Newsy Obok slidera Odleżyny Profilaktyka

Dlaczego chorzy na cukrzycę są szczególnie narażeni na powstawanie odleżyn?

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Rozwojowi odleżyn sprzyjają typowe dla cukrzycy schorzenia takie jak otyłość, zaburzenia krążenia i uszkodzenia układu nerwowego. W przypadku diabetyków wygojenie rany jest utrudnione i występuje wysokie ryzyko nawrotu odleżyn.

Owrzodzenia odleżynowe to przewlekłe, trudno gojące się rany. Odleżyny mogą doprowadzić do poważnych powikłań – zakażeń czy powstania ropnia. U pacjenta może dojść także do zapalenia szpiku i kości. Metody profilaktyki odleżyn zależą od uwarunkowań zdrowotnych pacjenta, w tym chorób, które przyczyniły się powstania rany. W przypadku cukrzycy wdrożenie działań profilaktycznych jest szczególnie istotne.

Jak powstają odleżyny?

Do odleżyn dochodzi w wyniku przewlekłego ucisku lub tarcia skóry. Długotrwały ucisk powoduje zaburzenia ukrwienia, które skutkują niedotlenieniem i niedożywieniem tkanek. W efekcie dochodzi do miejscowej martwicy niedokrwiennej skóry, której niekiedy towarzyszy też martwica tkanki podskórnej, mięśniowej i kostnej. Owrzodzenia odleżynowe najczęściej tworzą się tam, gdzie skóra pokrywa wyniosłości kostne – w okolicach pięty i kości krzyżowej, nad guzami kulszowymi, rzadziej na łokciach i kolanach.

Na powstanie odleżyn narażeni są zwłaszcza pacjenci o ograniczonej mobilności ruchowej, unieruchomieni, nieprzytomni czy obłożnie chorzy. Odleżyny to problem częsty u osób cierpiących na schorzenia o podłożu neurologicznym i urazy rdzenia kręgowego. Występowaniu odleżyn sprzyjają choroby skóry, zaburzenia odżywiania, w tym otyłość czy niedożywienie, zaburzenia metaboliczne oraz nietrzymanie moczu i stolca.

Wysokie ryzyko wystąpienia odleżyn u chorych na cukrzycę

W przebiegu cukrzycy może dojść do uszkodzeń ośrodkowego układu nerwowego, co powoduje zaburzenia w odczuwaniu bólu i temperatury. W związku z obniżoną wrażliwością na ból pacjent może nie zauważyć pierwszych objawów tworzącej się odleżyny – bólu i zwiększonej czułości skóry na dotyk. Często skutkuje to wykryciem odleżyny dopiero w jej zaawansowanym stadium. Uszkodzenia włókien nerwowych powodują również nadmierną suchość skóry, co zwiększa ryzyko utworzenia się rany.

Cukrzycy mogą towarzyszyć zaburzenia krążenia. U diabetyków istnieje wysokie ryzyko rozwoju miażdżycy tętnic dolnych. Miażdżycowe niedokrwienie kończyn dolnych prowadzi do zwężenia lub zamknięcia tętnic, które doprowadzają krew do tkanek. Niedostateczny przepływ krwi do kończyn dolnych jest czynnikiem sprzyjającym rozwojowi owrzodzeń odleżynowych.

Dla cukrzycy typowa jest także otyłość, której często towarzyszy nadmierne pocenie. Zwiększona wilgoć w fałdach skóry i tarcie pomiędzy nimi prowadzą do przerwania ciągłości skóry i mogą przyczynić się do powstania odleżyn.

U cukrzyków często występują niedobory białka, co wynika z zaburzonej przemiany glukozy. Niskie wartości białka skutkują pogorszeniem przepływu krwi, co może prowadzić do niedokrwienia i wystąpienia odleżyny.

Leczenie odleżyn w przebiegu cukrzycy

Jeżeli odleżyna powstała wskutek krótkotrwałego zmniejszenia mobilności ruchowej, często wystarczy usunięcie ucisku powodującego ranę oraz miejscowa terapia rany zgodna z powszechnie przyjętymi protokołami, m.in. strategią TIME.

W przypadku cukrzyków ryzyko nawrotu odleżyny jest wysokie i wymaga podjęcia dodatkowych działań profilaktycznych. Po wygojeniu rany konieczna jest stała kontrola cukru we krwi. Utrzymanie prawidłowego poziomu glukozy zapobiega zaburzeniom układu krążenia. Jest to kluczowe w profilaktyce odleżyn, powstających właśnie wskutek miejscowego niedokrwienia. Zaleca się również wdrożenie zbilansowanej diety cukrzycowej, która ogranicza ryzyko wystąpienia wahań poziomu glukozy i pomaga w utrzymaniu prawidłowej masy ciała.

Źródło: „Leczenie odleżyn w obrębie stóp u pacjentów leżących, długoterminowych, z cukrzycą i niedokrwieniem kończyn dolnych – opis przypadku”, w: „Leczenie Ran”, 2016; 13 (2), s. 57-64.

 

Przeczytaj także: Najczęstsze powikłania cukrzycy

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

Rany przewlekłe stopy – rosnący problem kliniczny i społeczny?

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