末期病人的壓力性損傷與皮膚衰竭

Pressure Injury and Skin Failure in Terminal Patients

壓力性損傷是照護臥床或年長衰弱病人時不可避免的挑戰，除了身體不適外，更可能衍生心理和社會問題，導致病人生活品質下降，這也是衡量醫療機構照護品質的一個重要指標。臨床觀察到的壓力性損傷，通常呈現漸進變化，由發紅、起水泡、脫皮進一步進展至壞死變黑。然而，在接受安寧緩和照護的末期病人身上，學者觀察到某些病人皮膚上出現的變化進展非常快速，有別於平常臥床病人觀察到的壓力性損傷。本專論蒐集了近年的國外學術文章，討論壓力性損傷的預防，安寧緩和病人的壓力性損傷，進而探討末期病人的皮膚衰竭文獻，囊括甘迺迪末期潰瘍與三點半症候群、生命末期的皮膚變化、T-B（Trombley-Brennan terminal tissue injuries）末期組織損傷和皮膚衰竭。末期病人的皮膚衰竭須與壓力性損傷進行鑑別，現今學者提出的皮膚衰竭臨床指標量表仍需進一步研究，以驗證其有效性，並期盼在臨床照護病人方面，能有更廣泛的推廣與運用。

Managing pressure injuries is an unavoidable challenge when caring for bedridden or elderly patients. In addition to physical discomfort, pressure injuries can lead to psychological and social problems hurting patients' quality of life and are further associated with greater health costs; management of pressure injuries is therefore recognized as an important indicator of the quality of care in health care facilities. However, studies have shown that the progress of skin changes in terminal patients and patients receiving palliative care tends to be more rapid than that of pressure injuries, which usually needs to go through redness and blistering before evolving into a wound covered by eschar. In this article, we reviewed recent studies regarding prevention of pressure injuries and management of pressure injuries in patients receiving palliative care. Also performed was a literature review of terminal skin injuries, including Kennedy terminal ulcer and 3:30 syndrome, skin changes at life's end, Trombley-Brennan terminal tissue injuries, and skin failure. Skin failure in terminal patients needs to be distinguished from pressure injury. The validity of the ＂Skin Failure Clinical Indicator Scale＂ merits further investigations before the scale can be expected to be widely applied in clinical settings.