rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-2-83-89rmt-2216Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSКонсервативное лечение декубитальных язв с использованием физических методов воздействия (обзор)Conservative Therapy of Pressure Ulcers Using Physical Methods (Review)ОсмановЭ. Г.OsmanovE. G.

119991

ул. Трубецкая, д. 8, стр. 2

Москва

Elkhan G. Osmanov

119991

8 Trubetskaya Str., Bldg. 2

Moscow

ШулуткоА. М.ShulutkoА. M.

119991

ул. Трубецкая, д. 8, стр. 2

Москва

Аleksandr M. Shulutko

119991

8 Trubetskaya Str., Bldg. 2

Moscow

 

ЯковлевА. А.YakovlevA. A.

107031

ул. Петровка, д. 25, стр. 2

Москва

107031

25 Petrovka Str.

Moscow

КрыловА. Ю.KrylovA. Y.

119991

ул. Трубецкая, д. 8, стр. 2

Москва

119991

8 Trubetskaya Str., Bldg. 2

Moscow

ЯковлеваА. В.YakovlevaA. V.

Александра Витальевна Яковлева

107031

ул. Петровка, д. 25, стр. 2

Москва

107031

25 Petrovka Str.

Moscow

avyakovleva@fnkcrr.ruАлтуховЕ. Л.AltuкhovE. L.

107031

ул. Петровка, д. 25, стр. 2

Москва

107031

25 Petrovka Str.

Moscow

ГандыбинаЕ. Г.GandybinaE. G.

119991

ул. Трубецкая, д. 8, стр. 2

Москва

119991

8 Trubetskaya Str., Bldg. 2

Moscow

МартыновИ. А.MartynovI. A.

119991

ул. Трубецкая, д. 8, стр. 2

Москва

119991

8 Trubetskaya Str., Bldg. 2

Moscow

Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава РоссииРоссияI. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian FederationФедеральный научно-клинический центр реаниматологии и реабилитологии (ФНКЦ РР)РоссияFederal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2022300420221828389Copyright © Османов Э.Г., Шулутко А.М., Яковлев А.А., Крылов А.Ю., Яковлева А.В., Алтухов Е.Л., Гандыбина Е.Г., Мартынов И.А., 20222022Османов Э.Г., Шулутко А.М., Яковлев А.А., Крылов А.Ю., Яковлева А.В., Алтухов Е.Л., Гандыбина Е.Г., Мартынов И.А.Osmanov E.G., Shulutko А.M., Yakovlev A.A., Krylov A.Y., Yakovleva A.V., Altuкhov E.L., Gandybina E.G., Martynov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2216

   В России и странах Европы частота пролежней или декубитальных язв (ДЯ) у малоподвижных пациентов с тяжелым коморбидным фоном, спинальной травмой и последствиями церебральной катастрофы варьирует от 3 до 40 %, достигая 80 % при хроническом критическом состоянии. Конечный результат консервативного лечения ДЯ, при условии адекватной коррекции сочетанной патологии и надлежащего ухода за обездвиженным больным, во многом зависит от выбора средств локального воздействия.   Цель обзора: показать спектр эффективных методов физического воздействия на пролежни, подходящих для консервативного лечения.   Материал и методы. Всего отобрали и анализировали 80 научных публикаций. Отбор источников осуществляли в базах данных медицинских и биологических публикаций PubMed, Scopus, РИНЦ. Охватили следующие методики: вакуум-терапия, ультразвуковые методы, гидрохирургическая обработка, плазменные потоки, лазерное излучение (в т. ч. низкоэнергетическая лазерная технология), «аппаратное» ускорение регенераторных процессов, включая электростимуляцию, а также сочетание указанных методов.   Результаты. Разнообразие физических методов воздействия на рану, с одной стороны, дает возможность подбора индивидуальной программы терапии. С другой стороны, у каждого метода имеются свои ограничения, противопоказания. Поэтому в практике целесообразно применение разных комбинаций приведенных методов.   Заключение. По ряду объективных причин нет оснований ожидать уменьшения встречаемости ДЯ в клинической практике. В связи с этим изучение и решение проблем доказательной базы клинической эффективности и экономической целесообразности применения различных технологий консервативного лечения пролежней имеет немаловажное значение.

   In Russia and European countries, the incidence of pressure (decubitus) ulcers in sedentary patients with severe comorbidities, spinal trauma, and cerebral accident sequelae varies from 3 to 40 %, reaching 80 % in the chronic critical illness. The final result of conservative treatment of pressure ulcers (PU) with adequate correction of comorbidities and proper care of the immobilized patient depends largely on the choice of local interventions.

   Aim of the review: to demonstrate the range of effective methods of physical treatment of pressure ulcers suitable for conservative treatment.   Materials and methods. We selected and analyzed 80 scientific publications. Sources were selected from the PubMed, Scopus, and RSCI databases of medical and biological publications. The following methods were covered: negative pressure wound therapy, ultrasonic methods, hydrosurgical treatment, plasma flows, laser therapy (including low-level laser therapy), «hardware» acceleration of regenerative processes, including electrical stimulation, as well as a combination of these methods.   Results. The variety of physical methods of wound treatment, on the one hand, provides an opportunity to select an individual therapy program. On the other hand, each method has its own limitations and contraindications. That is why in practice various combinations of these methods are reasonable.   Conclusion. For several objective reasons, no reduction of PU incidence in clinical practice is expected. Therefore, studying the issues of evidence-based clinical effectiveness and economic feasibility of various conservative techniques of decubitus treatment to find best solutions in this area is warranted.

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The authors declare that there are no conflicts of interest present.