- 期刊
半邊偏癱中風病人於股骨大轉子及薦椎骨在不同擺位之壓力分布
The Pressure Distribution of Hemiplegics at the Femoral Greater Trochanter and Sacrum in Different Bed Positions
摘要
半邊偏癱之中風患者常因臥床太久而導致壓瘡，尤其好發在薦椎骨、股骨大轉子、外側足踝和跟骨處。一旦產生壓瘡，對醫護人員、照顧者及病人本身都是額外的負擔，亦花費更多醫療費用。同時病人心情上也較容易沮喪，進而影響復健的意願及成效，所以有效預防壓瘡的發生對中風病人格外重要。 造成壓瘡最重要的因素是床墊對皮膚產生之壓力。當軟組織血管外壓力超過血管內壓力時，血管閉鎖造成組織缺氧壞死。為了探討早期中風半邊偏癱病人股骨大轉子和薦椎骨部位於不同體位下在床墊上所承受壓力的大小，我們讓中風病人及正常人之對照組在平躺、仰躺30、60、80 度及側躺下進行壓力分析測試。結果發現半邊偏癱病人薦椎骨處所受壓力隨仰躺角度上升而增加；側躺時患側股骨大轉子所受的壓力較健側為大。應用於臨床上，當半邊偏癱病人仰躺角度大於30度或患側側躺時，應經常檢查股骨大轉子和薦椎骨部位皮膚完整性，以降低壓瘡發生的機率。
並列摘要
Pressure ulcers frequently develop in hemiplegic stroke patients who are immobilized and bedridden. Common sites for pressure ulcers include the sacrum, greater trochanter of the femur, lateral malleolus, and the heel. Such ulcers cause extra burdens for the whole medical team, the caregiver, and the patients themself. The ulcers also increase more medical cost at the same time. Patients with pressure ulcers also become depressed and less motivated to undergo rehabilitation. The prevention of pressure ulcer formation has thus become an important issue among stroke patients. The most important factor in pressure ulcer formation is the direct pressure of the mattress on the skin. When the external pressure exceeds the capillary closing pressure, the tissue becomes ischemic and necrotic. Our study was designed to determine the external pressure applied to the skin of hemiplegic stroke patients at the greater trochanter of the femur and sacrum in different bed positions. The patient and control groups were positioned flat, semirecumbent (30, 60, and 80 degrees respectively), and bilateral side-lying. The pressure distributions were recorded and analyzed. The results revealed that, in the supine and semirecumbent positions, the pressure applied to the sacrum increased while the upright angle increased in hemiplegic patients. In the side-lying position, the pressure at the greater trochanter on the hemiplegic side was significantly higher than that on the unaffected side. These findings indicate that when hemiplegic stroke patients are in a semirecumbent position with an angle of more than 30 degrees or side-lying on the affected side, we should check the skin condition of the femoral greater trochanter and sacrum frequently to lower the incidence of pressureulcer.