mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/issn2072-3180.2020.2.90-96mossj-396Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEОБЪЕКТИВИЗАЦИЯ ВЫБОРА ЛЕЧЕБНОЙ ТАКТИКИ ПРИ ДЕКУБИТАЛЬНЫХ ЯЗВАХ У ПАЦИЕНТОВ, НАХОДЯЩИХСЯ В ХРОНИЧЕСКОМ КРИТИЧЕСКОМ СОСТОЯНИИ В СВЯЗИ С ПОРАЖЕНИЕМ ГОЛОВНОГО МОЗГАWAYS TO OPTIMIZE THE CHOICE OF THERAPEUTIC TACTICS FOR BEDSORES IN PATIENTS IN A CHRONIC CRITICAL CONDITION DUE TO BRAIN DAMAGEhttps://orcid.org/0000-0002-8482-1249ЯковлевА. А.YakovlevA. A.

заведующий хирургическим отделением, соискатель кафедры факультетской хирургии

т.8-919-108-34-00 (моб.), Тел. 8 (495) 641-30-06 (раб.)

141534, Московская область, Солнечногорский район, д.Лыткино, д.777 

head of the surgical department, MD

т.8-919-108-34-00 8 (495) 641-30-06

141534, Moskovskaya oblast’, Solnechnogorskij region, Lytkino-777

Ayakovlev@fnkcrr.ruhttps://orcid.org/0000-0002-8001-1601ШулуткоА. М.ShulutkoA. M.

д.м.н., профессор кафедры факультетской хирургии

т.8-916-690-46-20 (моб.), 8-499-246-69-23 (раб.)

119991, Москва, ул.Трубецкая, д.8, стр.2

MD, PHD, professor,

8-916-690-46-20, 8-499-246-69-23, 

119991, Moscow, Trubeskaya str.8 /2

shulutko@mail.ruhttps://orcid.org/0000-0003-1451-1015ОсмановЭ. Г.OsmanovE. G.

д.м.н., профессор

т.8-963-712-04-60 (моб.), 8-499-246-69-23 (раб.)

119991, Москва, ул.Трубецкая, д.8, стр.2

MD, PHD, professor

т.8-963-712-04-60, 8-499-246-69-23

119991, Moscow, Trubeskaya str.8 /2

mma-os@yandex.ruhttps://orcid.org/0000-0001-9903-7257ЯковлеваА. В.YakovlevaA. V.

младший научный сотрудники

т.8-919-108-34-00 (моб.) Тел. 8 (495) 641-30-06

Московская область, Солнечногорский район, д.Лыткино, д.777 

head of the surgical department, MD - Junior Researcher

8-919-108-34-00, 8 (495) 641-30-06

141534, Moskovskaya oblast’, Solnechnogorskij region, Lytkino -777

mogvv2016@yandex.ruНатрошвилиА. Г.NatroshviliA. G.

к.м.н., доцент

8-926-392-95-04 (моб.), 8-499-246-69-23 (раб.)

119991, Москва, ул. Трубецкая, д.8, стр.2 ORCID: 0000-0003-2950-159Х

MD, PHD, docent

8-926-392-95-04, 8-499-246-69-23

ORCID: 0000-0003-2950-159Х

119991, Moscow, Trubeskaya str.8 /2

alex.natroshvili@gmail.comНасировФ. Н.NasirovF. N.

к.м.н., доцент

8-926-246-11-26 (моб.), 8-499-246-69-23 (раб.)

119991, Москва, ул. Трубецкая, д.8, стр.2

ORCID: 0000-0001-8311-8228

MD, PHD, docent

8-926-246-11-26, 8-499-246-69-23

ORCID: 0000-0001-8311-8228

119991, Moscow, Trubeskaya str.8 /2

fnasirov@yandex.ruhttps://orcid.org/0000-0003-2965-3091ПаталоваА. Р.PatalovaA. R.

к.м.н., доцент

8-903-542-15-11 (моб.), 8-499-246-69-23 (раб.)

119991, Москва, ул. Трубецкая, д.8, стр.2

MD, PHD, docent

8-903-542-15-11, 8-499-246-69-23

119991, Moscow, Trubeskaya str.8 /2

Alisamay2000@mail.ruФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет) Минздрава России, Кафедра факультетской хирургии № 2 Института клинической медицины им. Н.В. СклифосовскогоРоссияI. M. Sechenov First Moscow state medical University (I. M. Sechenov Moscow state medical UNIVERSITY) Ministry Of Health Of Russia, Department of faculty surgery No. 2 of the N. V. Sklifosovsky Institute of clinical medicineRussian FederationНИИ ФГБУ Федеральный научно-клинический центр реаниматологии и реабилитологии РоссииРоссияFederal research and clinical center for resuscitation and rehabilitation of RussiaRussian Federation202020092020029096Copyright © Яковлев А.А., Шулутко А.М., Османов Э.Г., Яковлева А.В., Натрошвили А.Г., Насиров Ф.Н., Паталова А.Р., 20202020Яковлев А.А., Шулутко А.М., Османов Э.Г., Яковлева А.В., Натрошвили А.Г., Насиров Ф.Н., Паталова А.Р.Yakovlev A.A., Shulutko A.M., Osmanov E.G., Yakovleva A.V., Natroshvili A.G., Nasirov F.N., Patalova A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/396Цель

Цель: оценить эффективность модернизированной шкалы Бейтс-Дженсена в качестве инструмента выбора лечебной тактики при декубитальных язвах (ДЯ) у лиц с поражением головного мозга, находящихся в хроническом критическом состоянии.

Методы

Методы: проведено обследование пациентов с тяжелым поражением головного мозга и ДЯ III степени, перенесших восстановительное вмешательство – аутодермопластику (АДП) за период 2019-2017гг. Всего 30 человек: 23 (76,7%) из них мужчины и %23,3) 7) женщины в возрасте от 27 до 63 лет. В зависимости от исходов операции сформированы две группы – основная (n=17) c положительным исходом АДП и контрольная (n=13) с отрицательным исходом АДП (отторжение лоскута, ухудшение ДЯ). Для количественной оценки динамики ДЯ в предоперационном периоде использовали шкалу Бейтс-Дженсена, а также ее модернизированный аналог, дополненный тремя новыми критериями. Статистический анализ полученных результатов показал, что у лиц с суммарным баллом ≥50 по модернизированной шкале Бейтс-Дженсена на момент госпитализации следует считать абсолютным противопоказанием к АДП, предиктор положительного исхода операции можно считать ≤40 баллов после двухнедельной терапии (p<0,05).

Выводы

Выводы: модифицированная шкала Бейтс-Дженсена позволяет осуществлять комплексную оценку ДЯ, мониторинг раневого процесса и объективизировать лечебную тактику.

Aim

Aim: to evaluate the effectiveness of the modernized Bates-Jensen` scale as a method of objectify the choice of treatment for bedsores in patients with brain damage who are in a chronic critical condition.

Methods

Methods: a survey of patients with severe brain damage and grade III DL who underwent reconstructive surgery – autodermoplasty (ADP) for the period 2017-2019 was conducted. A total of 30 people: 23 (76.7%) of them men and 7 (23.3%) women aged 27 to 63 years. Depending on the outcome of the operation 2 groups were formed: 17 patients with a positive outcome of the intervention and 13 patients with a negative outcome of ADP (rejection of the flap, further progression bedsore). For a quantitative assessment of the healing dynamics we used the Bates-Jensen` scale and its modernized analogue supplemented by 3 new criteria. Scoring and statistical analysis of the results showed that a total score of ≥50 according to the adapted Bates-Jensen` scale at the time of hospitalization should be considered an absolute contraindication for ADP. A predictor of a positive outcome for ADP is ≤40 points by adapted Bates-Jensen` scale after two weeks of conservative therapy (p<0,05).

Conclusion

Conclusion: The modified Bates-Jensen` scale allows for a comprehensive assessment of pressure sores, monitoring of the wound hilling process and objectifying cure tactics.  

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Di.r Assoc, 2009, no. 10 (2). рр. 141-144. doi: 10.1016/j.jamda.2008.10.014.George-Saintilus E., Tommasulo В., Cal С., Hussain R., Mathew N., Dlugacz Y., Pekmezaris R., Wolf-Klein G. Pressure Ulcer PUSH Score and Traditional Nursing Assessment in Nursing Home Residents: Do They Correlate? J. Am. Med. Di.r Assoc, 2009, no. 10 (2). рр. 141-144. doi: 10.1016/j.jamda.2008.10.014.George-Saintilus E., Tommasulo В., Cal С., Hussain R., Mathew N., Dlugacz Y., Pekmezaris R., Wolf-Klein G. Pressure Ulcer PUSH Score and Traditional Nursing Assessment in Nursing Home Residents: Do They Correlate? J. Am. Med. Di.r Assoc, 2009, no. 10 (2). рр. 141-144. doi: 10.1016/j.jamda.2008.10.014.Gray M. Context for Practice: Revised Pressure Injury Staging System. Journal of Wound Ostomy & Continence Nursing., 2016, no. 43 (6), рp. 574-575. doi:10.1097/WON.0000000000000285.Gray M. Context for Practice: Revised Pressure Injury Staging System. Journal of Wound Ostomy & Continence Nursing., 2016, no. 43 (6), рp. 574-575. doi:10.1097/WON.0000000000000285.Gray M. Context for Practice: Revised Pressure Injury Staging System. Journal of Wound Ostomy & Continence Nursing., 2016, no. 43 (6), рp. 574-575. doi:10.1097/WON.0000000000000285.Gray M. Context for Practice: Revised Pressure Injury Staging System. Journal of Wound Ostomy & Continence Nursing., 2016, no. 43 (6), рp. 574-575. doi:10.1097/WON.0000000000000285.Waterlow J. Pressure sores: a risk assessment card. Nurs Times, 1985, no. 81 (48), рр. 49-55.Waterlow J. Pressure sores: a risk assessment card. Nurs Times, 1985, no. 81 (48), рр. 49-55.Waterlow J. Pressure sores: a risk assessment card. Nurs Times, 1985, no. 81 (48), рр. 49-55.Waterlow J. Pressure sores: a risk assessment card. Nurs Times, 1985, no. 81 (48), рр. 49-55.Choi E., Chin W., Wan E., Lam C. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. J. Adv. Nurs, 2016, May, no. 72 (5), рр. 1134-1143. doi: 10.1111/jan.12898.Choi E., Chin W., Wan E., Lam C. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. J. Adv. Nurs, 2016, May, no. 72 (5), рр. 1134-1143. doi: 10.1111/jan.12898.Choi E., Chin W., Wan E., Lam C. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. J. Adv. Nurs, 2016, May, no. 72 (5), рр. 1134-1143. doi: 10.1111/jan.12898.Choi E., Chin W., Wan E., Lam C. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. J. Adv. Nurs, 2016, May, no. 72 (5), рр. 1134-1143. doi: 10.1111/jan.12898.Dealey C., Chambers T., Beldon P., Benbow M., Fletcher J., Fumarola S., Guy H. Members of TVS Pressure Ulcer Working Group. Achieving consensus in pressure ulcer reporting. J. Tissue Viability, 2012, no. 21 (3), рр. 72-83. doi: 10.1016/j.jtv.2012.05.001.Dealey C., Chambers T., Beldon P., Benbow M., Fletcher J., Fumarola S., Guy H. Members of TVS Pressure Ulcer Working Group. Achieving consensus in pressure ulcer reporting. J. Tissue Viability, 2012, no. 21 (3), рр. 72-83. doi: 10.1016/j.jtv.2012.05.001.Dealey C., Chambers T., Beldon P., Benbow M., Fletcher J., Fumarola S., Guy H. Members of TVS Pressure Ulcer Working Group. Achieving consensus in pressure ulcer reporting. J. Tissue Viability, 2012, no. 21 (3), рр. 72-83. doi: 10.1016/j.jtv.2012.05.001.Dealey C., Chambers T., Beldon P., Benbow M., Fletcher J., Fumarola S., Guy H. Members of TVS Pressure Ulcer Working Group. Achieving consensus in pressure ulcer reporting. J. Tissue Viability, 2012, no. 21 (3), рр. 72-83. doi: 10.1016/j.jtv.2012.05.001.Vera-Salmerón E., Rutherford C., Dominguez-Nogueira C., Tudela-Vázquez M., Costela-Ruiz V., Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res. Protoc, 2019, no. 8 (8), рр. 13701-13708. doi: 10.2196/13701.Vera-Salmerón E., Rutherford C., Dominguez-Nogueira C., Tudela-Vázquez M., Costela-Ruiz V., Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res. Protoc, 2019, no. 8 (8), рр. 13701-13708. doi: 10.2196/13701.Vera-Salmerón E., Rutherford C., Dominguez-Nogueira C., Tudela-Vázquez M., Costela-Ruiz V., Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res. Protoc, 2019, no. 8 (8), рр. 13701-13708. doi: 10.2196/13701.Vera-Salmerón E., Rutherford C., Dominguez-Nogueira C., Tudela-Vázquez M., Costela-Ruiz V., Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res. Protoc, 2019, no. 8 (8), рр. 13701-13708. doi: 10.2196/13701.Thomason S., Luther S., Powell-Cope G., Harrow J., Palacios P. Validity and reliability of a pressure ulcer monitoring tool for persons with spinal cord impairment. J. Spinal Cord. Med. 2014, no. 37 (3), рр. 317-327. doi: 10.1179/2045772313Y.0000000163.Thomason S., Luther S., Powell-Cope G., Harrow J., Palacios P. 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The authors declare that there are no conflicts of interest present.