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【論文摘要】高齡者皮膚撕裂傷清潔與照護
【論文摘要】Cleaning and care of skin tears in the elderly
摘要
研究背景：皮膚為人體最大的器官，也是保護身體不受外來物質侵擾的第一道屏障，隨著年齡增長，新陳代謝變慢、膠原蛋白流失、汗腺萎縮及體液減少，易導致皮膚乾燥、變薄，進而失去彈性，使得高齡者皮膚受到外力輕微碰撞拉扯，就有可能造成撕裂傷。一旦皮膚受損，除影響生活品質、增加醫療照護成本外，由於高齡者免疫能力下降，細菌易從傷口入侵，可能因感染而引發蜂窩性組織炎，嚴重甚至演變成敗血症。救護技術員是院前傷口處置照護的第一線，為傷口評估與處置的執行者，透過正確的撕裂傷口辨識分級及適當的清潔與照護，達到降低感染及節省醫療成本之效益，本研究將針對高齡者常見的皮膚撕裂傷分級說明，以提供院前救護技術員執行高齡者撕裂傷清潔與照護之依據。研究方法（或案例描述）：本研究採用Payne-Martin撕裂傷分級法，將皮膚撕裂傷分為第一類型：皮膚撕裂呈現線性狀或皮瓣狀。第二類型：部分組織缺損，又分為兩種型態，分別為少量組織喪失即表皮皮瓣喪失小於或等於25%；若缺損大於25%，為中、大量組織喪失。第三類型：表皮皮瓣完全喪失。藉以區分高齡者皮膚撕裂傷之分類，並依各級提出對應之清潔、照護方式。研究結果（或案例討論）：皮膚撕裂傷依傷口外觀及組織受損程度不同，清潔與照護方式亦有所不同。包紮前除使用無菌生理食鹽水清洗傷口外，依其類型決定是否保留皮瓣及周圍組織，敷料選擇上，與傳統敷料相比，使用含銀離子敷料具有殺菌作用、吸收滲液及不易沾黏傷口等優點，可減少換藥次數，降低高齡者換藥時的不適，最後避免在脆弱皮膚上使用膠帶，傷口若在四肢可使用網繃固定，以有效的減少醫療及時間成本，增加傷患舒適度。
並列摘要
Background: The skin, the largest organ of the human body, serves as the primary defense against external agents. As individuals age, the body undergoes a deceleration in metabolism, loss of collagen proteins, atrophy of sweat glands, and reduction in bodily fluids, all of which contribute to skin dryness and thinning, ultimately resulting in diminished elasticity. Consequently, Elderly individuals' skin is susceptible to tearing upon minor external contact or stretching. Once the skin is compromised, it not only affects the quality of life and increases healthcare costs, but also due to the decreased immune function in elderly individuals, bacteria can easily invade through the wound, leading to infection and triggering cellulitis. In severe cases, it may even progress to sepsis. Prehospital paramedics are the frontline caregivers for prehospital wound care, responsible for wound assessment and management. Through accurate identification and classification of torn wounds, along with appropriate cleansing and care, the potential for infection risks can be effectively reduced, resulting in potential cost savings within the healthcare system. This research will focus on providing classification guidelines for common skin tears injuries in the elderly, offering prehospital paramedics a basis for performing wound cleansing and care for elderly individuals. Methods (Or case presentation): This study adopts the Payne-Martin classification method for skin tears, categorizing them into three types. Type I represents linear or flap-like skin tears. Type II encompasses partial tissue loss, further categorized into two subtypes: minor tissue loss, where epidermal flap loss is less than or equal to 25%; and extensive tissue loss, with loss exceeding 25%, denoting moderate to substantial tissue loss. Type III signifies complete loss of epidermal flaps. This classification serves to distinguish skin tears in the elderly and provides corresponding protocols for cleansing and care according to each level of severity. Results (Or Case Discussion): Depending on the appearance and degree of tissue damage in skin tears, the methods for cleaning and care also differ. Prior to dressing, in addition to using sterile physiological saline to cleanse the wound, the decision to retain flaps and surrounding tissue is determined by the type of wound. In terms of dressing selection, utilizing dressings containing silver ions offers advantages such as antimicrobial action, fluid absorption, and reduced adherence to the wound. This can reduce the frequency of dressing changes, alleviate discomfort during dressing changes for elderly patients, and ultimately avoid the use of tape on fragile skin. If the wound is located on the limbs, a mesh fixation method can be applied to effectively reduce medical and time costs and enhance patient comfort.