防止和预防是保持皮肤舒适的关键

菡萏尘雾

People with ALS need extra care to keeptheir skin healthy and comfortable.

ALS患者需要特别的照料才能保持皮肤的健康和舒适。

First, there are the changes wrought by thedisease. Skin becomes extremely fragile whenever there are nutrition orbreathing problems. ALS also seems to change the biochemical properties ofcollagen and elastin, which run in thin fibers through the middle layer of skincalled the dermis.

首先，疾病会带来一些改变。一旦当累及到吞咽和呼吸的时候，皮肤会变的非常脆弱。ALS也好像改变了真皮层中胶原蛋白和弹力蛋白的生物特性。

As ALS progresses, these fibers becomeirregular in size and shape. Blood vessels in the dermis also displayirregularities and protein deposits.

随着ALS患者病情的逐渐发展，这些纤维在大小和形状上变得不规则，真皮层中的血管也变的不规则，并伴有蛋白质沉淀。

Then, there are the common itchy or painfulailments brought on by weather and immobility. Caregivers can take severalsteps to ease skin woes for loved ones with ALS.

于是，天气因素和活动不便会导致常见的皮肤发痒和疼痛症状。护理人员可以采取一系列措施减轻家中ALS病人的皮肤问题。

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Dry, itchy skin

干燥、发痒的皮肤

Winter air sucks moisture from the skin. Toput it back, try these tips:

冬天的时候，空气干燥，皮肤中水分容易流失。为了保持湿润，可以尝试这么做：

Put moisture into the air. Use a humidifier or place a bowl of water on the heatingvents.

保持空气湿度。可以使用加湿器或者在通风口放一碗水。

Avoid hot baths or showers. Hot water strips the skin of moisture; use lukewarm instead. A15-minute lukewarm soak saturates the skin, giving it that “prune” look. If ahot soak is a must, use bath oil. It’s not necessary to takea full bath every day; a “parts” cleanup with a sponge usually issufficient.

不要用太热的水洗澡。热水能带走皮肤上的水分；尽量用温热水代替。一次15分钟的温水浴可以让皮肤充分吸收水分，白里透红。如果要泡热水浴的话就需要先涂好洗浴油。没有必要天天都洗个完整的澡，用洗浴球洗部分地方就可以了。

Pat dry, don’t rub. Skin specialists compare rubbing with a towel to rubbing withsandpaper. Patting the skin leaves more moisture behind.

用手轻拍，不要擦干。皮肤专家通常将用毛巾擦干比喻为用砂纸在摩擦。用手轻拍可以留住更多水分。

Use heavy, greasy lotions. Immediately after patting, seal in moisture with the greasiestlotion tolerated.

用保湿的、油性的润肤乳。轻拍后立即擦拭润肤乳，从而达到锁水的效果。

Shave with lotion. It’s much gentler than foam. When washing, use mild orsoap-free cleansers. Avoid deodorant soap.

用润肤乳刮胡子。比用泡沫更温和。清洗的时候，使用温和的或者无皂的洗面乳，不要使用除臭的肥皂。

Wash itchy scalps. This complaint comes up regularly among ALS patients. Tryusing cooler water in shampooing, changing hair products, moisturizing thescalp, using anti-itch or antifungal shampoos, and consulting a dermatologist.

发痒头皮的清洗。ALS患者头皮会经常发痒。可以尝试使用冷点的水来洗头、换换洗发水、增加头皮的水分、用止痒或者杀菌的洗发水并且可以咨询皮肤科大夫。

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Fungal infections

真菌感染

At the opposite end of the spectrum areskin problems caused by too much moisture.

太潮湿的环境也会引起一些皮肤问题。

“It’s ironic that you would develop ‘jockitch’ as a result of being confined to a wheelchair,” says Diane Huberty of Fort Wayne, Ind.,a retired neuroscience nurse who has ALS.

身为ALS患者的印第安纳州前神经科护士 Diana Huberty 提醒说长期坐轮椅容易生股癣。

Being seated all day in a wheelchair or arecliner creates warm, damp pockets in underarms, groin and skin folds that areideal for fungal growth.

一整天都坐在或者斜靠在轮椅上使得腋下、腹股沟、皮肤褶皱的部位温暖、潮湿，容易滋生真菌。

To combat infections:

应对措施：

Dry off completely. After gently washing and drying, dry the area further with ahair dryer on the cool setting.

完全烘干。温和的清洗和干燥后，可以使用电吹风的冷风档进一步吹干。

Wear absorbent clothing. Look for materials that draw moisture away from the surface ofthe skin.

穿易吸汗的衣服。穿一些易吸汗的材质的衣服。

Use medicated remedies. Avoid cornstarch, talcum or other nonmedicated powders thatcan encourage fungus when they get damp.

用药物控制。不要用玉米粉、滑石粉或者其它的无药效的粉剂，因为一旦他们变潮湿就会更容易滋生真菌。

Try herbal remedies. Some tried-and-true remedies include applying apple cidervinegar or vitamin E; eating six cloves of fresh garlic or six to nine garliccapsules a day; eating yogurt with live cultures; and taking more B-complexvitamins.

尝试用草药。一些可靠的办法包括可以涂抹苹果醋或者维他命E；吃6-9颗大蒜胶囊；吃常温存放的酸奶；或者摄取更多的维他命B复合物。

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Pressure sores

褥疮

Whenever skin is under prolonged pressure,tiny blood vessels are compressed, the supply of oxygen and water isinterrupted, and skin starts to die. People who are immobile should have theirskin checked thoroughly at least once a day. An area that stays red longer than15 minutes after pressure is removed is the beginning of a pressure sore. (Fordark-colored skin, look for areas that are darker or purplish-blue in color.)

对于长时间被压在身下的皮肤，毛细血管因为受压而导致氧气和水分供给中断，然后皮肤组织开始死亡。对长期卧床的患者至少每天彻底检查皮肤一次。当皮肤被压发红超过15分钟，褥疮就开始滋生。

To prevent sores:

应对措施“

Keep pressure off bony areas. Use padding to protect the most common pressure points (seegraphic, above). When making a foam pad, don’t cut out the center (as is donefor bunions or corns), as this can further decrease circulation. In bed, realor synthetic sheepskin pads are effective, as are “egg crate” foam mattresspads.

保证骨瘦的地方不受压。用一些垫板来保护最常见的压力点（见上图）。制作泡沫板时，不要把中间给挖空，这样会减少空气流通。在床上可以铺上用真羊皮和人工合成的羊皮制作成的蛋架型的床褥寝具是很有用的（目前患者较多使用防褥床垫，淘宝或医疗商店都有卖）。

Avoid giving massages over bony areas, orpositioning a person directly on the hipbone.

不要按摩骨头突出的地方，不要直接让臀骨受力。（在坐轮椅的时候需要加坐垫）

Beware of recliners. In sitting, the coccyx (tailbone area) takes the brunt of pressure.“As soon as mobility is affected, a pressure relief cushion, like a ROHOor Jay cushion, is a basic necessity,” Huberty says. Ordinary foamor air cushions “just won’t do the job.”

使用躺椅的时候要注意。当坐得时候，尾椎骨承受大多数的压力，Huberty说，一旦影响到患者的运动能力后，使用ROHO或者JAY轮椅垫就非常有必要了，普通的泡沫板或者空气坐垫不能有效的起到保护作用。

                     

ROHO坐垫                                JAY坐垫

Huberty warns that recliners aren’t meantfor people with limited movement and can cause bad pressure sores, especiallywhen people sleep in them at night. Outfit the chair with a proper pressurecushion and keep a close eye out for problems.

Huberty提醒运动受限的患者不要只关心褥疮的问题，给轮椅配合适的减压坐垫也会减少很多问题。

Ideally, immobile people need to be turnedevery two hours. At a bare minimum “one or two position changes a night willgreatly reduce the risk of pressure sores,” Huberty says. A programmableautomatic turning mattress can regularly shift an occupant’s weight, helpingcaregivers get some sleep.

通常，卧床患者需要每2个小时翻身一次。最少一晚上也需要翻身一到两次将会极大的避免褥疮的发生，Huberty说，一种可控的自动翻身床垫可以均匀的移动一个人的质量，能帮助护理人员得到更多的休息。

Don’t drag the skin. “Shearing force” is created when one layer of skin moves butthe other doesn’t. This happens when a person is dragged or sits up in ahospital bed raised to greater than 30 degrees.

切勿拉扯皮肤。当某一层皮肤在动，而其他层皮肤没有在动就会形成了一个“应力差“。特别是当患者向下滑动或者躺在超过30°角的病床上的时候。

Be as active as possible. Nancy Schuman, neuromuscular nursepractitioner at the MDA/ALS Center at the Universityof Washington in Seattle, says the center doesn’t see manypressure sores among ALS patients. She credits education and a philosophy that“encourages patients to be active and not to be in bed, which is probably theworst thing a person can do.”

尽可能的积极面对。Nancy Schuman,西雅图华盛顿大学MDA/ALS医疗中心的神经科护士说，该中心ALS患者中滋生褥疮的不多。她归咎于教育和理念“尽可能的鼓励患者更积极的面对，尽少的卧床，卧床可能是一个人能做的最不理想的事情“

Comfort Food for Skin    可以使皮肤舒适的食物    Skin is best nourished from the inside  out, through healthy foods and eight to 10 glasses of water a day.    皮肤的滋养由内而外，每天需要喝8-10杯水并且保证健康的饮食。    Because vitamins and minerals work  cooperatively to aid skin, start with a daily multivitamin-mineral supplement.  From there, follow healthy eating practices: plenty of fresh fruits and  vegetables, whole-grain breads and cereals, cooked dried beans and peas,  milk, and extra-lean meat or fish.    健康的皮肤需要补充矿物质-维他命。可以吃以下食物： 大量的新鲜水果和蔬菜，各种面包和谷类产品，烧熟的干扁豆和豌豆，牛奶，另外还有瘦肉和鱼类。    Skin care experts recommend including one  linoleic acid-rich food in the daily diet, such as safflower oil, nuts,  avocado or seeds. Other essential fatty acids, which help moisturize skin,  are found in soybeans, salmon, tuna, shrimp and corn oils. Repairing skin  damaged by pressure sores requires extra protein, zinc, and vitamins A, C and  K. Vitamin C also builds collagen, which is adversely affected by ALS.    皮肤护理专家推荐食用富含亚油酸的食物，例如 红花子油、坚果等。还需一些能滋润皮肤的脂肪酸 包括大豆、大马哈鱼、金枪鱼、虾和玉米油。修复因褥疮而损伤的皮肤可以多食用额外的蛋白质、锌和维他命A、C、K。维他命C也能有助于生成由ALS损伤的胶原蛋白。

内容来源于：《MDA/ALSMAGAZINE》：http://alsn.mda.org/article/protection-and-prevention-are-keys-comfortable-skin，感谢街灯的翻译！

xie

很好学习了。:handshake

风清云淡的苗

保证骨瘦的地方不受压。---------学习到了。