游朝慶醫師
接著來介紹低科技類減壓床墊中最多人使用的替代泡綿(alternative foam,foam alternative),其有三種型式,第一型為黏彈性泡棉viscoelastic,由PU泡綿添加一些化學藥劑而成,增加其黏性及密度,通常被稱為記憶泡棉(memory foam)、高特殊泡綿(high specification foam)、惰性泡綿low-resilience foam,也有人稱其為矽膠綿(和silicone無關),其為溫感temperature sensitive,當低溫時,其表現較硬,溫度高時會變軟,因此當人躺上去,幾分鐘後,高密度記憶泡棉感受到人的體溫就會變軟,而讓人沉下去,增加接觸的體表面積,而低密度記憶泡綿是壓力感測pressure-sensitive,人躺上去後會更快沉下去,但會比較沒有支撐,一般而言,會組合不同密度的記憶泡棉,在上層鋪上低密度泡綿以加強包覆性,而在底層用高密度記憶泡棉以加強支撐性。已有許多研究證實記憶泡棉床墊比傳統醫院泡棉床墊更能有效預防壓瘡1-3,甚至丹普公司還證實其丹普記憶床墊預防壓瘡的效果和交替式壓力氣墊床一樣好4,然而Russell等人於2003年發表一篇1000多人的大規模研究5,卻發現記憶床墊(CONFOR-Med廠牌)預防一度壓瘡的效果其實和傳統醫院泡棉床墊差不多。第二型是波浪式泡棉(Convoluted Foam)或塑性泡綿(contoured foam),大多長的像蛋架的波浪狀泡綿,如下圖,這樣的形狀可以增加接觸面積,並更可均勻地分散重力6,如此設計當人睡在上面時也比較通風。如前所述,波浪式泡棉要預防壓瘡的床墊厚度至少需4吋(10公分)以上7,而當其只有2英吋厚時,則完全沒有減壓效果8。 圖1. 波浪式泡棉
第三型為立方體泡綿(Cubed foam),其長得就如同下圖一般,如蜂巢式減壓鞋般,其可將壓瘡處或受壓較重處(如薦骨處或腳後跟處)的泡棉方塊拿掉,以減少局部壓力,其會放於這裡來說明主要是在1994年時Hofman等人以Comfortex DeCube這廠牌的泡棉床墊9,以44人做對照組的研究,發現這種床墊可以減少6成的壓瘡發生率。 圖2. Comfortex DeCube床墊
需注意的是,以上這些替代泡綿床墊要用在醫療用途預防壓瘡時,必須要先以防水布包住整體,如圖3.,以避免泡棉被患者體液汙染,健保局才會予以給付。 圖3.丹普的醫療用記憶泡棉床墊
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