A Holistic Approach to Manage Pressure Ulcers

以全人醫療的方式治療褥瘡

邱文寬(Wen-Kuan Chiu) ； 陳杰峰(Chieh-feng Chen) ； 李存昌(Chun-Chang Li) ； 黃俊源(Chun-Yuan Huang) ； 張瓊文(Chiung-Wen Chang) ； 王先震(Hsian-Jenn Wang)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 176-183

摘要

Background: A pressure ulcer is a difficult problem for reconstruction. Many medical problems must be dealt with first. A holistic approach can be used for these problematic conditions. We introduce our experience with the holistic approach for treatment of pressure ulcers. Methods: From July 2014 to October 2016, 42 patients with pressure ulcers underwent treatment with a holistic approach, including teamwork provided by medical and other specialists. We recorded the patient characteristics, methods of surgery and anesthesia, and complications. We also collected data on previous pressure ulcer patients for comparison of treatment effectiveness. Results: Dementia was the only comorbidity that was statistically significant (P = 0.04). However, high odds ratios (ORs) were noted with some comorbidities, such as end-stage renal disease (OR, 16.2), and parkinsonism (OR, 3.10). General anesthesia showed a high OR (12.39) in the holistic group. Regarding the method of surgery, a high OR (13.64) was noted for skin grafting in the control group. All procedures performed in the holistic group consisted of flap surgery. The holistic group had a much greater number of systemic complications, with a high OR (10.48). Conclusions: With the holistic approach, complicated problems may be treated more easily. Management of pressure ulcers is more difficult if there is no good management of underlying medical conditions. We concluded that the holistic approach should be helpful in patients with pressure ulcers.

關鍵字

holistic approach ； pressure ulcer ； teamwork

並列摘要

背景：壓瘡是重建手術的難題，因為在處理傷口之前，必須先處理好相關的內科問題。目的與目標：在處理這種複雜的狀況時，全人醫療就相形重要。本文介紹全人醫療處理褥瘡傷口的經驗。材料與方法：從2014年7月到2016年10月，總共有42位壓瘡病患接受了全人照護，包含了醫療團隊提供內科處治，並且結合其他相關的專科共同診療。我們分析了病人的特徵，手術的方法，麻醉的方式和併發症。同時我們也收集了之前褥瘡的病患資料，來當作治療效果的比較。結果：失智症是唯一具統計顯著意義的共病症(P = 0.04)。然而，其他的共病症也顯示出較高的勝算比，例如末期腎臟病(OR, 16.2)，巴金森氏症(OR, 3.10)。在全人醫療組，也顯示出有較高的全身麻醉比率(OR, 12.39)。在手術方法方面，對照組有較高的植皮手術比例(OR, 13.64)。相對的，在全人照護組，則全部都是以皮瓣手術來重建。整體而言，全人照護組有較多的併發症。結論：全人照護的方法可以較輕鬆的處理複雜的臨床問題。如果沒有先妥當處理背後的內科疾病，會讓褥瘡的治療變得困難。我們認為全人照護應該有助於褥瘡病患的治療。