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Jakie są wskazania i przeciwwskazania do stosowania terapii podciśnieniowej w leczeniu ran?

Marta2 411 komentarzy
Ten tekst przeczytasz w 2 min.

Terapia podciśnieniowa (ang. negative pressure wound therapy, NPWT) to skuteczne narzędzie w leczeniu ran trudno gojących się o zróżnicowanej etiologii, zalecane zwłaszcza w przypadku odleżyn oraz powikłanych ran pooperacyjnych. Jakie efekty daje terapia NPWT, jak prawidłowo ją stosować i w jakich przypadkach jest przeciwwskazana?

Terapia podciśnieniowa ma pozytywny wpływ na gojenie ran. Zastosowanie podciśnienia pozwala oczyścić łożysko rany z nadmiaru wysięku i drobnoustrojów, a jednocześnie zapewnia optymalne warunki do regeneracji tkanek. Ponadto terapia NPWT poprawia mikrokrążenie i stymuluje tworzenie nowych naczyń włosowatych. Dzięki tym właściwościom skutecznie przyspiesza gojenie ran.

Prawidłowe stosowanie terapii NPWT

W łożysku rany, na którą będzie zakładany opatrunek podciśnieniowy, nie może występować krwawienie, ponieważ może to doprowadzić do wytworzenia skrzepu pomiędzy gąbką i tkanką, a w konsekwencji do zmniejszenia siły ssania, co znacznie obniży skuteczność terapii. Z rany zostanie odessana mniejsza ilość wydzieliny, a opatrunek ulegnie zmięknięciu.

Podczas stosowania terapii NPWT należy monitorować u pacjenta stan układu krzepnięcia oraz hemostazy (płytki krwi, osoczowe czynniki krzepnięcia, obecność niedokrwistości) ze względu na ryzyko niedokrwienia mięśnia sercowego.

Optymalne ciśnienie stosowane w terapii NPWT mieści się w przedziale 80-125 mmHg.

Wskazania do terapii NPWT

Terapię podciśnieniową stosuje się w przypadku wystąpienia w łożysku rany krytycznej kolonizacji tkanek oraz stanu zapalnego. Ten rodzaj terapii jest szczególnie zalecany w leczeniu ran silnie sączących i wykazujących zahamowanie procesów gojenia.

Terapia NPWT jest również stosowana w chirurgii transplantacyjnej do oczyszczania tkanek w przygotowaniu do przeszczepu, w miejscach pobrania przeszczepów skórnych oraz do ochrony przeszczepów siatkowych skóry.

Przeciwwskazania do terapii NPWT

Terapii podciśnieniowej nie powinno się stosować na rany, w których występuje tkanka martwicza oraz u pacjentów ze stwierdzonymi zaburzeniami krzepnięcia. Stosowanie terapii NPWT jest również ograniczone w onkologii. Ta metoda leczenia nie jest zalecana u chorych z kacheksją (zespół wyniszczenia nowotworowego) oraz w przypadku występowania nowotworu w łożysku rany.

Przeciwwskazania względne do terapii NPWT obejmują ponadto niedokrwienie i nieleczone zapalenie kości. Leczenia tą metodą nie powinno się stosować na niejelitowe i niezbadane przetoki, na otwarte jamy stawów i wyeksponowane naczynia krwionośne, na zespolenia naczyń i narządy miąższowe oraz w okolicach nerwów.

Źródło:

M. Kucharzewski, E. Szkiler, „Niegojące się rany chirurgiczne. Rozejście się rany chirurgicznej i zakażenie miejsca operowanego”, „Forum Leczenia Ran” 2020, 1(4): 143-151.

Przeczytaj także: Zalecenia dotyczące terapii NPWT w trakcie epidemii COVID-19

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Leczenia Ran”:

Kombinowana terapia miejscowa leczenia ran. Opis przypadku 43-letniego pacjenta z przewlekłą raną grzbietu

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