伤口湿性愈合的新理念

湿性愈合的概念是近几年来，国外新型敷料不断进入医疗市场，并为伤口治疗、换药提出一个关于伤口愈合的新理念。同时为换药、伤口护理带来了新的措施和新的方法。更重要的是对传统的、常规的换药方法提出了挑战。     

湿性愈合疗法在腹部二期愈合手术切口中的应用

目的比较湿性与干性愈合疗法对腹部二期愈合手术切口的疗效。方法腹部手术后切口二期愈合患者60例,随机分为治疗组(31例)和对照组(29例)。治疗组采用湿性愈合疗法处理伤口,对照组采用常规方法换药。结果治疗组治愈率为83.9%,总有效率为96.8%,对照组治愈率为51.7%,总有效率为69.0%,两组比较有统计学差异(P0.05)。治疗组换药(6.8±2.0)次,明显少于对照组的(26.6±6.8)次(P0.05);治疗组治疗时间为(16.2±4.0)d,明显短于对照组的(28.5±7.2)d(P0.05)。结论湿性愈合疗法治疗时间短,换药次数少,治愈率及总有效率高,优于传统的干性愈合疗法,值得临床推广。     

湿性敷料在腹部手术术后伤口愈合不良中应用效果的观察

伤口愈合不良是外科手术后常见的并发症之一,发生率约为8．4％,不仅增加患者痛苦及治疗费用,延长患者住院时间,还会危及患者的生命,增加医护人员的工作量。我们选择应用以康惠尔系列产品为代表的湿性敷料用于腹部手术术后愈合不良伤口的换药,并与传统纱布敷料换药效果相比较,报告如下。     

湿性愈合理论在糖尿病足伤口处理中的实践

目的探讨处理糖尿病足伤口的方法。方法对2004年3月～2010年6月运用先进的湿性愈合敷料处理的糖尿病足伤口61例进行回顾性分析。结果湿性愈合敷料能溶解伤口坏死组织,有助于自溶性清创、促进肉芽生长。结论湿性愈合理论指导下的糖尿病足伤口处理方法能达到加快伤口愈合、有效降低致残率,提高病人的生存质量的目的。     

龙血竭外敷治疗肿瘤术后难愈合性伤口的效果观察

目的观察龙血竭治疗恶性肿瘤患者术后难愈合性伤口的效果。方法将77例恶性肿瘤术后难愈合伤口患者随机分为观察组(39例)与对照组(38例)。对照组采用常规换药,观察组采用龙血竭胶囊药粉外敷。结果观察组治疗3个疗程的效果显著优于对照组(P0.01)。结论龙血竭能改善伤口局部微循环障碍,提高恶性肿瘤术后难愈合伤口治愈率。     

红光和红外线辅助治疗创伤性伤口减痛促愈效果观察

目的 观察评价红光与红外线辅助治疗创伤性伤口的减痛促愈效果.方法 将107例创伤性伤口患者随机分为三组,分别为红光治疗20 min组(A组)36例和10 min组(C组)35例及红外线治疗10 min组(B组)36例,三组伤口处理均采用标准的湿性疗法,仅物理干预方法和时间不同,每种物理干预疗程均设为2个疗程28 d,治疗第1天、第7天和第14天测量每组伤口照射前后温度、疼痛评分;治疗后第7、14、21和28天测量伤口面积并计算伤口缩小率,记录伤口愈合时间.结果 干预治疗28 d,三组治愈率和愈合时间比较,差异无统计学意义(均P＞0.05).不同时间三组伤口缩小率、伤口温度和伤口疼痛评分比较,时间主效应均P<0.01.结论 红光10～20 min和红外线10 min均能提升伤口温度、减轻疼痛、促进伤口愈合和缩短愈合时间,连续干预28 d是安全有效的,以红光20 min法效果更优.     

运用湿性愈合法治疗四期压疮的护理体会

目的:总结和探讨四期压疮护理要点.方法:运用伤口湿性愈合法治疗四期压疮.结果:减轻患者疼痛,缩短伤口愈合时间.     

银离子敷料治疗糖尿病足伤口效果观察

糖尿病足是指与局部神经异常和下肢远端外周血管病变相关的足部感染、溃疡或深层组织破坏,其主要临床表现为足溃疡与坏疽,是糖尿病患者常见的一种慢性并发症,也是患者致残的主要原因之一。据统计,其发生率为15％～20％。近年,我科采用银离子敷料治疗糖尿病足,效果较好,介绍如下。     

银离子敷料治疗糖尿病足伤口效果观察

糖尿病足是指与局部神经异常和下肢远端外周血管病变相关的足部感染、溃疡或深层组织破坏,其主要临床表现为足溃疡与坏疽,是糖尿病患者常见的一种慢性并发症,也是患者致残的主要原因之一.据统计,其发生率为15%~20%[1].近年,我科采用银离子敷料治疗糖尿病足,效果较好,介绍如下.     

Moist Wound Healing with Occlusive Dressings: A Clinical Focus

The concept of moist wound healing, which is facilitated by the application of occlusive dressings, dates back to 1615 BC, and the technique is currently supported by a relatively large volume of data. It is clear that occlusive dressings are in many cases associated with more rapid reepithelialization, a reduced risk of infection, and more rapid wound healing than the alternatives. Nevertheless, many clinicians have been slow to accept this therapeutic technique. This article traces the history of moist wound healing from its earliest inception, examines the theoretical mechanisms of its effect, and explores its advantages and disadvantages. It also reviews the literature supporting the use of occlusive dressings in a variety of wound settings and examines the possible reasons behind the apparent reluctance on the part of the medical community to accept a potentially valuable therapy.     

新型湿性敷料在高位肛瘘术后创面中的应用

为探讨新型湿性敷料联合应用对促进高位肛瘘术后创面愈合的疗效,将35例高位肛瘘手术患者随机分为治疗组（新型湿性敷料）和对照组（传统方法）,进行创面愈合疗效的比较。结果显示,治疗组在减轻创面疼痛、渗出及创面愈合率方面均明显优于对照组（P〈0．01）。结果表明,新型湿性敷料联合应用在肛瘘术后的创面,能较好地控制局部感染,促进肉芽组织增生,加速上皮生长,并能缩短创面愈合时间,具有临床应用价值。     

光动力疗法在皮肤创面愈合中的作用

光动力疗法（PDT）是一种物理疗法,其作用机制在于利用光、光敏剂及氧的互相作用,从而发挥治疗疾病的作用,逐渐广泛应用于肿瘤疾病、皮肤疾病的临床治疗中。皮肤伤口愈合的生理过程较为复杂,是一种动态化改变。正常情况下皮肤可以通过自我更新和分化来维持皮肤代谢,但皮肤发生创伤后,皮肤中剩余的扩展多能干细胞（EPSCs）被激活并产生更多的扩增细胞。当EPSCs受损,皮肤则失去了自我修复的功能。随着PDT在临床的应用,其可对受损皮肤组织进行重建,对于促进皮肤感染和非感染性伤口的愈合具有积极作用。本文对PDT在皮肤创伤愈合中的作用、机制及临床意义作一综述,以期为同类皮肤疾病的治疗提供一定参考依据。     

创面修复的影响因素与治疗进展

从局部、全身和心理精神三大方面介绍影响创面修复的因素,综述促进创面修复的治疗进展.提示影响创面修复因素有局部、全身和心理精神因素,创面修复的治疗进展主要体现在基因工程、生物工程材料、纳米技术、中西医结合技术、创面覆盖物的应用以及营养辅助、氧气、心理治疗等方面.     

Low-Level Laser Therapy for Wound Healing: Mechanism and Efficacy

BACKGROUND: Given the recent interest in light-emitting diode (LED) photomodulation and minimally invasive nonablative laser therapies, it is timely to investigate reports that low-level laser therapy (LLLT) may have utility in wound healing. OBJECTIVES: To critically evaluate reported in vitro models and in vivo animal and human studies and to assess the qualitative and quantitative sufficiency of evidence for the efficacy of LLLT in promoting wound healing. METHOD: Literature review, 1965 to 2003. RESULTS: In examining the effects of LLLT on cell cultures in vitro, some articles report an increase in cell proliferation and collagen production using specific and somewhat arbitrary laser settings with the helium neon (HeNe) and gallium arsenide lasers, but none of the available studies address the mechanism, whether photothermal, photochemical, or photomechanical, whereby LLLT may be exerting its effect. Some studies, especially those using HeNe lasers, report improvements in surgical wound healing in a rodent model; however, these results have not been duplicated in animals such as pigs, which have skin that more closely resembles that of humans. In humans, beneficial effects on superficial wound healing found in small case series have not been replicated in larger studies. CONCLUSION: To better understand the utility of LLLT in cutaneous wound healing, good clinical studies that correlate cellular effects and biologic processes are needed. Future studies should be well-controlled investigations with rational selection of lasers and treatment parameters. In the absence of such studies, the literature does not appear to support widespread use of LLLT in wound healing at this time. Although applications of high-energy (10-100 W) lasers are well established with significant supportive literature and widespread use, conflicting studies in the literature have limited low-level laser therapy (LLLT) use in the United States to investigational use only. Yet LLLT is used clinically in many other areas, including Canada, Europe, and Asia, for the treatment of various neurologic, chiropractic, dental, and dermatologic disorders. To understand this discrepancy, it is useful to review the studies on LLLT that have, to date, precluded Food and Drug Administration approval of many such technologies in the United States. The fundamental question is whether there is sufficient evidence to support the use of LLLT.     

生肌膏对糖尿病足患者的疗效及对其创面愈合相关指标及预后的影响分析研究

目的:探究生肌膏对糖尿病足患者的疗效及对创面愈合相关指标和预后的影响。方法:选取我科收治的120例糖尿病足患者,根据治疗方式的不同,分为研究组及对照组两组(各60例),其中对照组采用常规治疗,研究组在常规治疗基础上联合生肌膏治疗,比较两组患者的临床疗效、中医证候积分、相关血清指标及生活质量评分等差异。结果:治疗后,研究组患者的创面相关愈合指标均较对照组明显改善(P<0.05);治疗后研究组患者患足的中医证候积分均较对照组明显改善(P<0.05);治疗后研究组患者的血小板衍生生长因子(PDGF)、血管内皮生长因子(VEGF)均较对照组明显改善(P<0.05);1个月后,研究组患者的生活质量评分显著高于对照组患者(P<0.05)。结论:生肌膏对糖尿病足患者的疗效较佳,不仅可促进创面愈合,还可提高患者的生活质量,值得临床推广应用。