不同负压值在负压伤口治疗中的作用

采用负压封闭辅助闭合(vacuum-assisted closure,VAC)技术实施负压伤口治疗是近十几年来提出的伤口治疗新方法,其中负压值的选择是此方法的研究重点。文中针对不同负压值对于伤口血流变化、渗液移除、减少细菌量和促进伤口肉芽组织生长等方面的影响作一综述。     

负压封闭技术的治疗进展

负压封闭技术是一种治疗急、慢性创伤创面和(或)创腔的新疗法,包括负压封闭引流技术和封闭负压辅助闭合技术,该项疗法能促进创面肉芽生长,使创面或创腔达到持续封闭的有效引流,促进炎症消退,有利于大创面的二期修复,因此负压封闭技术在临床中得到越来越广泛的应用,现就其在伤口治疗中的机制及临床应用进行综述。     

探讨封闭负压引流治疗肿瘤患者难愈性伤口

目的：探讨封闭负压引流技术是否通过促进伤口局部血液循环、持续负压引流减低炎症反应来促进慢性创面愈合。方法：选取2008年10月～2010年1月南方医科大学附属江门医院收治的急、慢性创面的肿瘤患者26例为研究对象,应用封闭负压引流技术处理患者的伤口。结果：慢性创面的肿瘤患者应用封闭负压引流技术处理的伤口比传统换药处理的伤口愈合速度快。结论：封闭负压引流技术适合推广应用在临床上急、慢性创面的患者,该技术能促进伤口局部血液循环、持续负压引流减低炎症反应,促进创面愈合。     

负压封闭辅助伤口闭合技术的研究进展

负压封闭辅助伤口闭合（vacuum-assisted closure,VAC）技术是近十多年来提出负压伤口治疗（negative pressure wound therapy.NPWT）的关键技术之一,其临床应用和实验研究取得了显著进展,文中对技术的材料和治疗方法的研究进展作一综述。     

简易负压封闭引流应用于慢性伤口的护理体会

目的：探索简易负压封闭引流治疗慢性伤口的护理方法。方法对15例慢性伤口患者采用简易负压封闭引流治疗。结果15例患者经8 d~15 d简易负压封闭式引流治疗后均恢复良好,伤口周围皮肤红肿均明显减退,伤口内无脓性分泌物,肉芽组织生长好,血运佳,经常规换药后伤口均愈合。结论简易负压封闭引流术用于慢性伤口,可缓解患者痛苦,减少医务人员工作量,并减轻患者的经济负担。     

负压封闭辅助闭合技术在处理慢性伤口中的应用

目的 探讨负压封闭辅助闭合技术(VAC)在处理慢性伤口中的应用效果.方法 将14例慢性伤口患者作为研究对象,所有患者均应用持续低负压中心吸引辅助闭合技术进行负压伤口治疗,治疗后,对患者的伤口愈合计分、愈合方式、治愈时间以及治愈率等指标进行观察.结果 VAC治疗时间为(27.6±22.4)d;其中3例经过VAC后治愈,11例后期结合湿性敷料,8例治愈,2例好转(伤口面积缩小超过94.0%),其余1例因为反复骨髓炎无效后转为外科手术再次清创后换药治愈;治疗1、2以及4周后,患者的PUSH计分明显低于治疗前,经对比差异有统计学意义(P<0.05).结论 治疗慢性伤口患者应用负压闭合技术,能够显著提高患者难愈伤口治愈率,可推广应用.     

西宁地区负压封闭引流治疗慢性溃疡伤口的疗效观察

目的：探讨西宁地区应用负压封闭引流治疗慢性溃疡伤口的疗效。方法：将68例患者随机分为两组。观察组采用负压封闭引流治疗;对照组常规外科无菌清创换药处理伤口。结果：采用负压封闭引流治疗组的总有效率及愈合时间及住院费用明显优于对照组。结论：采用负压封闭引流治疗慢性溃疡伤口,可有利于促进创面的血液循环,减轻组织水肿并控制感染,刺激肉芽组织生长,加速创面愈合,缩短愈合时间。     

负压伤口治疗关键技术的研究进展

负压伤口治疗技术是近十几年来开展的伤口治疗新方法,临床各科得到了应用和发展。本文就负压伤口治疗的两项关键技术(封闭负压引流技术和封闭负压辅助闭合技术)在伤口治疗中的作用机制、适应症、应用、优缺点及注意事项作一综述。     

可冲洗负压封闭引流治疗腹部手术后感染伤口的临床观察

目的 探讨和评价可冲洗负压封闭引流治疗腹部手术后感染伤口的临床效果.方法 140例腹部手术后感染伤口,分为观察组(可冲洗负压封闭引流组)和对照组(无冲洗负压封闭引流组),每组70例,观察比较两组在浅部感染伤口、深部感染伤口中的愈合情况.结果 对于浅部感染伤口,观察组与对照组在伤口清洁时间、伤口愈合时间方面差异无统计学意义(P>0.05),但换药次数明显减少(P<0.05);而对于深部感染伤口,在伤口清洁时间、伤口愈合时间及换药次数等方面,观察组与对照组比较,差异均有统计学意义([ 6.6±2.1)d比(9.2±3.4)d,(14.3±4.3)d比(18.8±5.3)d,(1.8±0.3)次比(3.2±0.8)次,均P<0.05].结论 应用可冲洗负压封闭引流治疗腹部手术后感染伤口,尤其是深部感染伤口,其效果优于无冲洗负压封闭引流.     

负压伤口治疗技术用于36例慢性伤口的效果观察

目的 观察对慢性伤口采取负压伤口治疗技术的效果.方法 选取2014年10月—2016年12月到我科接受治疗的72例慢性伤口患者为研究对象,将其随机分成对照组与观察组,每组均为36例.对照组实行基础治疗处理,观察组则采用VSD材料等进行持续负压封闭技术治疗,对比2组的疗效.结果 经过治疗后,观察组患者的伤口温度、伤口渗液pH值、伤口缩小率均明显优于对照组;观察组的总治愈率明显高于对照组,差异均有统计学意义(P<0.05).结论 与常规治疗相比,在慢性伤口治疗中采取持续负压封闭技术可以取得更好的临床效果,有效提升治愈率,同等时间下更为显著地缩小伤口面积,加快伤口愈合速度,值得在临床中推广应用.     

Wound closure technique for lateral extensile approach to intra-articular calcaneal fractures

Multiple wound closure techniques have been described for a lateral extensile calcaneal incision in the literature. In this article, a technique is presented that involves a subcutilar closure over a closed drain system, which has proven to be effective in minimizing sural nerve injury and wound dehiscence in open reduction internal fixation of 20 calcaneal fractures.     

难愈创面的发生机制和治疗进展

慢性难愈创面形成机制复杂,治疗困难.随着创面愈合机制的研究进展及新治疗技术的临床应用,此种情况有所改观.本文着重讨论了难愈创面的发生机制,并介绍了各种治疗手段如皮肤替代物、生长因子、创面负压治疗技术等的应用进展.     

Diagnostic and Prognostic Utility of Non-Invasive Multimodal Imaging in Chronic Wound Monitoring: a Systematic Review

Monitoring chronic wound [CW] healing is a challenging issue for clinicians across the world. Moreover, the health and cost burden of CW are escalating at a disturbing rate due to a global rise in population of elderly and diabetic cases. The conventional approach includes visual contour, sketches, or more rarely tracings. However, such conventional techniques bring forth infection, pain, allergies. Furthermore, these methods are subjective as well as time-consuming. As such, nowadays, non-touching and non-invasive CW monitoring system based on imaging techniques are gaining importance. They not only reduce patients’ discomfort but also provide rapid wound diagnosis and prognosis. This review provides a survey of different types of CW characteristics, their healing mechanism and the multimodal non-invasive imaging methods that have been used for their diagnosis and prognosis. Current clinical practices as well as personal health systems [m-health and e-health] for CW monitoring have been discussed.     

三种新技术在创面修复中的临床应用

创面的修复和再生是一个高度复杂的过程,虽然主要难点依然存在,但随着科技的发展,一些新的治疗技术和方法在临床上的应用,创面修复已经得到很大的进步。本文的目的是概略介绍目前文献中提到最多的三种实用的、先进的治疗方法：组织工程,封闭负压疗法、高压氧治疗技术在创面修复中的应用。     

海军基层卫生人员现场急救技术训练现状调查

目的 了解海军基层卫生人员对战伤救治技术的掌握程度,为改进战伤救治训练提出建议。方法 结合海军开展的群众性战伤救治技术练兵活动,针对新大纲、新考核标准的要求,自制调查问卷,对172名海军基层卫生人员进行调查,区分熟练、较熟练、不熟练和难以掌握的技术及其构成比,重点分析战伤救治训练开展情况和战伤救治技术掌握情况。结果 回收有效问卷172份,有效回收率100%。海军基层卫生人员掌握较好的技术为止血、通气、包扎、固定、搬运、基础生命支持六大传统技术,而经骨输液技术、高级气道管理等技术掌握不熟练、甚至难以掌握。结论 应持续开展群众性战伤救治技术练兵活动,改进现代战伤急救理念,加强培训,建立实战化战伤救治训练和考评系统,以提高海军基层卫生人员战伤救治能力。     

Surgical wound sepsis

With the help of a surgical nurse and using data-processing techniques, a prospective clinical study was conducted to determine the wound infection rate in two hospitals in Calgary. The overall sepsis rate was 5.2% and the clean wound rate 3.5%. The latter is the more meaningful figure as it allows for comparison between hospitals, specialties and individuals and is a good guide for hospital morbidity reviews. The groundwork for succeeding wound infection is laid in the operating theatre, and it is believed that wound infection would be reduced more by attention to Halsted's principles than by more rigid aseptic techniques. It is estimated that wound sepsis costs the Province of Alberta 1.5 million dollars per year for hospitalization alone. This amounts to roughly $1 per person per year. The annual cost of a prospective study such as the present one is approximately $7000. This is equivalent to the cost of hospitalizing 24 patients with infected wounds for one week (at $300 per week). One dividend of a prospective study is an associated reduction in infection rate. This reduction more than pays for the cost of the program.     

会阴侧切术后“T”形裂伤的缝合对伤口愈合的影响研究进展

根据临床上常用的会阴侧切缝合方法及愈后、会阴自然裂伤的缝合方法及愈后、会阴侧切术后＂T＂形裂伤的缝合方法及愈后等方面阐述会阴侧切术后＂T＂形裂伤的缝合方法对伤口愈合的影响,结合近年的相关研究,提出缝合材料、缝合方法、预防感染对伤口愈后至关重要。探讨会阴侧切术后＂T＂形裂伤缝合时缝线选择、缝合方法、缝合步骤及技巧,为提高会阴侧切术后＂T＂形裂伤的缝合技术提供参考,以提高此类裂伤的愈合率。     

皮肤软组织创伤的早期整形外科处理

目的探讨运用整形外科原则和技术,对急性皮肤软组织损伤进行紧急处理的方法,尽可能使瘢痕面积减少。方法严格清洁体表皮肤软组织急性创伤面,再根据创伤面的具体情况运用适当的整形外科原则和技术对其进行处理。对于不伴组织缺损的普通裂伤运用整形外科精细缝合法来关闭伤口,对于伴有组织器官缺损的创面运用组织移植方法来修复伤口,如皮片、皮瓣移植等常用的整形外科技术。结果该组共治疗了1800例患者,1687例I期愈合,随访患者6个月~1年,无明显瘢痕增生现象发生,功能上也都基本实现无障碍,不需要做II期修复手术,达到了减轻瘢痕的美容效果。结论通过运用整形外科基本原则和技术来处理各种急性皮肤损伤,是能够达到良好的美容效果的,在临床上值得对其进行推广和应用。     

The Jones compression bandage. Review and clinical applications

Lower-extremity edema is a common condition that can be caused by many pathophysiologic processes. Control of edema associated with surgery or trauma is important and will help minimize pain and discomfort and prevent wound complications and blisters. Many techniques are used to control edema. The Jones compression dressing is an excellent tool that has been used successfully by the senior author for 18 years. It continues to be a primary treatment technique for the control of edema.     

Wound sepsis in 10,000 surgical patients.

A twelve year prospective wound audit was undertaken in an academic surgical unit. Data from 10,000 operations were analysed. Overall, wound infection rates decreased during this time. Infection rates in contaminated wounds in particular fell from 19.2% to 4.7%. This decrease in wound infection may be related in part to a change in the antibiotic prophylactic regimen and in part to the institution of the wound sepsis audit which provided regular information on the unit infection rates. This audit permitted early detection of adverse trends, and may have had a direct influence on surgical techniques.