a risk of developing a protracted pathogenesis with a long period of wound healing.

Causes of bedsores

The appearance of bedsores is very easy to explain. The entire human body is permeated with capillaries - tiny blood vessels. It is through them that blood moves to different organs. If you block the blood supply (pressure the vessels) to the tissues, they begin to die.

When you remain motionless even for two hours, the capillaries are compressed, which means that blood does not flow to certain parts of the human body, and bedsores appear. Be aware that it is extremely dangerous to sit or lie motionless for a long time!

Pulling a wet sheet from under a patient is very dangerous. This is what can lead to bedsores, since in this case the blood vessels can rupture, which means that blood will not flow to the tissues. Rupture of capillaries is invisible to our eyes, but very dangerous.

Another common cause of vascular rupture is the patient sliding down to take a different position if he cannot walk or there is no one to help him.

Risk factors for developing pressure ulcers

In bedridden patients, bedsores can appear at any time. In hospitals, the Norton, Waterlow or Braden scales are used to determine risk factors for pressure ulcers. Based on the assessment of these scales, risk factors are identified that may be associated with errors in patient care or individual characteristics.

Factors associated with errors in patient care:

• lack of hygiene of bedding, changing the bedding less than once a day;
• the patient’s underwear is not regularly changed to dry and clean;
• lack of thoroughness in carrying out hygienic procedures (drying the skin, treating with special solutions, body massage without traumatizing damaged skin);
• unevenness and hardness of the bed surface.

Factors related to the individual characteristics of the patient:

• exhaustion or obesity;
• elderly age;
• cardiovascular diseases;
• diseases that disrupt the innervation of the body;
• violation metabolic processes body (insufficient drinking, water-salt imbalance, diabetes mellitus);
• lack of protein in the diet, protein dystrophy, or simply an unbalanced diet;
• dementia, coma and other conditions in which urination and bowel movements are not controlled.

In addition, it is necessary to separately note the factors that provoke the development of bedsores in a patient: smoking, restriction of water and nutrition, weight that does not meet the standards, urinary and fecal incontinence, skin contamination, poor bed hygiene, allergies to skin care products, presence on clothing buttons, seams and folds, increased sweating (especially at fever), diseases of the brain and spinal cord.

Stages and degrees of bedsores

The development of bedsores occurs in stages and 4 stages of the pathogenesis of this disease can be distinguished:

First stage of bedsores

At the site where the skin adheres to a hard surface, venous erythema can be visually detected. It is the result of difficulty in the outflow of blood in a specific area of ​​the body.

It is important to be able to distinguish venous erythema from bruising and arterial hyperemia.

Erythema differs from a bruise in that when pressed with a finger, the skin on the damaged area turns pale. But with a bruise, the color remains the same.

Venous erythema differs from arterial hyperemia in the following ways:

• arterial erythema is bright red, and venous erythema is red-bluish;
• the temperature of the skin area with arterial hyperemia corresponds to the temperature of the whole body, and with venous hyperemia it may be lower than body temperature.

Thus, one of the main signs of a bedsore at the first stage is venous hyperemia (erythema) of protruding areas of the body without violating the integrity of the epidermis.

Second stage of bedsores

At the second stage of a bedsore, you can already see thinning of the upper layer of skin - the epidermis, and then its peeling, the appearance of blisters. The bedsore begins to develop rapidly, stagnation of blood in the veins causes:

• disruption of tissue nutrition;
• innervation of the affected area;
• excess fluid in the skin;
• swelling and rupture of epidermal cells.

Thus, one of the main signs of a pressure ulcer at the second stage is thinning, peeling, maceration and destruction of the skin.

Third stage of bedsores

At the third stage of a bedsore, the wound is already visible to the eye without suppuration, or with suppuration (contamination with microflora).

Thus, one of the main signs of a pressure ulcer at the third stage is damage to the deep layers of tissue, subcutaneous tissue, as well as muscles with accompanying purulent inflammation and the onset of necrosis (tissue death).

Fourth stage of bedsores

At this stage, the local cavity itself, which appears due to necrosis, is visually clearly defined. Along the edges of the cavity, purulent inflammations are visible, which continue to form.

Thus, one of the main signs of a pressure ulcer at the fourth stage is a necrotic cavity, which continues to expand due to inflammation of the walls.

It is important to note that bedsores of different stages can be observed on different parts of the body.

Purulent bedsores

At the second stage of the disease, suppuration of skin areas begins, which continues to worsen in the third and fourth stages. This is facilitated by the introduction of pyogenic microorganisms into the wound. It is erysipelas and phlegmon that often contribute to the development of purulent bedsores.

A severe case of purulent bedsore can develop into sepsis or gas gangrene.

Purulent bedsores of the erysipelas type

Erysipelas is purulent inflammation local area of ​​skin. The causative agent is hemolytic staphylococcus or other pyogenic microorganisms. Erysipelas most often appears in elderly people with weakened immune systems and is accompanied by hyperthermia and toxicosis.

Symptoms of erysipelas with bedsores:

• the color of the skin at the site of the bedsore is bright red;
• at the site of the bedsore there is a dense cold swelling;
• body temperature is increased (up to 39 degrees);
• weakness;
• nausea;
• headache;
• the appearance of a purulent wound;
• exudate is released from the wound, which then penetrates the blood.

Purulent bedsores of the type of phlegmonous inflammation

Cellulitis is a purulent inflammation that does not have clear boundaries. The causative agent is Escherichia coli, staphylococcus and other pyogenic microorganisms. Phlegmon is usually localized under the skin, fascia, and in the armpit.

Symptoms of phlegmonous inflammation with bedsores:

• a shiny red swelling at the site of the bedsore, which has no clear boundaries. The swelling is hot to the touch, which is the main signal of phlegmonous inflammation;
• body temperature is significantly increased (reaches 40 degrees);
• A fistula with purulent or putrefactive filling quickly develops.

Purulent bedsores by type septic inflammation

Purulent blood poisoning is called sepsis. It is sepsis that is the result of erysipelas or phlegmonous inflammation. The final stage of sepsis is septic shock, which often leads to death.

Symptoms of septic inflammation in bedsores:

• absence of a pathognomonic (main) symptom with a variety of others;
• at first the patient’s body temperature is high, and then becomes low (below normal);
• fast development inflammation.

The fight against sepsis begins as early as early stages development of bedsores using antibiotic therapy. In modern medicine, there are rarely cases of a patient’s bedsore being brought to a septic state. However, this happens if a person is in an immunodeficient state or is not sensitive to antibiotics.

Purulent bedsores similar to gas gangrene

Gas gangrene is a severe purulent, putrefactive pathology. The causative agent of the disease is considered to be Clostridium (mainly Clostridium perfringens - soil microorganism). If contaminated soil comes into contact with the softened surface of a bedsore, infection occurs.

Symptoms of gas gangrene in bedsores:

• a specific crunch when passing over the surface of a bedsore, this is a pathognomonic symptom;
• the development of the disease occurs very quickly - within 6-7 hours;
• the skin acquires a gray-blue tint;
• the wound becomes dry;
• a strong smell of rot spreads.

Skin treatment for bedsores

There are 3 main areas of skin treatment for bedsores:

• hygienic skin treatment. Used to keep the skin in optimal condition. physiological state(pH level, humidity, softening, elasticity of the skin, etc.), removing the patient’s body secretions (sweat, sebum, urine, feces) and deodorizing the skin;
• preventive treatment. Used to stimulate blood circulation and restore sensitivity in certain areas of the body, prevent cracks in the skin;
• therapeutic treatment. Special medicines are used in the form of ointments, gels, powders, powders, creams, solutions, etc.

Prevention of bedsores in bedridden patients.

In order to prevent bedsores in patients, a number of measures must be observed: change bed linen more often, avoid folds and crumbs on it, try to keep the patient’s body in contact with urine and feces for as little time as possible. Change the position of the patient’s body more often, wipe it first with a damp cloth, then with a dry one. Folk remedies will also help in prevention. In addition, you can buy a mattress for bedsores, or make a mattress yourself according to folk recipes.

Solution for treating bedsores.

Modern medicine uses solutions less and less often to treat bedsores. But the simplest solutions were very popular and effective for treating wounds and wound complications, especially in military surgery.

For preventive purposes, it is recommended to use camphor alcohol (2% solution, ammonia(0.5% solution), tannin (1-2% solution in alcohol), salicylic alcohol (1% solution). It is necessary to treat the skin with these solutions at least 2-3 times a day.

For medicinal purposes they use:

• external solutions: magnesium sulfate (25% solution), sodium chloride (10% solution with chymotrypsin), chlorhexidine bigluconate (0.5% water solution);
• parenteral solutions that are administered to the patient intravenously using a dropper, for example, metronidazole (0.5% solution).

In addition to treating the skin, it is important that the patient eats properly. It is recommended to include in your diet foods rich in iron, zinc and other useful microelements. This is very important, since bedsores are formed in many cases due to a lack of iron in the patient’s body. All dairy products, poultry, eggs, fish are rich in iron. If the patient is unable to digest meat, then meat broths will be a good alternative. Be sure to eat as many fresh fruits and vegetables as possible, mostly green.

Bedsores on the heels, buttocks and tailbone

It is the buttocks, tailbone, heels, and sometimes shoulder blades that are the most common areas for bedsores to appear, because most often patients lie on their backs. When carrying out hygiene procedures, it is important to pay attention to certain areas of the patient’s body that are most susceptible to the formation of bedsores.

Bedsores on the heels

This localization of bedsores occurs quite often. It is the heels that are susceptible to various diseases, including bedsores, although this seems very unusual.

Causes of bedsores on the heels:

• it is difficult to notice the first symptoms of the disease due to rough and thick skin;
• cracked heels increase the likelihood of penetration of pathogens;
• congestion in the legs - often found in older people, people suffering from diabetes, etc.

Symptoms of bedsores on the heels

Often, bedsores develop asymptomatically. Sometimes tingling may occur, a white spot may appear on the heel, or loss of sensitivity in this area.

Prevention of pressure sores on the heels:

• you should use special devices (wedge-shaped pillows, sheepskin, special mattresses) that unload the heels;
• stimulating blood circulation with a light massage of the calves, rubbing camphor alcohol 2%;
• frequent change leg positions (recommended - every 2 hours);
• protection of the skin of the heels from the penetration of microorganisms. You can use a colloidal butterfly dressing, which creates a moist and sterile effect. The material and impregnation of this bandage allows you to leave it on the leg for up to several days.

Treatment of pressure sores on the heels:

Bedsores on the heels differ from others only in the anatomical features of the location, which means they are treated with the same means and methods as bedsores on other parts of the body.

Bedsores on the buttocks

It is bedsores on the buttocks that have serious consequences, since they are located near important organs such as the hip joint, rectum, nerve nodes, pelvic organs, blood vessels supplying blood to the legs. Disruption of the functioning of these organs greatly affects human health, and sometimes can lead to death.

There are strong muscles on the buttocks, which, it would seem, should prevent the formation of bedsores. But if the skin is regularly exposed to urine and feces and is not treated properly with hygiene products, then a bedsore can easily form. Extensive tissue defects appear on the buttocks, which are very difficult to treat. Precursors and symptoms of gluteal pressure ulcers do not differ characteristic features.

Prevention of bedsores on the buttocks:

• You should regularly perform hygiene procedures for the perineum and buttocks. For this purpose, special sprays, washing creams and liquids are used. You should put on latex gloves on your hands, which will not injure the patient’s skin and will ensure hand hygiene for the person caring for him;
• absorbent sheets, diapers, panties, diapers, powders help to avoid the appearance of diaper rash;
• it is necessary to change the patient’s position every 2 hours;
• It is recommended to use anti-decubitus mattresses with adjustable hardness, special pillows and bolsters.

Treatment of bedsores on the buttocks:

If bedsores are in an advanced state, then treatment will be similar to the treatment of other purulent wounds, but taking into account the anatomical features of the affected area.

Bedsores on the tailbone

Bedsores often appear on the tailbone, since it protrudes slightly when lying down and, accordingly, comes into contact with the surface of the bed. Since the muscle layer in this area of ​​the body is insignificant, and there are plenty of nerve plexuses, bedsores on the tailbone are quite dangerous. With bedsores, nerve endings are damaged, which can lead to disruption of the innervation of the lower parts of the body.

The harbingers and symptoms of bedsores on the coccyx do not differ in their characteristic features. Prevention and treatment of such bedsores are identical to gluteal ones.

How to treat bedsores?

Treatment of bedsores in the second to fourth stages corresponds to the treatment of purulent wounds. Any purulent wounds are quite difficult to treat. There is a standard algorithm of actions developed over the long history of field surgery. The principle of treatment remains the same as many years ago, but there are some minor improvements.

Treatment of pressure ulcers in the first phase of pathogenesis

At this stage, the wound is filled with necrotic tissue and pus. Treatment consists of:

• ensuring the outflow of pus;
• relieving swelling;
• suppression of microbial contamination of bedsores.

Treatment of bedsore wounds is carried out only in the surgical departments of the hospital. To ensure the drainage of pus, drainage tubes are used, which are cleaned regularly.

Passive drainage can be done at home.

The mechanism for performing passive drainage at home:

1. Fill the wound with napkins, which are pre-impregnated with a composition that promotes the outflow of pus. Wipes should be changed regularly. You can use both special medical wipes and regular bandages, you just need to make sure that they do not leave threads. Various solutions and ointments are used as impregnation, which can be divided into outdated and modern.

For example, sodium chloride (10% solution) and boric acid (3-5% solution) are considered obsolete. These and other hypertonic solutions are currently little used because they need to be changed frequently as their effect wears off after 4-8 hours.

Hydrophobic ointments, emulsions, vaseline-based liniments, for example, syntomycin emulsion, balsamic liniment (according to Vishnevsky), tetracycline, neomycin emulsions and others can also be considered obsolete products. Such products are ineffective because they do not absorb pus, and the antibiotics they contain do not have full effect.

Modern means are hydrophilic ointments, such as Levomekol, Levosin and other ointments that have a water-soluble composition. It is these products that can perfectly remove pus for up to 24 hours. It is important to note that if there is no pus in the wound, then water-soluble ointments are ineffective; they are used only for purulent bedsores.

1. Enzyme therapy involves removing pus with enzymes. Proteolytic enzymes such as trypsin, chymotrypsin and others are used. To enhance the effectiveness of treatment, enzymes are used together with ointments (for example, Iruksol).
2. Treatment of the wound antiseptic solutions external use. Boric acid, furatsilin and hydrogen peroxide have recently been rarely used to treat bedsores. It is recommended to use more modern drugs- iodopyrine (0.5% solution), dioxidine (1% solution).
3. The use of so-called traditional physical methods of treatment. These are UHF therapy, ultrasonic cavitation, vibraphonation, oxygenation, laser therapy and other similar methods.

Treatment of pressure ulcers in the second phase of pathogenesis

At this stage, the bedsore has already been cleared of pus; it is necessary to achieve the formation of new healthy tissue. Appearance the crust that covers the wound (scab) provides information about the condition of the bedsore itself. A healthy scab is a thin, dried granulation. A purulent scab, on the contrary, is distinguished by a thick crust of dried pus. Getting rid of a wound under a purulent scab is impossible, so careful treatment of the bedsore in the first phase is very important.

When healthy granulations appear, treatment is prescribed, which:

• relieves inflammation;
• protects healthy tissues from possible infection;
• stimulates restoration processes in tissues.

To relieve inflammation use:

• ointments (in particular, methyluracil and troxevasin, bepanten and other ointments for water based);
• herbal remedies (aloe juice, Kalanchoe, sea buckthorn and rosehip oils);
• laser therapy to stimulate the appearance of epithelial tissue.

Treatment of bedsores in the third phase of pathogenesis

At this stage, it is important to achieve regeneration and scarring of the wound. For this purpose, modern drugs are widely used (EDAS-201M ointment, various vitamins and immunostimulants), which improve the processes of tissue scarring and the appearance of new epithelium.

Throughout the treatment of a bedsore, you can use antibacterial agents, as well as intravenously administer Metrogyl solution and antibiotics.

Various consequences Bedsores are treated inpatiently.

Treatment of bedsores at home - folk remedies and treatment recipes:

Prevention of bedsores is proper care of bedridden patients, which consists of frequent turning over, hygiene, and proper eating and drinking. If swelling is observed during examination of the body, they may be harbingers of bedsores; measures must be taken immediately. At first, it is still possible to improve the situation, but the disease progresses very quickly, and it is important not to miss its transition into an irreversible process.

There is quite a lot of medicine

There are times in life different situations. Sometimes, due to a serious illness, a person becomes bedridden for a long time. In case of prolonged stay in a serious condition, bedsores may form on the patient’s body, treatment of which must begin immediately after the detection of primary signs.

Bedsores are superficial and sometimes deep injuries to the skin and soft tissues. Such disorders are usually caused by excess pressure on a certain area of ​​the body, which leads to cessation of blood circulation, pinching of small vessels and tissue necrosis.

There are several degrees of development of bedsores:

1. The first degree is characterized by persistent hyperemia, which may not go away after the pressure on parts of the body stops.
2. In the second degree, superficial and shallow disorders of skin areas can be detected.
3. The development of the third degree is associated with the almost complete destruction of the skin and the formation of a wound in which muscle tissue can be seen.
4. The fourth degree of pressure ulcers is characterized by damage not only to soft tissues, but also to bones.

Bedsores are dangerous because they can consistently spread deeper. Therefore, if signs are detected that may resemble symptoms of bedsores, it is necessary to immediately provide additional care patient and take all measures to eliminate skin damage. But it is much easier to prevent bedsores, and to do this you need to understand why they may appear.

What causes bedsores

Bedsores are most often located on areas of bone that protrude outward and are tightly covered with skin. The ankles, buttocks, elbows, heels, sacrum and spine are potentially at risk. When pressure is constantly applied to these areas of the body, circulatory problems occur. The intensity and duration of pressure determine the severity of the consequences and the degree of development of bedsores. Constant damage to the skin leads to tissue necrosis, and dead tissue, in turn, attracts many bacteria, which contributes to the spread of various infections.

In general, a phenomenon such as bedsores may have the following causes:

• constant pressure with body weight on the bends of the elbows;
• too much friction on the sheet or blanket by the patient;
• increased friction between surfaces due to increased humidity.

Anyone who is prescribed bed rest for a long period of time is at risk of developing bedsores. In the absence of sensitivity and complete limitation of movements, the danger increases significantly. The following circumstances contribute to the formation of bedsores:

• poor and low-quality nutrition, which leads to weight loss;
• incontinence;
• various diseases: anemia, diabetes, stroke;
• the presence of malignant tumors;
• lack of vitamin C;
• thinning skin or overly dry skin.

If the development of the patient’s disease and its treatment takes place in such conditions and there is a suspicion of bedsores, the diagnosis of such a disorder should be carried out regularly for the timely detection of the disease.

What are the signs of bedsores?

At different stages of the disease, special symptoms appear.

1. In the first stage, the skin will take on a reddish tint and the area underneath will feel warm to the touch. The patient may feel pain when touched.
2. In the second stage, the entire skin layer is destroyed, red spots, blisters and swelling appear, and the temperature rises.
3. At the third stage, a shallow ulcer forms and becomes covered with a crust.
4. At the fourth stage, the ulcer goes deep and affects the muscles and even bones. At the same time, it is quite difficult to determine the degree of its depth and damage by eye.

The development of necrosis or the appearance of erosion in areas of the skin may be a consequence of insufficiently conscientious patient care. When dealing with severely ill patients who may have pressure ulcers, symptoms should be identified immediately by a specialist. Some signs of bedsores can resemble skin cancer, so sometimes it is necessary to resort to differential diagnosis or biopsy.

Sepsis is the most terrible consequence which may occur in a patient with advanced bedsores. Bacteria and microorganisms spread throughout the body through the blood and in worst cases can be fatal.

Sometimes bedsores can lead to the development of diseases such as contact osteomyelitis, wound myiasis or purulent arthritis. In any case, these are unpleasant additions to the patient’s underlying disease, so at the first signs it is necessary to eliminate damage to the patient’s body.

How are bedsores treated?

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If ulcers are found on the patient’s skin, you should immediately call a doctor. Self-medication can only aggravate the situation and contribute to the further development of a bedsore.

To eliminate such a phenomenon as bedsores, treatment should be prescribed based on the following principles:

• in the damaged area it is necessary to restore blood flow;
• it is necessary to take measures to reject necrotic masses;
• measures must be taken to heal ulcers or wounds.

To implement the measures described above, the drug Iruksol is used. Sometimes it is necessary to remove dead tissue with surgical instruments. After this, dressings with special tissue-restoring drugs are prescribed and bandages with wound-healing drugs are applied.

For advanced bedsores, the patient may be prescribed antibiotics and antiseptics.

How to prevent bedsores

Basic methods for preventing pressure ulcers include:

• regularly turning the patient over in bed. In this case, it is necessary to turn the patient over as carefully as possible so as not to damage his skin;
• using products that reduce friction between skin areas and other surfaces. Such means include: special mattresses and pillows that should be filled with air, helium, water or foam.
• quick change of bed linen, which will keep it dry and clean. In some cases, you can use hygiene products that absorb unnecessary liquid. For example, diapers, pads or diapers.
• maintaining optimal indoor air temperature. It should not be too hot to prevent excessive sweating.

In addition to the methods described above for suspected bedsores, treatment and prevention should include caring for the patient’s vulnerable skin. To do this, it is necessary to use gentle hygiene products that do not contain alcohol and do not have a strong odor. Hygiene procedures should also be carried out regularly intimate places patient.

What folk remedies can be used to prevent bedsores?

To prevent bedsores, the patient can be placed on a mattress made of millet. This product will provide access to air and will regularly provide a kind of massage. For the same effect, you can use a mattress made of straw or hay, which will need to be changed regularly.

After hygiene procedures, the patient’s skin can be lubricated camphor oil which will prevent diaper rash from occurring. Also, a patient at risk of developing bedsores can do light exercises even while lying down and all kinds of massage.

The most important task when caring for the elderly and bedridden people is the prevention and treatment of skin pressure sores. This is the name for degenerative changes in soft tissues in places where they have been subjected to prolonged compression. Competent, comprehensive care is the key to the prevention and successful treatment of bedsores.

How does a bedsore occur on the skin?

In most cases, the cause of bedsores is prolonged compression of soft tissue between the bones and the surface of the bed. The resulting chronic disruption of blood microcirculation leads to oxygen starvation of cells and increasing trophic disorders. Gradually, necrosis (necrosis) and tissue rejection begin; at this stage, a bacterial infection often occurs.

Pressure sores form in places where the human body comes into close contact with the surface of the bed. The most vulnerable areas bony protrusions, where there is little muscle and subcutaneous tissue. These are the heels, sacrum, angles of the shoulder blades, back of the head, spinous processes of the vertebrae. Bedsores can also form in the area of ​​the ribs and wings of the pelvic bones. When lying on the side, the area of ​​the greater trochanters at the hip joints is primarily affected.

In some cases, the appearance of bedsores in bedridden patients is facilitated by significant displacement of superficial tissues. This is possible when pulling a sheet from under a lying patient, dragging him along the bed, or carelessly delivering the bedpan.

Predisposing factors

Conditions accompanied by a high risk of developing bedsores:

• recumbent lifestyle;
• paresis and paralysis after stroke and spinal injuries;
• overweight or underweight;
• diabetes;
• neurological diseases with impaired superficial sensitivity;
• pathology of the cardiovascular system.

The formation of bedsores is facilitated by an uneven mattress, folds in linen, and the presence of crumbs. And increased humidity of the skin and bedding, contamination of the body with urine and feces accelerate the formation of ulcers.

Symptoms

There are 4 stages of development of bedsores:

• The stage of skin changes is the appearance of persistent congestive hyperemia, dense cold swelling, cyanosis or blanching of the skin that does not go away after changing body position;
• The stage of detachment of the epidermis and the spread of changes to the subcutaneous tissue;
• The appearance of skin defects with the formation of ulcers, most often it is weeping, with purulent-necrotic discharge;
• The spread of necrosis to the underlying tissues with the formation of cavities, exposure of tendons and ligaments, and the spread of the process to osteochondral structures.

The formation of bedsores significantly worsens the quality of life of patients. Indeed, in addition to local changes, they experience severe pain, and their general health worsens. Even everyday care and attempts to change body position cause suffering.

The main danger of bedsores is the development of purulent-septic complications. These include erysipelas, phlegmon, gangrene, osteomyelitis, sepsis and infectious-toxic shock. These conditions are potentially life-threatening and require the most intensive treatment possible. The patient usually requires hospitalization.

Principles of treatment and prevention

Systematic, competent, careful care is the basis for the prevention of bedsores and can prevent their further progression. The most important events is daily re-making of the bed, straightening out wrinkles in the linen, regular gentle washing and thorough drying of the skin. It is necessary to cleanse the body of urine as quickly as possible and feces, arrange air baths.

Therapeutic treatment of the affected area begins already at stage 1 of the bedsore. In consultation with the doctor, rubs, powders, ointments, sprays and other dosage forms are used. When necrotic masses and signs of purulent inflammation appear, the help of a surgeon, careful regular cleaning of the wound and its drainage are required. Drugs with proteolytic, antiseptic and antimicrobial effects can also be prescribed. In the absence of contraindications, various types of physiotherapy are used.

The appearance of granulations at the bottom of the wound is a favorable sign. To activate the healing processes, agents with anti-inflammatory, protective and regenerative effects are used, and physical therapy is continued.

Caring for a bedridden patient: at home or in a boarding house?

Prevention and treatment of pressure ulcers requires integrated approach and systematic procedures, which is not always possible to ensure at home. A worthy option for solving this problem is to house an elderly person and/or recumbent person to the boarding house. Currently, there are private nursing homes, where staying in does not lead to psychological discomfort for the patient and his relatives. Even bedridden patients experience minimal physical and psychological discomfort during hygienic treatment. And the thoroughness and competence of the comprehensive care allows you to prevent the appearance of bedsores and promotes the healing of existing trophic changes.

Elderly and especially bedridden people need special attention to their health. Be attentive, patient and correct when communicating and caring for them.

Bedsores are areas of tissue death in patients forced to lead a sedentary lifestyle. Their appearance not only causes additional suffering to the patient, but can also cause severe complications and even death. What to do if you or your loved ones are faced with a similar problem?

This article is help for those who want to learn everything about bedsores: what causes them, how to suspect their occurrence in time, how they can affect a person’s health, and whether it is possible to die from bedsores. We will also touch upon the question of what types of modern methods their prevention and treatment.

Heavy operations requiring prolonged bed rest. Injuries that permanently (or permanently) limit the patient’s mobility. Severe exhaustion associated with any disease or life situations. Comatose states in which a person can remain unconscious for days, months and even years. There are quite a few situations in which bedsores can occur on the body.

Bedsores occur in 15-20% of patients treated in hospitals: this is the data presented in the document of the Ministry of Health of the Russian Federation “ Patient management protocol. Bedsores"(2002). The protocol also states that this complication significantly increases the cost of treating patients, since the patient’s time in hospital increases, additional medications, care products, etc.

“It is also necessary to take into account non-material costs: severe physical and moral suffering experienced by the patient,” the protocol states. At the same time, as the drafters of the document report, “adequate prevention of bedsores can prevent their development in patients at risk in more than 80% of cases”!

So, bedsores - what are they? This is necrosis (necrosis) of soft tissues and skin that occurs in a person who has been immobile for a long time. Surgeons often characterize these lesions as “necrotic ulcers formed due to pressure” (A.D. Klimiashvili 2004).

The most common places for bedsores to form are areas of the body that have little fatty tissue (fiber) to cushion the pressure. Therefore, the more severe the patient’s exhaustion, the higher the risk of developing this problem. Also, the places where they occur depend on the position of the patient - lying on his back, on his side, sitting.

According to the data presented in the Patient Management Protocol, the most common places for pressure ulcers to occur are the thoracic spine, sacrum, and greater trochanters. femur, heels, elbows, ears.

Also places where bedsores can form are the back of the head, shoulder blades, ankles, and toes. That is, protruding parts of the body in which there is little or no fatty tissue (especially when exhausted), in contact with hard surfaces on which the patient lies or sits.

In addition, possible places where bedsores appear are areas where there is contact between the skin and a plaster cast, splint, corset, orthopedic device, or poorly fitted prosthesis, which exert constant pressure on the skin and underlying tissues, leading to their damage.

For example, with an injury such as a fracture of the femoral neck, which often occurs in old age, in which patients find themselves bedridden for a long time (months or even years), bedsores often begin to form in the area of ​​the sacrum and buttocks, as well as in places where the pressure of the plaster cast is applied.

Even pressure from catheters used to administer medications that remain in vessels for a long time, as well as urethral catheters, which are used to drain urine from the urethra or bladder, can lead to the formation of bedsores. Such damage is small in size, but can cause infection and the development of inflammatory processes in tissues, as well as blood poisoning.

What do bedsores look like? It depends on their stage of development. The Case Management Protocol talks about four stages of the process. At the very beginning (stage 1), only redness on the skin may be noticeable, which does not disappear immediately after the pressure stops. Only the top layer of skin (epidermis) is involved in the process; there is no damage to the skin. At stage 2, there is already a violation of the integrity of the skin associated with the death (necrosis) of skin cells; the upper and deep layers of the skin (epidermis and dermis) are affected.

When we are talking about stage 3, a bedsore is already a fairly deep ulcer that penetrates the subcutaneous tissue and reaches the muscle layer. In stage 4, necrosis (death) of cells of all soft tissues - skin, fiber, muscles - is observed. The lesion resembles not so much an ulcer as a deep cavity in which tendons and bones can be visible. You can read more about the stages, types and classification of pressure ulcers in this article.

To understand what bedsores are, you can look at the photographs:

Stage 1– noticeably persistent redness of the skin without damage or ulcer formation.

Stage 2– here we see characteristic bedsores in bedridden patients – in the photo it is noticeable that the damage affects the upper layers of the skin.

Stage 3– the bedsore shown in the photo is characterized by the presence of an ulcer with deep damage to the skin, but not affecting the muscle tissue.

Stage 4– deep damage to all layers of soft tissue (skin, subcutaneous tissue, muscles) with the formation of a cavity. These bedsores often occur on the back and buttocks.

Thus, bedsores are, in essence, open wound(especially in stages 3-4). Considering that they most often develop in weakened patients, the risk of infection of the skin and soft tissues in such patients is very high. Such complications in people in the hospital are often caused by the so-called hospital infection: certain microorganisms (staphylococcus, Pseudomonas aeruginosa, Escherichia coli, etc.), which, as a rule, have low sensitivity to antibiotics.

The addition of an infection significantly complicates the treatment of bedsores: long-term non-healing ulcers form, there is a risk of developing such serious complications as osteomyelitis (inflammation of bone tissue), blood poisoning (sepsis), which significantly increases the likelihood of death.

Therefore, in the Protocol for the management of patients with pressure ulcers, it is recommended to pay special attention to the prevention of such complications: timely diagnosis of associated purulent diseases of soft tissues. Signs that need to be paid attention to in order to detect infections in a timely manner are the appearance of pus in the wound, the development of swelling of its edges, and complaints of pain in the affected area.

However, even if, upon examination of a bedsore, signs such as suppuration and soft tissue swelling, indicating that soft tissue inflammation is developing, are not revealed, doctors are recommended to regularly conduct so-called bacteriological examination. It consists in taking liquid from an ulcer or cavity (smear or puncture with a syringe), and the resulting material is placed (“seeded”) on nutrient media that ensure the growth of microbes. This method Allows timely detection of pathogens infectious processes and take measures against the development of inflammation.

What causes bedsores?

The name “bedsore”, which arose from the word “to lie down”, as well as the Latin term decubitus (decubitus) denoting this lesion, derived from the word decumbere, which means “to lie”, does not reflect modern ideas about the reasons for the development of this phenomenon. Because:

• firstly, similar problems are also observed in sedentary patients;
• secondly, prolonged immobility (sitting or lying down) is only one of the reasons for their formation.

Thus, despite the fact that the definition of “bedsores” is still used in medicine, it is necessary to take into account various factors (in addition to the “bedsore” itself) that lead to their occurrence in order to apply effective methods for their prevention and treatment.

So, what are the causes of bedsores?

The life of every cell in the body is maintained thanks to the nutrients and oxygen that come to it along with the blood flow through the smallest vessels - capillaries. In addition, the blood and lymphatic vessels carry out the removal of waste products and dead cells from the cells.

How do bedsores start? When a person remains in a stationary position for some time, in areas of the body (primarily in places where there is a minimal layer of muscle and fatty tissue between bone tissue and skin) in contact with a hard surface, capillaries and nerves that regulate metabolism are pinched substances in tissues. As a result, cells begin to suffer from a deficiency of nutrients and oxygen.

Also due to compression of blood vessels and lymphatic vessels the removal of processed substances from cells is disrupted, they begin to accumulate, negatively affecting the condition of healthy cells, which also begin to die. At first, these changes are reversible and disappear without any consequences when the pressure is removed. If measures are not taken in time, mass death cells.

According to A.D. Klimiashvili (Department of Hospital Surgery, Experimental and Clinical Surgery, N.I. Pirogov Russian Research Medical University, Moscow), the formation of bedsores begins when continuous pressure of 70 mm Hg is applied to the tissue. Art. within 2 hours.

In a person lying on his back, the pressure in the area of ​​the back of the head, sacrum, heels and buttocks, on average, is about 60 mmHg. Art. It can increase due to the patient’s large body weight, additional weight of clothing, blankets and reach 70 mm Hg. Art. Therefore, in these areas, bedsores can occur after just two hours of the patient being immobile. This is why it is recommended to change body position in patients who are unable to move independently every 2 hours.

When the patient lies on his stomach, the highest pressure is about 50 mmHg. Art. – are exposed rib cage and knees. Therefore, it takes more time for damage to occur in these places (from 3 or more hours), however, even here, an increase in pressure is possible due to the large weight of the patient and additional factors (the weight of a blanket, clothes, etc.).

How do bedsores associated with tissue shear form? As Doctor of Medical Sciences, Professor of the Department of Surgical Diseases and Clinical Angiology at MSMSU M.D. points out in his works. Dibirov, they often occur when a bedridden patient “slides” in bed. The fact is that many bedridden patients in hospitals are placed on so-called functional beds, in which the head end is raised. In addition, sometimes pillows and bolsters are placed under the patient's head and back, elevating the head and back. Raising the head end of the bed is necessary for a more comfortable stay for the patient in bed - this relieves the load from cervical region spine, creates convenience for eating. However, it is necessary that the patient’s legs have support, otherwise the body begins to slide, and a shift occurs in the deeper tissues (subcutaneous tissue, muscles) relative to the motionless skin. In this case, the vessels feeding the muscle tissue become bent, thrombi (blood clots) form and rupture. Most often, such injuries occur in the sacrum area.

The development of internal (exogenous) bedsores is often associated with tissue displacement. These are situations where mass death muscle cells, caused by a violation of the supply of oxygen and nutrients, occurs with externally intact skin. Compression of nerve fibers leads to a decrease in sensitivity in the areas where these complications develop, which also makes it difficult timely diagnosis. Therefore, in such situations, a soft tissue infection may occur more quickly, which negatively affects general condition patient, and can cause blood poisoning (sepsis) and death of the patient.

Folds in bed linen, rough clothing, seams in linen, buttons, etc. - all this causes friction, as a result of which the protective layer of the skin peels off and damage occurs. Bedsores that form as a result of friction are more often observed in the area of ​​the elbows, heels, knees, shoulder blades, and buttocks, depending on the position of the patient.

Also, trauma to the skin and underlying tissues associated with friction can occur due to improper technique for changing bed linen, when the sheets are “pulled” from under a motionless patient. Violation of the integrity of the skin threatens the addition of infectious processes.

Increased skin moisture is one of the the most important factors, contributing to the formation of bedsores. It can be associated with intense sweating, which can be caused by both an unfavorable microclimate in the room where the patient is (dry, hot air) and internal problems (inflammatory processes accompanied by an increase in body temperature, dysregulation of sweating, etc.).

Also, the cause of increased humidity, leading to bedsores, can be urinary and fecal incontinence, especially if the rules of patient care are not followed. Constant wetting of the skin leads to its saturation with moisture and swelling (in medicine the term “maceration” is used), the bonds between the cells of first the superficial and then deeper layers are broken.

Increased humidity increases the friction of the skin on the surface, increases the “adhesion” of the skin to them, which increases the likelihood of microtraumas. Gradually, the skin wears out, cracks and abrasions appear on it, and it begins to peel off. With fecal and urinary incontinence, changes in the skin caused by moisture are accompanied by irritation caused by the acids contained in these physiological fluids.

External and internal risk factors for the development of pressure ulcers

When we talk about such a problem as bedsores, the causes of their occurrence can be associated not only with the direct impact on the skin of the forces of friction, pressure, tissue shear and humidity. An important role in their development is played by both the conditions in which the patient is located and the characteristics of his care (external factors), as well as the state of the body (immunity) and the presence of various diseases (internal factors).

For example, most high risk The occurrence of bedsores exists in patients with severe injuries of the spine and spinal cord - the probability of their development with improper care is up to 95% (M.A. Kurbanov, 1985). This is due to the fact that with such injuries, the nervous regulation of tissue nutrition, including the skin, is disrupted, and metabolic processes in the cells begin to suffer.

Therefore, bedsores that occur in patients with injuries nervous system, is called neurotrophic (“trophy” translated from Latin means “nutrition”). Also, according to various sources, the probability of sepsis (blood poisoning) in such patients ranges from 25 to 50%.

The Ministry of Health Protocol for the management of patients with pressure ulcers identifies the following risk factors for their development:

Microvibration resource deficiency as a factor in the development of bedsores

Bedsores - what causes them? In addition to the above-mentioned direct causes of their development, such as pressure, friction, tissue displacement and humidity, as well as risk factors that create conditions for their formation, the deficiency of the body tissue resource is of utmost importance. What it is? It is known that to maintain life we ​​constantly require resources such as air, food, water and heat. However, in order for each cell to perform its function efficiently (which is how health is maintained), it is necessary that a sufficient level of microvibration is constantly maintained in the body.

Microvibration is the result of contraction of millions of muscle cells in the body, which is observed even at rest and during sleep; the body spends a huge amount of energy to maintain it. Famous physicist V.A. Fedorov explains in the book that just as Brownian motion is a necessary condition for any chemical reactions, microvibration is needed to maintain biochemical processes in every cell. The molecules of organic compounds are too large to be affected by Brownian motion. At the same time, movement is necessary for the interaction of biological substances - this is one of the conditions of life. In this case, the role of Brownian motion in the human body is played by the energy of microvibration arising from the work of muscle cells.

A sufficient level of microvibration is necessary for the normal functioning of the blood vessels responsible for supplying each cell with nutrients and oxygen, that is, with a deficiency of microvibration, tissue nutrition is disrupted. In addition, the body’s ability to remove and process (recycle) damaged cells and harmful substances(slags, poisons).

Even in a relatively healthy person, cell death constantly occurs in the body - as a result of natural causes, and as a result of action. The more damaged cells in the body, the worse the immunity, the lower the ability of tissues to recover (regenerate). The lymphatic and circulatory systems are responsible for Bone marrow, spinal cord, liver, kidneys. The work of all these organs and systems is closely related to the level of microvibration. This means that the more pronounced its deficiency, the more damaged cells accumulate in the body, which negatively affects all its functions.

What determines the level of microvibration? First of all, from motor activity person. Walking, running, swimming, exercise - any movement saturates the body with the most valuable resource. However, today even many healthy people experience microvibration deficiency associated with lack of movement: sedentary work, hours spent in front of the TV or computer, car trips instead of walking - all this creates conditions for a lack of resources and creates the preconditions for the development of diseases.

If we consider from this position what bedsores are in a person forced to lead a sedentary lifestyle due to illness or injury, it becomes clear that in the development of this phenomenon, a decrease in the level of microvibration plays an important, almost key role! According to V.A. Fedorov, bedridden patients, patients with injuries (especially with plaster casts, severely limiting movement and putting pressure on tissues) experience a pronounced deficiency of this resource. Because such a patient does not have the opportunity to replenish it naturally, through movement.

In addition, over time, a person deprived of physical activity, there is a decrease in the mass of muscle tissue, which leads to a further decrease in the level of microvibration.

How does a deficiency of this resource lead to the development of pressure ulcers? First of all, blood vessels are affected, which disrupts the nutrition of tissues, including skin cells and muscle fibers, and their ability to regenerate worsens. Also, a decrease in the level of microvibration affects the work lymphatic system and other organs responsible for the disposal of damaged cells. The situation is aggravated by the fact that in bedridden patients, skin and soft tissue cells die not only due to natural reasons (the physiological process of tissue renewal, the completion of normal life cycle each cell), but also under the influence of the factors that we talked about above: pressure, friction, etc.

Thus, in such a situation, the lymphatic system is under increased load, while it suffers from a microvibration deficiency and cannot cope with the increased volume of work. All this leads to the rapid accumulation of damaged cells and increases the risk of developing bedsores. As V.A. points out. Fedorov, while healthy cells are a stronghold for the body’s immune system, damaged cells are an excellent breeding ground for microbes. This is why patients with bedsores so often develop acute purulent diseases of the soft tissues, which can lead to blood poisoning and death of the patient.

Also, microvibration deficiency is one of the reasons increased risk development of bedsores in older people. V.A. Fedorov explains that over the years, most people’s ability to fully restore internal resources, including maintaining a sufficient level of microvibration, decreases. Therefore, any damaging factors cause much greater harm to health than at a young age. When such a person becomes confined to a bed or a wheelchair (and the risk of injuries and diseases that threaten such an outcome also increases with age), the likelihood of bedsores, as well as complications associated with infection of soft tissue in the area of ​​injury, increases many times over.

Thus, considering such a problem as bedsores, we see that this phenomenon is associated not only with the influence of external factors and various diseases of the patient, but also with a decrease in the microvibration background in the body of a person forced to lead a sedentary lifestyle. This means that one of the most important tasks in the prevention and treatment of bedsores is to increase the level of microvibration. But how can this be done if a person is deprived of the ability to actively move? The solution in this situation is vibroacoustic therapy. We will talk about how it can help in a situation with bedsores below.

Such a phenomenon as bedsores adversely affects the general condition of the patient. Symptoms of the underlying disease, which has led to limited mobility of a person, include: painful sensations from ulcers that have arisen on the body, which further limits the patient’s mobility. This, in turn, can lead to the development of lesions in new areas of the body.

What are the dangers of bedsores in bedridden patients? First of all, by the addition of an infection. Immunity weakened by disease sharp decline the level of microvibration, the accumulation of damaged cells - all this creates favorable conditions for the development of inflammatory processes in the skin and soft tissues caused by various pathogens.

Often, patients and their relatives have a question: is it possible to die from bedsores? It is necessary to understand that the threat to life is not so much the ulcers themselves, which arise due to a sedentary lifestyle, but the complications that lead to infection of the affected area. What diseases can occur as a result of infection? Here are just a few of them:

• Cellulitis is a purulent inflammation of the subcutaneous fatty tissue, which tends to quickly spread to surrounding tissues.
• Osteomyelitis is the involvement of bone tissue in the inflammatory process. Often there is damage to the bones of the back of the head, heel bones, and the head of the femur, which can lead to its destruction and disability of the patient.
• Purulent arthritis – inflammation of joints and ligaments.
• Purulent melting of the vascular wall: when the vascular wall is involved in the inflammatory process, on the one hand, bleeding may occur (especially dangerous when large vessels, such as the femoral arteries, are affected), and, on the other hand, through the resulting defect, the infection can penetrate into the bloodstream and spread throughout the body at lightning speed.
• Sepsis (blood poisoning) is the most dangerous complication of bedsores. The bacteria that cause inflammation spread throughout the body, affecting vital important organs: heart, brain, kidneys, etc. According to various sources, the mortality rate from blood poisoning ranges from 50 to 70%.

Thus, answering the question of how long a person with bedsores can live, doctors explain that the prognosis depends both on the severity of the underlying disease and on the severity of infectious complications of this phenomenon. Diseases of the brain and spinal cord, severe vascular disorders, old age - all these are factors that increase the risk of infection and rapid spread of infection throughout the body. At the same time, the probability of death of the patient increases.

Also the answer to the question “how many people live with bedsores?” depends on how quickly measures were taken for their timely treatment. If a skin and soft tissue defect is detected at an early stage and proper treatment is carried out, the risk of serious complications and death is minimized. When it comes to patients with severe lesions, comprehensive support for the body is important, aimed at improving blood supply to tissues, etc. Express resource support in such a situation can be provided by vibroacoustic therapy.

If severe defects with already developed infectious complications are detected, it is very important to start treatment with antibiotics and perform surgical treatment in a timely manner - this will reduce the likelihood of damage to surrounding tissues and the development of sepsis.

Symptoms and signs

With a problem such as bedsores, the description of the signs and symptoms of their occurrence depends on the stage of the process:

The initial stage doctors call stage of circulatory disorders(M.D. Dibirov, “ Bedsores: prevention and treatment", 2013), that is, changes associated with impaired blood circulation in tissues subjected to compression. In order to understand how bedsores begin, you can look at the photo: first, redness appears, which does not disappear after the pressure stops, then the skin turns pale and acquires a bluish tint, which indicates a progressive disruption of the blood supply to the tissues.

If measures are not taken to stop the pressure, the skin becomes cold to the touch and swollen.

Bubbles appear, indicating a detachment of the upper layer of skin (epidermis). The patient himself may notice increased sensitivity of the skin in the affected area, mild soreness, or, on the contrary, a feeling of numbness, which is associated with pinching of the nerve endings.

In the absence of adequate measures to prevent further development of the process, stage of necrotic changes and suppuration, massive death of skin cells and underlying tissues, infection. The first signs of the transition of bedsores to this stage can be seen in photographs: if external factors (pressure, friction) play a leading role in the development of damage, external (exogenous) or dry necrosis more often develops, in which the tissues dry out and “mummify.” In this situation, the damage to the skin and underlying tissues has clear boundaries, the wound is dry, and, as a rule, shallow. The general condition of the patient with such lesions most often does not suffer.

If the leading role belongs to internal factors (primarily we are talking about lesions of the nervous system: injuries to the brain and spinal cord, strokes, brain tumors), leading to disruption of tissue nutrition, endogenous (internal) necrosis develops. In this case, mass death of soft tissue cells occurs - muscles, subcutaneous fat, and infection quickly develops. Doctors say that in this situation, the bedsore develops according to the type wet gangrene with progressive necrosis of surrounding tissues. This means that the damage (ulcer) that occurs at the site of the bedsore can quickly increase in size, affecting more and more new areas.

When such bedsores occur, symptoms such as the release of foul-smelling fluid, pus from the wound, and swelling of the surrounding tissues are observed. The ulcer is deep and tendons and bones may be visible.

Due to the addition of infection, the patient’s general condition suffers: there may be an increase in temperature to 39-40 ° C, chills, disturbances of consciousness, delirium, palpitations, decreased blood pressure, and enlarged liver.

According to Professor M.D. Dibirov (Department of Surgical Diseases and Clinical Angiology of the A.I. Evdokimov Moscow State Medical University) the rate of development of necrotic changes (death of skin cells and underlying tissues) and the time of appearance of associated symptoms and the occurrence of complications depends on the cause of the development of bedsores.

With predominant external causes and a fairly favorable general condition of the patient, necrotic changes develop more slowly - several days, a week. If we are talking about patients with lesions of the brain or spinal cord, cell death can begin within 20-24 hours after the first signs of a bedsore appear, with rapid progression infectious lesions soft tissues.

Diagnosis of bedsores

In most cases, to diagnose bedsores, especially in the early stages, it is enough to examine the lesion site. Congestion in characteristic areas of the body exposed to pressure in patients with limited mobility, desquamation of the upper layers of the skin, detection of an ulcerative defect: most often, the data obtained during the examination is sufficient to establish a diagnosis and determine the stage of the process. However, in some cases, when it comes to deep lesions, it may be necessary to perform an ultrasound of soft tissues.

What is soft tissue ultrasound? This is an ultrasound examination that allows you to obtain information about the condition of deep-lying tissues, the extent of damage to which cannot be assessed during a routine examination: subcutaneous fatty tissue, muscles, tendons, ligaments, joints. This study is especially relevant when it comes to purulent complications of bedsores. And also with the development of lesions in patients with injuries to the nervous system, when changes on the surface of the skin may be minimal, and the main changes are hidden in the deeper layers.

In addition, to assess the condition of a patient with bedsores, especially when infectious complications are associated, a laboratory examination may be prescribed (a general blood test to identify the severity of the bacterial process, biochemical analysis blood, general urine analysis, etc.), as well as other examinations aimed at identifying the involvement of other organs in the inflammatory process.

Which doctor should I contact for bedsores? Surgeons treat severe lesions: after examining and examining the patient, they decide on the need surgical intervention, determine the tactics of patient management. If bedsores occur in a patient undergoing treatment at home, it is necessary to call the attending physician (therapist), who will decide whether to send the patient to the surgical department of the hospital, or (in the initial stages of the process) will give recommendations for caring for the patient.

Prevention of pressure ulcers is a complex process that should include:

1. Competent patient care with mobility restrictions.
2. Informing relatives caring for the patient about how to identify lesions in initial stage and what measures need to be taken.
3. Required organization of proper nutrition, allowing the patient’s body to be provided with all the necessary components for the full functioning of each cell.
4. Competent treatment underlying disease, prescribing drugs that improve blood supply to tissues, etc. You can read more about this in the articles “ Prevention of bedsores" And " An effective remedy from bedsores at home».

One of the most effective methods prevention and treatment of bedsores is vibroacoustic therapy or . Application allows you to saturate the body with the healing resource of microvibration. This will have a beneficial effect on the condition of blood vessels and will lead to improved nutrition of skin cells and muscles in the area of ​​the bedsore.

Vibroacoustic therapy is a powerful support for the lymphatic system and other organs responsible for, which is one of the most pressing tasks in treatment And prevention of bedsores. Getting rid of the ballast of damaged cells, achieved through the use of, has a beneficial effect on work and helps prevent infectious complications.

A vibroacoustic mattress included in the composition was developed especially for patients forced to lead a sedentary lifestyle. It includes 8 vibraphones at once, allowing you to completely cover the area of ​​bedsores and nearby tissues with vibroacoustic effects. The automatic mode of operation of the device does not require human intervention for a long time (up to 14 hours), while the vibraphones are turned on and off according to a given program (for 3 minutes every 24 minutes), providing continuous and dosed exposure.

As a result:

• the functioning of the nervous system improves (which is especially important for the prevention of bedsores in patients with injuries to the brain and spinal cord);
• the problem area is saturated with blood, oxygen and nutrients;
• , which is important for preventing the development of infectious complications;
• restoration (regenerative) processes improve in all tissues and organs, including skin and muscles.

In essence, the application vibroacoustic therapy- This the only way to form a sufficient level of microvibration background in patients who are unable to independently replenish this resource with the help of movement. Activation of metabolic processes, improvement of blood supply to tissues, creation favorable conditions for skin and muscle regeneration - all this effective methods prevention And treatment of bedsores which are achieved through the use of vibroacoustic therapy.

Bibliography:

1. Baskov A.V. Surgical treatment of bedsores in patients with spinal cord injury / Issues of neurosurgery. – 2000 – No. 1
2. Dibirov M.D. Bedsores. Prevention and treatment / Medical Council, No. 5-6, 2013.
3. Vorobiev A.A. Treatment of bedsores in spinal patients / Bulletin of the Volgograd Scientific Center of the Russian Academy of Medical Sciences. – 2007 – No. 2.
4. Klimiashvili A.D. Prevention and treatment of bedsores / Russian Medical Journal. – 2004 – T. 12, No. 12.
5. / “Doctor” No. 7 / 2014
6. Musalatov H.A. Treatment of bedsores in patients with spinal cord injuries / Medical care. – 2002 – No. 3.
7. Patient management protocol. Bedsores. / Appendix to the order of the Russian Ministry of Health dated April 17, 2002. No. 123.
8. Fedorov V.A., Kovelenov A.Yu., Loginov G.N. and others / St. Petersburg: SpetsLit, 2012.

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