W praktyce klinicznej wyróżnia się grupy pacjentów, którzy ze względu na szczególne uwarunkowania zdrowotne są bardziej narażeni na występowanie odleżyn niż pozostali pacjenci. Opieka terapeutyczna nad pacjentami z tych grup musi się opierać na świadomości dodatkowych czynników ryzyka i metod prewencji.
Do ogólnych czynników ryzyka rozwoju odleżyn zalicza się ograniczoną mobilność ruchową, zaburzenia neuropatyczne, zaburzenia związane z wagą (zarówno niedożywienie, jak i nadwaga oraz otyłość), a także schorzenia wpływające na upośledzenie krążenia. W pewnych grupach pacjentów wymienione czynniki ryzyka są bardziej nasilone lub występują dodatkowe okoliczności zwiększające ryzyko rozwoju odleżyn.
Do grup tych należą m.in. pacjenci z urazami rdzenia kręgowego, a także pacjenci po amputacjach oraz pacjenci pediatryczni i w podeszłym wieku.
W przypadku tych pacjentów szczególnie istotne jest prowadzenie profilaktyki odleżyn.
Pacjenci z urazami rdzenia kręgowego ze względu na korzystanie z wózka inwalidzkiego są narażeni na powstawanie ran i odleżyn w obrębie pośladków. Z tego powodu w zakresie prewencji odleżyn potrzebują wyposażenia w specjalistyczny sprzęt. Konieczne jest stosowanie poduszek przeciwodleżynowych lub siedzisk (piankowych, żelowych, pneumatycznych), które równomiernie rozkładają ciężar ciała na całą powierzchnię pośladków i ud, a dodatkowo zapewniają stabilizację i wyrównują postawę. Poduszki powinny także zapewniać odpowiednią wentylację.
W przypadku pacjentów po amputacjach istnieje znaczne ryzyko rozwoju odleżyny w miejscu, gdzie kikut po amputowanej kończynie stale styka się z protezą. Przyczyną takiego stanu rzeczy jest zwiększona wilgotność w tym obszarze, znaczny nacisk i tarcie występujące podczas chodzenia. Z tego powodu bardzo istotne jest odpowiednie dobranie leja protezowego (część protezy, która bezpośrednio przylega do kikuta). Powinien on równomiernie rozkładać ciśnienie i niwelować drgania protezy w czasie chodzenia. Pozwala to na zachowanie dobrego ukrwienia w obrębie kikuta oraz zapobieganie uszkodzeniom skóry, w tym także odleżynom.
Istotna jest także pielęgnacja kikuta. Musi on być zawsze czysty i suchy. Zalecane jest stosowanie maści nawilżających z witaminami A i D.
Wśród pacjentów pediatrycznych szczególnie narażoną na powstawanie odleżyn grupą są wcześniaki. Skóra u niemowląt urodzonych przedwcześnie jest niedojrzała, delikatniejsza, bardziej podatna na uszkodzenia. Wcześniaki leczone w inkubatorach są narażone na powstawanie odleżyn w jeszcze większym stopniu. Z tego powodu istotne jest regularne zmienianie pozycji dziecka oraz regularne kontrolowanie stanu skóry w celu wykrycia ewentualnych uszkodzeń.
U pacjentów w podeszłym wieku skóra stopniowo traci elastynę i kolagen, staje się mniej elastyczna i delikatna, a przez to bardziej podatna na uszkodzenia. Zmniejsza się także stopień uwodnienia skóry oraz jej ukrwienia. Ponadto pacjenci w tej grupie wiekowej często mają ograniczoną mobilność ruchową bądź cierpią na schorzenia neurodegeneracyjne wpływające na upośledzenie funkcji motorycznych, kognitywnych i sensorycznych. Schorzenia te mogą także wpływać na nietrzymanie moczu, co dodatkowo zwiększa ryzyko uszkodzeń skóry na skutek maceracji i odparzeń.
W przypadku pacjentów w podeszłym wieku konieczne jest regularne kontrolowanie stanu skóry pod kątem występowania uszkodzeń mogących rozwinąć się w odleżyny. Istotna jest higiena (prowadzona za pomocą delikatnych środków myjących, bogata w preparaty nawilżające i natłuszczające). W przypadku pacjentów leżących należy zadbać o regularne zmienianie pozycji. Jeżeli pacjent zachowuje przynajmniej częściową mobilność, zalecane jest asystowanie mu w poruszaniu się i ćwiczeniach.
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