Epidemia koronawirusa znacząco utrudniła leczenie ran trudno gojących się, w tym również owrzodzeń na podłożu przewlekłej choroby żylnej. Schorzenie to w przypadku niewdrożenia odpowiedniej terapii może prowadzić do poważnych powikłań. Ważne jest więc, by pacjent otrzymał diagnozę i podstawowe wytyczne dotyczące leczenia.
Opieka terapeutyczna nad pacjentem z przewlekłą chorobą żylną uległa w dobie pandemii reorganizacji. Wywiad lekarski oraz badanie są prowadzone najczęściej za pośrednictwem telefonu lub nośników elektronicznych. Na jakie elementy należy zwrócić uwagę podczas zdalnej diagnostyki i terapii PChŻ?
Wywiad lekarski
Bardzo istotny jest dokładny wywiad lekarski, obejmujący informacje o przebytych chorobach, urazach i zabiegach operacyjnych. W wywiadzie należy uwzględnić, czy pacjent choruje na cukrzycę, zakrzepicę żył głębokich lub powierzchownych oraz czy występują objawy miażdżycy zarostowej. Istotne są również informacje dotyczące stylu życia (tryb pracy, aktywność ruchowa, nadwaga, otyłość, występowanie PChŻ u członków najbliższej rodziny).
W wywiadzie dotyczącym stosowanych środków farmaceutycznych należy uwzględnić zwłaszcza, czy pacjent stosuje preparaty hormonalne (np. środki antykoncepcyjne).
W przypadku pacjentek istotne są również informacje o ciąży (liczba i przebieg ciąży i porodów, występowanie i nasilenie objawów przed ciążą i w trakcie).
Zdalne badanie
W prowadzonym zdalnie badaniu lekarskim należy odnotować obecność objawów takich jak przebarwienia skóry, siatka poszerzonych żył, miejscowe ucieplenie lub stwardnienie skóry, zgrupowane teleangiektazje lub żylaki, występowanie czynnych owrzodzeń oraz blizn po owrzodzeniach lub zabiegach operacyjnych. Należy również zwrócić uwagę, czy w obrębie kończyn lub innych części ciała występuje obrzęk.
W zdalnym badaniu lekarskim bardzo pomocna może być dokumentacja fotograficzna. Warto poprosić pacjenta o przyłożenie do rany linijki, dzięki czemu możliwa będzie ocena planimetryczna zdjęcia. Pozwoli to ustalić, jaki obszar rany zajęty jest włóknikiem, ziarniną, martwicą, maceracją lub wypryskiem. Dokumentacja fotograficzna powinna również obejmować zdjęcia zdejmowanych z rany opatrunków. Analiza tych fotografii pozwoli ustalić ilość i rodzaj wysięku.
Ważnym narzędziem diagnostycznym, które można zastosować w zdalnym badaniu, jest również pomiar obwodu kończyny. Pacjent może dokonać pomiaru w warunkach domowych, przy pomocy członka rodziny lub opiekuna.
Pomiar powinien być wykonywany w następujących miejscach na obu kończynach: w najcieńszym miejscu nad kostką, w połowie długości goleni, poniżej kolana oraz w połowie uda. Regularnie wykonywane i archiwizowane pomiary pomogą w ustaleniu, czy zmiany ulegają progresji, czy gojeniu.
Nasilenie bólu związanego z raną można w badaniu zdalnym określić za pomocą skali VAS. Pacjent powinien oznaczać nasilenie bólu w stałych odstępach czasu.
Źródło:
G. Krasowski, K. Tarara, P. Jagoda, „Kwarantanna a przewlekła choroba żylna – od pajączka do owrzodzenia”, „Forum Leczenia Ran” 2020, 1(2): 59-68.
Przeczytaj także: Pedobarografia w leczeniu stopy cukrzycowej
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