EMRE İNÖZÜ, Hülda ÖZAKPINAR RIFAT, MUSTAFA DURGUN, Avni Tolga ERYILMAZ, Caferi Tayyar SELÇUK, Ali Teoman TELLİOĞLU

Geriatrik hastalarda bası yaralarına yaklaşım

Amaç: Bu çalışmanın amacı bası yarası nedeniyle kabul edilen geriatrik hastalara gerekli beslenme desteği sağlandıktan sonra planlanan tedavi ve sonuçlarını değerlendirmektir. Gereç ve yöntem: Bu çalışmaya 2006 ile 2011 yılları arasında bası yarası nedeniyle servisimize kabul edilen geriatrik hastalar dahil edildi. Hastaların vücut kitle indeksleri hesaplandı, albumin değerleri kaydedildi. Hastalarda protein- enerji malnütrisyonu değerlendirilerek gerekli beslenme desteği verildi. Malnütrisyonu düzelen hastalarda tedaviye başlandı. Bulgular: Kliniğe kabul edilen hastaların ortalama albumin değerleri 2,53 ± 0,25 g/dL iken beslenme desteği sonrası 3,95 ± 0,42 g/dL idi. Hastaların %75’inin genel durumu uygun olduğunda bası yaraları cerrahi olarak onarıldı, kalan %25’i ise eşlik eden sistemik sorunlarına bağlı olarak yüksek riskli oldukları için ameliyat edilmedi ve konservatif yöntemlerle takip edildi. Ameliyat sonrası ortalama taburculuk süresi 12 (8-21) gündü. Gerek cerrahi, gerekse konservatif yöntemler kullanılarak hastaların %78,6’sının bası yaraları başarı ile tedavi edildi. Sonuç: Geriatrik hastalarda bası yarasının tedavi başarısı, eşlik eden malnutrisyon gibi patolojilerin beslenme desteğiyle düzeltilmesine bağlıdır. Operasyon öncesi yapılan beslenme desteği ile sağlıklı granülasyon dokusu oluşumuyla birlikte aynı zamanda hızlı ve güvenilir yara iyileşmesi sağlanmıştır. Kronik birçok hastalığı olmasına rağmen hastaların çoğu opere edilerek bası yaraları kapatılmıştır.

Approach to the pressure sores in geriatric patients

Objectives: The aim of this study was to evaluate the follow- up results of nutritionally supported geriatric patients who were admitted for their pressure sores then planned their treatment. Materials and methods: In this study, we analyzed the hospitalized geriatric pressure sore patients in our clinic who were admitted between 2006 and 2011. We calculated Body Mass Index and the blood albumin levels of all hospitalized geriatric patients. In this patient group protein energy malnutrition and deficiency were analyzed and proper nutrition support was provided accordingly. After recovering from malnutrition further treatment surpassed. Results: The mean albumin levels of the hospitalized patients was 2,53 ± 0,25 g/dL after nutritional support those levels increased to mean 3,95 ± 0,42 g/dL . Of all those patients 75% were operated when their general condition allowed us for a surgery. Due to their high risk we did not perform any surgical operation to the remaining 25%.. Post operative mean hospitalization period was 12 (8-21) days. Majority of the patients (78.6%) were treated successfully either with surgical or conservative treatment modalities. Conclusions: The success of the geriatric pressure sore treatment is highly related with the proper nutritional support for the ongoing malnutrition-like pathologies. Before operation nutritional support not only makes a healthy granulation tissue but also yields fast and reliable wound healing. Despite their chronic health problems many of our geriatric patients were treated surgically for their pressure sores.

PDF

___

1. Primiano M, Friend M, McClure C, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J 2011; 94(6):555-66.
2. White-Chu EF, Flock P, Struck B, et al. Pressure ulcers in long-term care. Clin Geriatr Med 2011;27(2):241-58.
3. Guy N, Lerman Y, Justo D. Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients with deconditioning. Arch Gerontol Geriatr 2012;54(2):381-4.
4. Beldon P. Skin changes at life’s end: SCALE ulcer or pressure ulcer? Br J Community Nurs 2011;16(10):491-4.
5. Baumgarten M, Rich E, Shardell MD, et al. Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc 2012;60(2):277-83.
6. Theisen S, Drabik A, Stock S. Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study. J Clin Nurs 2012; 21(3-4):380-7.
7. Fontaine J, Raynaud-Simon A. Pressure sores in geriatric medicine: the role of nutrition. Presse Med 2008;37(7- 8):1150-7.
8. Thomas DR. Improving outcome of pressure ulcers with nutritional interventions: a review of the evidence. Nutrition 2001;17(2):121-5.
9. Leigh B, Desneves K, Rafferty J, et al. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. J Wound Care 2012;21(3):150-6.
10. Desneves KJ, Todorovic BE, Cassar A, et al. Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clin Nutr 2005;24(6):979-87.
11. Wyffels JT, Edsberg LE. Granulation tissue of chronic pressure ulcers as a predictive indicator of wound closure. Adv Skin Wound Care 2011;24(10):464-73.
12. Pham B, Stern A, Chen W, et al. Preventing pressure ulcers in long-term care: a cost-effectiveness analysis. Arch Intern Med 2011;171(20):1839-47.
13. Van Anholt RD, Sobotka L, Meijer EP, et al. Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. Nutrition 2010;26(9):867-72.
14. Schols JM, Heyman H, Meijer EP. Nutritional support in the treatment and prevention of pressure ulcers: an overview of studies with an arginine enriched oral nutritional supplement. J Tissue Viability 2009;18(3):72-9.