Objective To quantitatively evaluate the effect of 2 types of pressures induced injury by using threedimensional (3D) reconstruction of rats loaded tibial is anterior muscle from two-dimensional (2D) image of serial histological sections. Methods Twenty female or male Sprague Dawley rats, aged 10-12 weeks and weighing 280-300 g, were randomlydivided into experimental group (n=10) and control group (n=10). The random side of tibial is anterior muscle was givenintermittent gradient (8.0-21.3 kPa) and sustained (13.3 kPa) pressure in 0.12 cm2 area in experimental group and controlgroup, respectively; the experiment was terminated and the general condition of rats was observed after 3 cycles, and a single cycle included 2 hours of compression and 30 minutes of release. The general observations of pressed skin and tibial is anterior muscle were done after 24 hours of pressure rel ief, and the tibial is anterior muscle was harvested integrally from the loaded side, then made into interval 4 μm serial sections. After HE staining, 2D images were obtained. Necrosis and injury areas were distinguished by Image Pro Plus (IPP) 6.0 software and image registration was conducted by Photoshop 8.0.1 after 2D panorama images acquired by digital microscope (× 40) and IPP mosaic software. 3D reconstruction was establ ished via data processing using Mimics 10.1 software so as to get the volume, the surface area, and 3D images of the whole piece of tibial is anterior muscle and injury areas respectively. Results All rats of 2 groups survived till experiment terminated and no skin ulcers occurred after 24 hours. Edema and indentation were observed on press side skin and tibial is anterior muscles of 2 groups, fadeless maroon area was observed in control group. A total of 994 sl ices were obtained from 20 samples of tibial is anterior muscles. 3D images suggested that injury of control group was severe, which penetrated the whole piece of tibial is anterior muscle and expandedalong the tibia bony prominence. By contrast, injury of experimental group was less, but had similar width to the contact surface of indentor. There was no significant difference in the volume and the surface area of tibial is anterior muscle between 2 groups (P gt; 0.05), while the injury volume and the injury surface area were significantly smaller in experimental group than in control group (P lt; 0.05). Conclusion 3D reconstruction is an effective method to quantitatively evaluate pathological changes inside the integrity tissue and can provide the visual basis for the mechanical property distributed in the loaded muscle. Intermittent gradient pressure can reduce deep tissue injury.
Objective To compare the effect of two types of intermittent pressure on formation of pressure ulcer in rabbit hind l imbs and to investigate the mechanism of gradually changed intermittent pressure produced by waves bed in the prevention of pressure ulcer. Methods Gracil is (3 cm2) in both hind l imbs of 12 adult Japanese white rabbits were randomlyloaded with gradually changed intermittent pressure (50-160 mm Hg, 1 mm Hg=0.133 kPa) and sustained pressure (100 mmHg) serving as the experimental group and the control group, respectively. The experiment was terminated after 4 cycles, and a single cycle included 2 hours of compression and 30 minutes of compression-release. Blood velocity of hind l imbs and blood perfusion of wound were detected by bidirectional doppler blood flow detector and laser doppler perfusion imaging detection system before compression and at every 10 minutes in compression-release period of each cycle (0, 10, 20 and 30 minutes). After the termination, gross observation of the wound was conducted, pathomorphological changes of tissues from compressed area were observed by HE staining, and contents of NO, malondialdehyde (MDA), and superoxide dismutase (SOD) in muscle tissue were measured using colorimetry method. Results No significant difference was evident between two groups in terms of blood flow velocity before compression (P gt; 0.05); the blood flow velocity of two groups decreased significantly at 0 minute in every compressionrelease period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the blood flow velocity of theexperimental group was higher than that of the control group at 10, 20 and 30 minutes (P lt; 0.05). No significant difference was noted between two groups in terms of wound blood perfusion before compression (P gt; 0.05); the wound blood perfusion of two groups decreased significantly at 0 minute in every compression-release period of each cycle, and no significant differences were noted between two groups (P gt; 0.05); the difference between two groups was not significant at 10 minutes in the first cycle (P gt; 0.05), and the experimental group was higher than the control group at 20 and 30 minutes in the first cycle (P lt; 0.05). In the following 3 cycles, the recovery of perfusion in the experimental group was faster than that of the control group (P lt; 0.05). Gross observation showed the experimental group had less effusion than the control group. The experimental group had intact cutaneous appendage, less inflammatory cell infiltration, and no obvious ulcer formation, whereas the control group had obvious skin ulcer, depletion of cutaneous appendage, and more inflammatory cells infiltration. Significant differences were noted between two groups in terms of NO, MDA, and SOD content (P lt; 0.05). Conclusion Gradually changed intermittent pressure can maintain the blood perfusion of tissue, reduce ischemia-reperfusion injury and cell apoptosis, and prevent the formation of pressure ulcer.
ObjectiveTo explore the effect of level management model in the application of nursing for pressure ulcers after spinal surgery. MethodA total of 3 558 patients underwent spinal surgeries between January 2014 and September 2015 were selected. We established a level management model, confirmed the personnel responsibilities, strengthened the pressure ulcers risk assessment of new inpatients, and standardized the processes of reporting pressure sores. We carried out the level management model between January and June 2014, summarized experience and formed a system file between July and December 2014, applied to the clinical work after continuous improvement between January and September 2015. High risk of pressure ulcers reporting rate, incidence of high-risk pressure ulcers, and healing rate of pressure ulcers were compared at the various stages. ResultsThe reporting rate of pressure ulcers raised, the incidence of pressure ulcers increased and the curing rate decreased after continuous improvement (P<0.05). ConclusionsLevel management model may effectively improve the quality of the nursing for spinal pressure ulcers.
Objective To formulate an evidence-based adjuvant therapeutic plan for a patient with large area pressure ulcers. Methods Based on an adequate assessment of the patient’s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2008), DARE (Issue 3, 2008), CCRT (Issue 1, 2008), MEDLINE (1980~ March 2008) and Chinese Journal Full-text Database CNKI (1979~2008) for the best available clinical evidence on adjuvant therapy of large area pressure ulcers with infrared rays, nutrition support and some special overlays. Results Two systematic reviews and three randomized controlled trials were included. According to the current evidence, as well as the patient’s clinical condition and preference, a comprehensive therapeutic plan was given to the patient. And in the next three months with the therapeutic plan, the patient’s large area pressure ulcers had already recovered. Conclusion Evidence based approaches can help us develop the best comprehensive therapeutic plan for the patient and will help improve the therapeutic results for patients with large area pressure ulcers.
ObjectiveTo investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse.MethodsThe subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups (n=15). The wounds were injected with 100 μL of hADSCs (1×106 cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day.ResultsThe cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group (t=5.781, P=0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group (P<0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group (P<0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days (P<0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection.ConclusionLocal transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.
ObjectiveTo research on the types of pathogenic bacteria in wound infection and analyze the effectiveness of long-term use of nano-silver dressing in the treatment of pressure ulcers, in order to provide references for the management of pressure ulcer wound. MethodsFifty-five patients (60 wounds) with stage Ⅲ-Ⅳ pressure ulcer wound treated in all departments between September 2011 and August 2015 were chosen to be our study subjects. Under overall intervention, all the wounds were assessed by the same method, cleansed and debrided, after which nano-silver antimicrobial dressing was used to intervene until the wound healed or the end of 8 weeks. The wounds which were not healed were treated with wet dressing therapy until wound healing. The detection rate of pathogenic bacteria before intervention and 2, 4 and 8 weeks after intervention, change of pressure ulcer healing score and the rate of wound healing were observed. ResultsBefore the intervention, 12 kinds of pathogenic bacteria were detected, including mainly Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase negative Staphylococci. The detection rate of pathogenic bacteria was 92.73% (51/55). With the use of nano-silver dressing during different time periods, the detection rate of pathogenic bacteria and the total score of pressure ulcer were lowered by varying degrees (P<0.01). Four and 8 weeks after intervention, wound bed improved significantly and the detection rate of pathogenic bacteria decreased faster. The healing rate during the intervention period was 23.64% (13/55). ConclusionThe incidence of pressure ulcer wound infection is high. The use of nano-silver wound dressing can effectively remove pathogenic bacteria and promote wound healing.
Objective To systematically evaluate the effectiveness and safety of Resina Draconis for pressure ulcer. Methods Such databases as The Cochrane Library (Issue 4, 2013), PubMed, Elsevier SDOL, Web of Knowledge, CBM, CNKI, VIP and WanFang Data were searched from inception to May 2013 to collect randomized controlled trials (RCTs) about Resina Draconis for pressure ulcer. Two reviewers were assigned to independently screen the literature according to inclusion and exclusion criteria, extract data, and appraise the methodological quality. Then, meta-analysis was conducted using RevMan 5.2.4 software. Results A total of 14 RCTs were included, involving 610 patients. The results of meta-analysis showed that, Resina Draconis treatment were associated with a higher effective rate for pressure ulcer (RR=1.17, 95%CI 1.08 to 1.26, Plt;0.000 1). The results of descriptive analysis showed that, compared with the control group, Resina Draconis treatment shortened healing time. As for safety, adverse reactions had not been reported. Conclusion Resina Draconis can improve the effective rate for pressure ulcer and shorten the healing time, compared with other drug treatments. However, due to limited quality and quantity of the included studies, this conclusion needs to be proved by more high quality studies.
ObjectiveTo explore the best nursing interventions for advanced-age diabetes with pressure ulcer in Sichuan area. MethodsWe retrospectively analyzed the reasons for pressure ulcer and the nursing process for 37 patients with diabetes treated between March 2012 and March 2013 in our hospital. Then, we analyzed and summarized the susceptibility factors, wound nursing, nutritional support and blood sugar monitoring in all the patients. ResultsThrough intensive nursing, pressure ulcer in 36 patients were cured, and one patient died due to lung infection. ConclusionThe risk of pressure ulcer is high in advanced-age diabetes patients, and they need promising nursing. Individualized plan is necessary for them to improve their life-quality.
ObjectiveTo investigate the clinical effectiveness of high-glucose insulin mixture on the local treatment of patients with grade Ⅱ and Ⅲ pressure ulcers. MethodsA total of 124 patients with grade Ⅱ and Ⅲ pressure ulcers treated between January 2011 and June 2012 were randomly divided into three groups: saline group (group A, n=41), high-glucose insulin mixture group (group B, n=41) and modern dressing group (group C, n=42). We observed and compared the treatment effects among the three groups using both measurements of traditional evaluation criteria and pressure ulcer scale for healing (PUSH) after a week of dressing. ResultsThe overall treatment effects among the three groups were significantly different (χ2=30.453, P<0.001). The results of pairwise comparisons was that the treatment effect was significantly different between group B or C and group A (P<0.01), but the treatment effect was not statistically different between group B and C (P>0.05). Subgroup analysis for patients with grade Ⅱ or Ⅲ pressure ulcers also came to the similar results. ConclusionBoth high-glucose insulin mixture and modern dressing have significant effects on patients with grade Ⅱ and Ⅲ pressure ulcers. However, the high-glucose insulin mixture costs less and is worthy of extensive promotion.
ObjectiveTo enhance nurses'awareness of pressure ulcer management and reduce the incidence of pressure ulcers by using the risk early warning management idea. MethodsWe analyzed the data of patients with pressure ulcers and patients at high risk of pressure ulcers reported through nursing software between January 2009 and December 2011.Then,we timely and actively gave instructions and formulated corrective measures for the weak points in order to optimize pressure ulcer management process. ResultsNurses'awareness of prevention of pressure ulcers was improved,and the number of patients at high risk of pressure ulcers reported was increased year by year.From 2009 to 2011,the ratio of extremely high-risk and high-risk patients to all discharged patients was respectively 0.76%,1.01% and 0.76%;while from 2009 to 2011,the rate of in-hospital pressure ulcers hard to avoid was respectively 0.06%,0.06% and 0.02%. ConclusionBased on pressure ulcers wound team management,training nurses'early warning management idea,assigning corresponding responsibilities and management goals can help to standardize the management of pressure ulcers and raise the discipline level unceasingly.