Бинты эластичные средней растяжимости, тканые и вязаные, что выбрать?
Медицинские эластичные бинты применяются для профилактики и лечения хронических венозных воспалительных процессов в до- и послеоперационный периоды, а также для профилактики образования гематом и удержания эндопротезов в стабильном состоянии при пластических операциях, профилактики и лечения травм суставов, мышц и связок, связанных со спортом.
В зависимости от того, какое давление повязка оказывает на поврежденный участок конечности, выделяют бинты малой, средней и высокой растяжимости. Бинты выпускаются разной ширины и длины. Кроме того, в зависимости от технологии производства, различаются бинты тканые и вязаные.
Чем тканые бинты отличаются от вязаных?
Тканая технология производства бинта придает ему особую выносливость даже при особо длительном применении (до 1 года и более) и после многократных стирок. Растяжимость вязаных бинтов после нескольких стирок заметно снижается.
Какой бинт выбрать?
Эластичные бинты, применяемые в компрессионной терапии венозных и лимфатических сосудов конечностей, различаются по нескольким характеристикам. Если врачом не предписан какой-то конкретный вид эластичного бинта, выбрать нужный вариант среди всех представленных непросто. 
Различные производители предлагают эластичные бинты с разной степенью растяжимости — от 30 до 170 и даже более процентов. Чем больше растяжимость бинта, тем меньше давление под повязкой (при накладывании одним слоем). Бинты средней степени растяжимости создают большее “рабочее давление” во время нагрузки и минимальное в покое. Поэтому такие бинты чаще используются при лечении более запущенных заболеваний, где необходимо создать среднее или высокое давление под повязкой.
Особенности эластичных бинтов:
Вязаные эластичные бинты:
- Высокое содержание хлопка.
- Изготовлены вязаным способом из натуральных материалов (хлопковой пряжи и латексных нитей); воздухопроницаем, не раздражает кожу.
- Легко моделируется на конечности и закрепляется при помощи клипс.
- За счет своей объемной структуры витки бинта не скользят и повязка хорошо удерживается.
Тканые эластичные бинты:
Эластичные бинты. Дань уходящему времени или повседневная необходимость?
Использование компрессионных изделий, безусловно, является одним из самых доступных и распространенных методов локального лечебного воздействия в различных областях медицины.
В настоящее время позитивное влияние компрессии на формирование послеоперационного рубца и профилактики его келоидной трансформации используется при лечении ожогов в пластической хирургии. С целью ранней иммобилизации для предотвращения прогрессирования отека тканей нашло широкое применение в спортивной медицине и амбулаторной травматологии. Тем не менее, основной областью применения лечебных компрессионных изделий, с учетом распространенности и социальной значимости патологии, является их использование при хронической венозной недостаточности (ХВН) нижних конечностей.
Эпидемиологические данные, представленные многими ведущими зарубежными клиницистами свидетельствуют о значительной распространенности ХВН. Последние данные, о распространенности хронической патологии вен нижних конечностей среди россиян, опубликованные отечественной группой ученых под руководством академика В.С.Савельева, наглядно показывают масштабность данной проблемы. 38 млн. россиян страдают ХВН нижних конечностей. 15 млн. из них нуждаются в хирургическом лечении. 10 млн. имеют тяжелые формы ХВН из них у 5млн. имеются открытые трофические язвы, 1,8 млн. — являются инвалидами в следствие ХВН.
С позиции современных представлений об этиологии и патогенезе хронической венозной недостаточности адекватная компрессионная терапия является фундаментом комплексного лечения у данной группы пациентов. Терапевтический эффект компрессионного лечения определяется целым рядом механизмов действия: ускорение венозного оттока и снижение патологической венозной «емкости» нижних конечностей, происходит за счет уменьшения диаметра поверхностных вен и межмышечных венозных сплетений. Устранение или уменьшение венозного рефлюкса реализуется как следствие улучшения функциональной способности клапанов вен за счет их диаметра. Возрастание резорбции тканевой жидкости в венозном колене капилляра и снижением ее фильтрации в артериальном за счет повышения тканевого давления. Увеличение фибринолитической активности плазмы крови за счет более интенсивной выработки тканевого активатора плазминогена. Компрессионное лечения показано при любой форме ХВН. В зависимости от характера патологии и преследуемых целей она может быть назначена на ограниченный или длительный срок. На ограниченный промежуток времени назначают при хирургическом или инъекционном лечении варикозной болезни, профилактики ХВН во время беременности, профилактики и лечении острого венозного тромбоза у пациентов хирургического, терапевтического, неврологического и т.д. профиля. Показаниями к длительной компрессии являются посттромботическая болезнь, трофические расстройства в т.ч. открытые трофические язвы нижних конечностей, врожденные аномалии развития венозной системы, хроническая лимфовенозная недостаточность, при наличии противопоказаний к оперативному лечению ХВН. По мнению многих авторов абсолютных противопоказаний к эластической компрессии не существует. В качестве относительных противопоказаний можно рассматривать облитерирующие заболевания артерий (РСД
Тем не менее, широкая распространенность эластичных бинтов, доступность и, порой незаменимость продолжают делать их необходимым атрибутом в повседневной клинической практике врачей для реализации многих лечебных задач. До сих пор эластичные бинты являются методом выбора при лечении пациентов с трофическими язвами в следствии ХВН. Трудности, а порой невозможность использования трикотажа при наличии выраженных венозного или лимфатического отека, индивидуальных особенностей строения нижних конечностей определяют необходимость использования эластичных бинтов. Поэтому, противопоставлять компрессионный трикотаж эластичным бинтам было бы поспешным. В связи, с чем возникает необходимость детального рассмотрения показаний к выбору и правилам наложения эластичных бинтов.
Классификация и виды эластичных бинтов.
Продукция немецкой компании Пауль Хартманн (Германия) имеет в своем арсенале достаточно широкий ассортимент эластичных бинтов, в которых гармонично пересекаются качество и эстетические свойства, что в сочетании с адекватным выбором и соблюдением правил наложения эластичных бинтов определяют их положительное лечебное воздействие. По своим свойствам компания предлагает бинты с цинковой пастой, текстильные, когезивные и пластырные бинты.
Бинты с цинковой пастой (Varix) это готовый к использованию стерильный марлевый бинт с цинковой пастой длиной 5, 7 и 10 метров, которую можно использовать изолированно и в качестве 3-х слойной повязки вместе с Stulpa и Putterbinde. По механизму действия сопоставим с известной долговременной цинк-желатиновой повязкой Unna. Применяется для быстрой ликвидации отеков нижних конечностей различной этиологии. Зарубежные клиницисты рекомендуют использовать Varix для профилактики тромбоэмболических осложнений у хирургических пациентов во всех группах риска в предоперационном и раннем послеоперационном периоде. Проведенные последние научные исследования по применению повязки Varix показали его позитивное влияние на заживление трофических язв, особенно в сочетании явлениями периульцерозного дерматита и экземы. Так как лечебные свойства наложенной повязки сохраняются до 10-14 дней, в связи с чем использование Varix является экономически обоснованным методом лечения в амбулаторном практике у данной категории пациентов.
Текстильные бинты (Putterbinde, Idealbinde, Idealflex) характеризуются высоким содержание хлопка, при этом эластичные свойства определены особым способом плетением нити. Поэтому эти бинты являются выбором в лечении пациентов с повышенным местным аллергическим фоном, с трофическими изменениями нижних конечностей, в том числе, при открытых трофических язвах венозной этиологии. Может поэтому не случайно Putterbinde является своеобразным бестселлером среди отечественных и зарубежных врачей.
Когезивные бинты (Idealhaft, Idealast-haft, Lastohaft, Idealast color) имеют двухсторонний эффект сцепления за счет микроточечной пропитки латексом.
Пластырные бинты (Hypolastic, Ideaiplast) имеют односторонний эффект сцепления за счет нанесения на поверхность бинта гипоаллергенного полиакрилатного клея. Как и когезивные бинты идеальны для длительной фиксации. Как и предыдущие два типы бинтов все они имеют высокое содержание хлопка, воздухопроницаемы, устойчивы к облучению и стерилизации.
Так как выбор, наложение и контроль в процессе использования эластичных бинтов относится к врачебной процедуре, то необходимо перед выбором «правильных» бинтов руководствоваться таким важным параметром для всех видов эластичных бинтов как степень из растяжения.
В зависимости от степени растяжения бинты делятся на три типа:
• короткой – (удлинение бинта не более чем на 70% от исходной длины). К этому типу бинтов относятся: Idealhaft, Lastobind, Hypolastic, Lastocomp, Ideaiplast.
• средней – (70-140%). Это таки бинты как Putterbinde, Idealbinde, Idealast, Idealast-haft, Idealast color, Idealflex.
• длиной – более 140%. Представителями этого типа бинтов являются Lastohaft, Lastodur-straff и Lastodur-weich.
Основными параметрами, определяющими терапевтический эффект бинта является «рабочее давление». Это такое давление, с которым повязка давит на ногу при мышечном сокращении. «Давление покоя» это давление, с которым давящая повязка или компрессионный бандаж действуют на ногу при расслабленных мышцах.
Таким образом, бинты короткой степени растяжения оказывают высокое рабочее давление и низкое давление покоя. Это важно учитывать при сохранении двигательной активности пациента в ходе лечения.
Между тем бинты длиной растяжимости оказывают низкое рабочее давление и высокое давление покоя. Область их применения ограничена профилактикой кровотечений и формирования гематом в ближайшем послеоперационном периоде на венозной системе нижних конечностей или у лежачих пациентов для профилактики тромбоэмболических осложнений при отсутствии антитромботических чулок.
Бинты средней степени растяжимости (70-140%) занимая срединное положение между коротко- и длинорастяжимыми бинтами обладает их преимуществами и могут с успехом использоваться в том и другом случаях. Это делает их универсальными в том числе и в затруднительных случаях выбора «правильного» бинта.
Правила наложения эластичного бинта.
Характерной особенностью компрессионной терапии бинтами является необходимость обязательного участия медицинского работника (врача или сестры) в наложении бандажа. Как показывает практика, не более 5% пациентов овладевают навыками правильного бинтования конечности. Остальные накладывают бандаж с такими погрешностями, которые способны привести лишь к ухудшению симптоматики. Чтобы избежать возможных осложнений при наложении эластичного бинта пациента необходимо научить бинтовать ногу. Для этого нужно следовать определенным правилам:
• повязку накладывают при тыльном сгибании стопы;
• начинают от основания пальцев стопы с захватом пятки;
• бинт должен следовать форме конечности;
• необходимо формировать цилиндрический профиль конечности. При наложении компрессионного бандажа необходимо учитывать распределение давления на поверхности конечности – закон Лапласа (давление = сила натяжения бинта/ радиус конечности). Например: сегменты конечности с малым радиусом (лодыжки, край стопы, передняя поверхность голени) компрессия всегда выше по сравнению с относительно плоскими участками (тыл стопы, подколенные и подлодыжечные ямки). В этом случае можно использовать дополнительные аксессуары, обеспечивающие выравнивание давления и создание «цилиндрического профиля» при помощи Rolta, Rolta soft. При правильно наложенном компрессионном бандаже в покое кончики пальцев синеют. При начале движения они должны восстановить свой обычный цвет. После наложения эластического бинта пациенту рекомендуют тренировочную ходьбу в течение 20-30 минут. Если в этот промежуток времени появляются ишемические боли, — требуется коррекция повязки.
наложения долговременной многослойной компрессионной повязки с использованием продукции компании Пауль Хартманн при открытой трофической язве годени (С6 класс ХВН по СЕАР). После обработки трофической язвы раствором антисептика от нижней трети голени накладывается первым слоем повязка Varix с последующеи наложением защитного трубчатого хлопкового чулка Stulpa. В подлодыжечные ямки для придания цилиндрического профиля конечности накладывается Rolta или Rolta soft которым можно фиксировать пластырем (Fix-elastic и т.п.). В дальнейшем накладываем Putterbinde по любой из выбранной методике (Sigg, Fischer, Putter technique) с соблюдением правил наложения бандажа. Следующую перевязку осуществляем через 10-14 дней.
1. Плохой результат компрессионной терапии — это результат плохой компрессии. Поэтому важно иметь четкие представления о правилах наложения и контроле эффективности эластичного бандажа.
2. Дифференцированный подход к выбору компрессионного воздействия основанный на характере патологических изменений и лечебным задачам, обеспечивает максимальное лечебное воздействие и комфорт на всем протяжении курса лечения пациента.
3. Эластичные бинты прочно занимают свою нишу практического применения в различных клинических ситуациях, основанный на доступности, эффективности метода. При этом методом выбора их использования, является лечение трофических венозных язв, наличие индивидуальных особенностей строения нижних конечностей.
4. С учетом сложности методики правильного наложения компрессионных бинтов, постоянного контроля медицинского персонала в течение всего периода их использования методом выбора является использование компрессионного трикотажа.
Эластичный бинт — изделие, которое используется во многих сферах медицины: в травматологии, ортопедии, хирургии и др. Он обладает широкой областью применения и отличается разнообразием видов. Главная особенность — возможность многоразового использования. Но для этого необходимо соблюдать основные правила применения и ухода за бинтом.
При выбора изделия следует предварительно проконсультироваться с врачом.
Эластичный бинт представляет собой мягкую на ощупь ленту, сохраняющую форму. Для его изготовления используют лайкру, хлопок и синтетические материалы. Лучше отдать предпочтение изделию из хлопчатобумажной ткани, так как она обладает хорошей проводимостью воздуха. Это обеспечивает дыхание кожи в области повязки. Стоимость продукта зависит от качества и области применения.
- 1. Травматология. Эластичные повязки накладывают для фиксации переломов и предотвращения риска отека тканей. Ее снятие происходит после исчезновения отека. После накладывают гипсовую повязку. Это защищает от осложнений, связанных с нарушением кровообращения в окружающих тканях.
- 2. Ортопедия. В этой области бинты применяют как профилактическое средство — для фиксации ослабленных связок и суставов.
- 3. Хирургия. Эластичные бинты назначаются после оперативного вмешательства для улучшения процесса заживания ран, коррекции циркуляции крови и лимфы, а также для предотвращения чрезмерного образования рубцов.
- 4. Спорт. Использование эластичных повязок позволяет избежать травматизации суставов, растяжения мышц и развития варикозной болезни нижних конечностей в силовых видах спорта. Эластичные повязки значительно снижают нагрузку на коленные суставы и уменьшают степень их износа.
- 5. Лечение варикоза. Правильно наложенный бинт уменьшает диаметр расширенных вен и снижает их патологическую наполняемость.
- 6. Терапия лимфедемы. При этом заболевании происходит застой лимфы в тканях и образование отека. Наложение эластичной повязки проводится с целью предупреждения отека тканей.
По форме эластичные бинты делятся на ленточные и трубчатые.
В зависимости от материала и технологии производства существует несколько видов эластичных бинтов:
| Название | Характеристики |
Латексные  |
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Тканные  |
|
Вязаные  |
|
Трубчатые  |
|
Фиксирующие самоскрепляющиеся  |
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Наиболее популярными считаются тканные бинты из хлопка с различными включениями лайкры, полиамида и латекса.
Для удобства использования на различных участках тела эластичные бинты различаются по длине:
| Участок тела | Длина изделия |
| Запястье | От 1 до 1,5 м |
| Голеностоп | От 1,5 до 2 м |
| Локоть или колено | От 2 до 3 м |
| Рука | От 3 до 4 м |
| Нога | 5 м |
По ширине бинты бывают от 5 до 12 см.
Растяжимость бинта достигается за счет используемых компонентов. Если в составе присутствует большое количество хлопка, то продукт будет менее растяжим. Если больше полиэстера, то наоборот.
Для определения действия бинта используются понятия:
- 1. Рабочее давление — сила, с которой бинт воздействует на напряженные мышцы.
- 2. Давление покоя — сила воздействия на расслабленные мышцы.
Существует три категории бинтов, отличающихся друг от друга степенью растяжимости:
| Растяжимость | Характеристики |
| Высокая или длинная |
|
| Средняя |
|
| Низкая или короткая |
|
Особенности эластичных бинтов:
- 1. Равномерность давления достигается за счет высокой растяжимости.
- 2. Высота давления зависит от количества слоев (чем больше слоев, тем выше давление ).
- 3. Чем больше хлопка содержится в продукте, тем легче он накладывается на выступающие участки тела (колено, плечо).
Раньше эластичные бинты фиксировались путем подворачивания конца под витки. Сейчас для этого существуют специальные зажимы, металлические крепления и липкие концы.
Для достижения желаемого результата необходимо следовать определенным принципам:
- 1. Нельзя накладывать бинт на отек.
- 2. Перед использованием на конечности нужно подержать ее некоторое время в вертикальном положении.
- 3. Эластичный бинт всегда накладывают от узкого места к широкому.
- 4. Наложение должно происходить снизу вверх, а не наоборот.
- 5. Следует не допускать образование складок.
- 6. Каждый последующий виток должен перекрывать предыдущий на 1/3.
- 7. Для обеспечения равномерности давления в области суставов нужно руководствоваться следующими правилами:
- Бинтование лучезапястного сустава начинается от пальцев и заканчивается серединой предплечья.
- Локтевого — от середины предплечья до середины плеча.
- Голеностопного — от пальцев ноги до середины голени.
- Коленного — от середины голени до середины бедра.
- 8. Повязку надо снять, если появилось чувство онемения и пульсации.
- 9. Бинтование используют только во время активности.
- 10. Не рекомендуется накладывать бинт на ночь во избежание нарушения кровообращения.
Советы по уходу:
- 1. Стоит избегать машинной стирки. Лучше стирать вручную с использованием мыла.
- 2. Пред сушкой — отжать с помощью полотенца.
- 3. Нельзя замачивать в горячей воде.
- 4. При использовании мазей и растворов рекомендуется применять изолирующие прокладки.
- 5. Некоторые модели не подлежат глажке.
В настоящее время эластичные бинты представлены в широком ассортименте.
Некоторые фирмы и их особенности:
| Производитель | Страна | Характеристики |
| ООО «Альмед» | Россия |
|
| «Интекс» | Россия |
|
| ООО «ЛСЭЗ Лаума Фабрикс» | Латвия |
|
| ООО «Леонарда-Сервис» | Россия |
|
| «Тонус» | Россия |
|
| «MedTextile» | Швейцария |
|
| «Hartmann» | Германия |
|
| Название | Производитель | Характеристики |
| Идеаласт колор когезив | «Hartmann» |
|
| Венопроф с ионами серебра | «Интекс» |
|
| Бинт фирмы «Lauma» | «Lauma» |
|
| Декомпрессионный бинт средней растяжимости | «MedTextile» |
|
| Декомпрессионный бинт высокой растяжимости | «Фарм» |
|
Перед покупкой эластичного бинта лучше посоветоваться с врачом. Он поможет подобрать подходящее изделие, отталкиваясь от причины патологии.
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