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Patients, female, 60 years old, because of \Admission examination: 36.2 ℃, P 96 times / min, BP 118/80 mm Hg, R 20 times / min, severely limited the right limbs, sacral skin ulcers black pus accompanied by pain, evil smell. Hospital treatment given after surgical debridement, removal of necrotic tissue, wound area of 10 cm × 10 cm, depth of the periosteum, and the right side of the extension to the subcutaneous tissue with a 6 cm × 14 cm compartment. The author developed the case for meticulous patient care plan,[link widoczny dla zalogowanych], after 30 days of intensive care to achieve the desired goal: the growth of good granulation tissue bed sores, wound area is reduced to 6 cm × 7 cm, the original 6 cm × 14 cm compartment closed, underwent sacral flap consultation by doctors over patients, discharged after 18 days of stitches.
1 clinical data
1 case of grade Ⅳ patients with stroke sequelae bedsore care

<div style=\Key words stroke sequelae pressure ulcer care

Pressure ulcers (pressure ulcer) is a good long-term local tissue pressure, blood circulation, local tissue ischemia and hypoxia sustained, nutritional deficiencies, loss of normal function of the skin caused by tissue damage and necrosis [1] . Treatment and care of pressure sores There are many ways, but each patient has its particularity, we must make the overall assessment for the characteristics, proper care and measures to develop and implement a timely manner in order to obtain satisfactory results. 1 patient admitted to our department this year, patients with grade Ⅳ sequelae of stroke in patients with bedsores, after careful treatment and nursing care were discharged. Now experience are summarized below.
2 nursing
2.1 Psychological care of patients bedridden after a stroke, mood fluctuations, but also a large area Ⅳ, pressure ulcers, it is difficult to accept when the patient and meticulous care every day with patient communication, describes the causes and prevention of bedsores, treatment and care methods, to enable patients to actively participate in self-care in the past, and to give encouragement and support to keep a positive attitude,[link widoczny dla zalogowanych], and enhance the confidence of patients, and actively cooperate with the treatment and care. In addition to the family members for support and cooperation, further promote the patient's positive attitude.
2.3 designate a person for wound care and wound care, guarantee continuous,[link widoczny dla zalogowanych], dynamic observation of the wound, and timely treatment. (1) line of the first day of hospitalization in patients with debridement of necrotic tissue, debridement after the use of hydrogen peroxide, wash the wound with normal saline, gauze packing Rivanol wet bandage, and sent to sensitivity of necrotic tissue culture experiments. Top 5 talent times removed of residual necrotic tissue wound, scrape purulent discharge, we can see the growth of granulation tissue in wounds. Susceptibility test results came out, given ciprofloxacin for sensitive flora liquid 50 ml + 50 ml rivanol wound wet dressing and filling cavities, 10 were significantly higher in the future see the wound cleanliness, no purulent exudate secretion, granulation rapid tissue growth; subcutaneous compartment without leakage, reduced to 5 cm × 8 cm, after the dressing is not filling cavities, to the corresponding parts of the appropriate pressure dressing. (2) give the TDP infrared therapy 2 times a day, every 20 ~ 30 min, from 30 ~ 40 cm, can guarantee the effects of treatment, patients without causing burns. Physical therapy at the same time to give 654-250 mg + saline 10 ml spray wounds to promote wound blood circulation and accelerate the growth of new granulation tissue. (3) After treatment, covering the wound with a plastic bag and properly fixed to the bag blowing oxygen, the oxygen flow rate 8 ~ 10 L / min, day 1, every 10 ~ 15 min. Improve the oxygen content of wound tissue to achieve the purpose of promoting the growth of granulation tissue. Has been observed after the wound tissue oxygen blowing time was to become red. (4) to enhance patient nutrition, promote tissue repair. Encourage patients to eat high-protein, high energy, high-vitamin diet to ensure positive nitrogen balance and promote wound healing [2]. And fractionated to give human albumin,[link widoczny dla zalogowanych], plasma input, and enhance the body resistance of patients and tissue repair capacity. (5) encourage patients to stay in bed for whatever activities, limited to assist patients with daily passive limb movement, 2 times a day, every 30 min. To promote blood circulation in patients. 3 Results for 30 days or more integrated care, clean the wound bed sores in patients with red, except at the depth of the periosteum, the other are covered by granulation tissue, healing of the original subcutaneous compartment. After consultation by doctors at the hospital 35 days after the flap over the line sacrococcygeal postoperative continuous suture removal 16 days, 18 days after the stitches completely cured. 4 Summary of pressure ulcers for long-term bed-ridden patients with limited movement is indeed difficult to avoid bedsores occur after the appropriate care of us also have high requirements, the majority of pressure ulcers in patients with grade Ⅳ delayed healing of the wound, to cause great physical and mental patients hazards. The patients successfully treated in our department Ⅳ degree bedsore patients, treatment and care for our future similar cases provide a good reference.

2.2 vertical pressure acting on the general care of skin is the most important factor lead to bedsores occur. Dinsdale and other research, the body continued to be more than 9.3 kPa 2 h the pressure will produce irreversible tissue damage, causing pressure sores [2]. Bedside stand establishment card,[link widoczny dla zalogowanych], a position change every 2 h, and detailed examination of the pressure areas, and timely treatment. Air bed spread in patients with body weight, reduce the partial pressure conditions. Does not raise the bed higher than 30 °, to avoid blood shear forces cause skin disorders, damage the skin. Element to keep clean sheets, dry flat, no foreign body debris, a wet pollution, change in time. Wear soft, breathable clothing to prevent skin lesions caused by friction. Following the above care, patients with pressure ulcers during hospitalization addition to the outside into no new pressure ulcers occur. More articles related to topics：

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