Expert consensus on the surgical management of pressure injuries (2026 edition)
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摘要: 压力性损伤是常见的慢性难愈性创面之一。随着人口老龄化加剧和慢性疾病患病率上升,压力性损伤的发生率逐年升高,外科治疗需求随之显著增长。尽管相关临床技术不断发展,但压力性损伤外科治疗的全流程仍缺乏统一的规范化路径,影响患者预后。为进一步指导临床实践,中国医师协会创面修复专业委员会组织国内多学科专家,制订了《压力性损伤外科治疗专家共识（2026版）》。该共识内容涵盖压力性损伤外科治疗的适应证、术前评估和准备要点、外科清创和创面床准备、外科修复方法及术后并发症的预防与康复要点等,旨在规范临床行为、提升治疗效果,促进各级医疗机构压力性损伤外科治疗能力的同质化提升。Abstract: Pressure injuries are common chronic hard-to-heal wounds. With population aging and the increasing prevalence of chronic diseases, the incidence of pressure injuries has gradually increased, accompanied by a growing demand for surgical management. Despite continuous advances in relevant clinical techniques, a unified standardized treatment pathway covering the entire process of surgical management of pressure injuries remains lacking, which may adversely affect patient outcomes. To further standardize clinical practice, the Wound Repair Professional Committee of the Chinese Medical Doctor Association organized a multidisciplinary panel of experts from across China to develop the Expert consensus on the surgical management of pressure injuries (2026 edition). The consensus covered key aspects of the surgical management of pressure injuries, including indications for surgical management of pressure injuries, key considerations for preoperative assessment and preparation, surgical debridement and wound-bed preparation, methods of surgical repair, and key considerations for the prevention of postoperative complications and rehabilitation. It was intended to standardize clinical practice, improve treatment outcomes, and promote consistency in the surgical management of pressure injuries across healthcare institutions at different levels.
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Key words:
- Pressure ulcer /
- Surgical procedures, Operative /
- Debridement /
- Infections /
- Surgical flaps /
- Skin transplantation /
- Expert consensus
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参考文献
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DOI: 10.1111/iwj.12537. -
Table 1. 压力性损伤的分期与评定标准
分期 评定标准 Ⅰ期 局部皮肤完好,出现压之不变白的红斑,常位于骨隆突处。与邻近组织相比,这一区域可能会出现痛感、发硬、变软、皮温升高或降低 Ⅱ期 部分皮层缺损,表现为浅表的开放性溃疡,创面呈粉红色,无腐肉；也可为完整或破裂的浆液性水疱,外观透亮或干燥,无腐肉或淤伤 Ⅲ期 仅全层皮肤缺损,可见皮下脂肪,但骨、肌腱、肌肉并未外露。可有腐肉,可伴有窦道和潜行腔隙 Ⅳ期 全层皮肤缺损,并伴有骨、肌腱或肌肉外露。在创面基底可有腐肉和焦痂覆盖,通常伴有窦道和潜行腔隙 不可分期压力性损伤 创面覆盖有腐肉和/或焦痂,除非去除足够多的腐肉和/或焦痂来暴露创面基底,否则无法判断实际深度和分期 可疑深部组织损伤 压力或剪切力导致皮下软组织受损,皮肤完整或部分缺损,局部出现持续不褪的紫色或栗色改变,或形成充血的水疱。此部位与邻近组织相比,先出现痛感、发硬、糜烂、变软、皮温升高或降低。在肤色较深的个体中,很难辨识出深层组织损伤 注：表格引自参考文献[6] 
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Table 2. 2009版牛津大学循证医学中心证据分级标准
证据等级 定义 1a级 RCT的系统评价 1b级 结果可信区间小的RCT 1c级 显示“全或无效应”的任何证据 2a级 队列研究的系统评价 2b级 单个队列研究（包括低质量的RCT,如失访率>20%） 2c级 基于患者结局的研究 3a级 病例对照研究的系统评价 3b级 单个病例对照研究 4级 病例系列报告、低质量队列研究和低质量病例对照研究 5级 专家意见（即无临床研究支持的仅依据基础研究或临床经验的推测） 注：RCT为随机对照试验
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Table 3. 压力性损伤外科治疗推荐意见的推荐强度与定义
推荐强度 定义 强 综合现有证据、获益与风险、患者价值观与接受程度及临床实施可行性等因素,专家组认为该措施的预期获益明确超过潜在风险或负担,推荐实施 弱 综合上述因素,专家组认为该措施可能获益,但证据确定性、获益与风险平衡、患者接受程度或实施条件等仍存在一定不确定性,建议根据患者具体情况选择性实施 无特别推荐 现有证据或获益与风险平衡尚不足以支持明确推荐,或不同患者、医疗条件下选择可能存在较大差异,暂不作普遍推荐,可根据具体情况个体化选择
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