创口保护膜在皮肤护理中的应用

目的探讨创口保护膜对腹泻、大小便失禁、造口及肠瘘病人皮肤的保护作用.方法应用3M创口保护膜对需保护的皮肤进行喷洒.结果对大小便或分泌物浸渍的皮肤有明显预防作用,有效控制皮炎发展,而且不影响造口袋的粘贴,病人感觉舒适,提高病人的生活质量.结论创口保护膜使用简单,效果满意,特别适用于腹泻、大小便失禁、造口及肠瘘病人的皮肤保护.     

创口保护膜在皮肤护理中的应用

目的 探讨创口保护膜对腹泻、大小便失禁、造口及肠瘘病人皮肤的保护作用。方法应用3M创口保护膜对需保护的皮肤进行喷洒。结果 对大小便或分泌物浸渍的皮肤有明显预防作用，有效控制皮炎发展，而且不影响造口袋的粘贴，病人感觉舒适，提高病人的生活质量。结论 创口保护膜使用简单，效果满意，特别适用于腹泻、大小便失禁、造口及肠瘘病人的皮肤保护。     

医用胶对剖宫产切口的愈合效果观察

目的观察妇产科剖宫产手术后应用医用胶粘合腹部切口的效果,探讨相应的护理方法。方法选择2011年1月~2013年1月以来妇产科行剖宫产手术的74例患者作为观察组,应用医用胶粘合切口代替传统针线缝合法,同期应用针线缝合患者65例作为对照组。比较切口愈合情况。结果观察组缝合时间小于对照组,且愈合率显著高于对照组,两组比较差异均有统计学意义(P0.05)。结论与传统针线缝合方法相比,应用医用胶粘合剖宫产切口手术时间短,操作简单,减少了切口暴露的时间,从而减少了感染机会,有助于切口愈合,同时缩短了缝合时间,值得推广。     

应用创口净冲洗鼻腔在鼻咽癌放射治疗中的效果观察

通过对114例鼻咽癌病人在放疗期间使用创口净冲洗进行观察总结，使鼻咽癌病人在放疗中出现的口腔、鼻腔、鼻咽等分泌物增多、粘膜充血水肿、溃疡等并发症得到改善，提高了治疗效果及生活质量。     

康派特医用胶用于会阴切口的效果观察

<正>阴道分娩时,为避免分娩造成严重会阴裂伤、缩短第二产程,利于胎儿顺利娩出,部分产妇需进行会阴切开协助分娩[1]。传统的会阴切口用可吸收缝线或丝线进行逐层缝合,缝合后产妇会阴疼痛及肿胀较明显,加之阴道恶露对会阴切口的不良刺激,易造成会阴切口感染,影响产妇产后恢复。康派特医用胶系α-氰基丙烯酸酯类医用高分子化合物经过改性而成的快速医用组织粘合剂,近年来逐渐应用于临床关闭切口皮肤[2]。     

新型敷料用于过度渗出创口的效果观察

目的:探讨新型敷料对促进过度渗出创口愈合的临床效果。方法:将80例过度渗出创口的病人随机分为实验组和对照组各40例,对照组采用传统敷料治疗;实验组采用新型敷料治疗,对少量渗出者应用水胶体类敷料,对中量渗出者应用藻酸类敷料,对大量渗出者应用泡沫类敷料。结果:实验组总痊愈时间为(19.7±6.3)天,对照组为(27.3±4.7)天;实验组治愈率为80%,对照组为47.5%;实验组总有效率为100%,对照组为85%。两组疗效比较有统计学意义(P<0.05)。结论:新型敷料能加速过度渗出创口的愈合,其疗效优于传统敷料治疗。     

新型敷料在治疗乳腺脓肿手术后创口的效果观察

目的探讨新型敷料在治疗乳腺脓肿切开引流术后创口的效果。方法将60例哺乳期乳腺脓肿患者随机分为观察组和对照组,每组各30例。对乳腺脓肿切口引流术后的创口,观察组采用新型敷料换药,对照组采用凡士林纱布换药。比较两组患者创口愈合时间、换药疼痛情况和换药次数的差异。结果观察组创口愈合时间短于对照组,换药次数少于对照组,疼痛程度低于对照组,两组比较,差异具有统计学意义(均P<0.01)。结论新型敷料不仅能保持创面湿润,创造湿性愈合环境,促进伤口愈合,缩短治疗时间,同时有效减轻患者的痛苦,值在临床推广应用。     

钢丝减张缝合Ⅰ期闭合下肢创口四例临床应用

腹壁切口哆开及腹壁缝合张力大时常选择减张缝合[1] ,切口哆开后用减张缝合术能治愈伤口.笔者认为,在四肢创伤中,当直接缝合创口困难或不适宜Ⅰ期缝合创口时,用减张缝合术应该能降低创口张力,并逐渐对合拧紧钢丝闭合创口,达到早期愈合目的.我们总结采用钢丝减张缝合4 例下肢创口的经验体会,经临床应用及对照观察,该方法取得满意疗效.     

精准内镜下组织胶治疗胃静脉曲张的临床效果

目的研究精准内镜下组织胶治疗胃静脉曲张的临床价值。 方法回顾性分析2013年3月至2019年11月浙江中医药大学附属杭州市西溪医院内镜下组织胶治疗食管胃静脉曲张3型（GOV3）患者60例,根据内镜下选择治疗胃静脉曲张（GV）的不同,分为精准组和经典组各30例。采用χ²检验比较2组患者治疗后1、3、6个月再出血率、急性门静脉血栓形成、并发症（包括异位栓塞）和转归（包括TIPS/外科手术、死亡率）等方面的差异;采用t检验比较2组患者GV穿刺点数、组织胶用量和Child-pugh评分等方面的差异。 结果2组患者在年龄、性别、病因、Child-pugh评分、急性门静脉血栓形成、呕血/黑便病史、脾切除术、GV联合钛夹等方面比较,差异均无统计学意义（P＞0.05）。精准组6个月累积GV穿刺点数和组织胶应用支数显著多于经典组［（9.07±3.59）点vs（2.90±1.71）点,（9.27±4.27）支vs（3.90±1.95）支,P均＜0.01］。精准组治疗后1、3、6个月再出血率均低于经典组（0 vs 16.7%,3.3% vs 36.7%,10.0% vs 46.7%,P均＜0.05）。2组患者在治疗后Child-pugh评分、发热、急性门静脉血栓形成、异位栓塞、再出血而死亡或转TIPS/手术等方面均无统计学差异［（6.47±1.48）分vs（6.40±1.54）分,10% vs 10%,0 vs 0,0 vs 0,0 vs 6.7%,0 vs 6.7%,P均＞0.05）］。 结论精准治疗可以减少GV组织胶治疗的再出血率。精准治疗发热、急性门静脉血栓形成、异位栓塞等并发症少见,对肝硬化患者Child-pugh评分亦无影响。     

羊膜在不同创口中的临床应用

羊膜在不同创口中的临床应用３２４２００浙江省常山县人民医院鲁土娜临床上常见到一些创口，经呋喃西林、雷佛奴尔换药往往创口经久不愈，延长了治疗期。笔者改进换药方法，对于创面大而深的创口，使用羊膜换药，取得比较满意的效果。１临床资料羊膜代替植皮治疗四期褥疮...     

拉合伤口法在促进感染伤口愈合中的应用效果观察

目的观察拉合伤口对促进感染伤口愈合的效果。方法将80例患者随机分为拉合组和对照组,各40例。均为脓肿切排引流术后、外伤感染、术后感染裂开等伤口,拉合组换药处理后对伤口进行拉合,对照组换药处理后行二次缝合。并对两组平均愈合时间、疼痛感、伤口愈合满意程度及费用等进行比较。结果平均愈合时间及伤口愈合满意拉合组优于对照组,有显著性差异(P<0.05),疼痛感及医疗费用拉合组明显低于对照组,有显著性差异(P<0.01)。结论拉合伤口法对于一些初期由于感染无法缝合的伤口,能有效缩短愈合时间,减轻患者痛苦及减少医疗费用。     

组织胶水粘合技术闭合皮肤伤口后并发症的护理

目的探讨组织胶水粘合技术闭合皮肤伤口的效果及术后并发症的护理方法。方法对1 589例外伤所致皮肤裂伤的患者采用组织胶水粘合技术闭合伤口,术后观察患者有无伤口渗血、伤口裂开、皮下血肿、伤口感染、局部灼热感等并发症并给予对症处理。结果术后伤口愈合良好率为99.3%,发生并发症10例(包括伤口裂开5例、皮下血肿1例、伤口感染1例、伤口渗血1例和伤口局部灼热感2例),对症处理后伤口愈合良好。结论组织胶水粘合技术闭合伤口,操作简便、快速、防水、抗菌,术后皮肤平整,呈线状瘢痕,患者满意。术后做好并发症的观察及细致的护理、加强宣教指导是治疗成功的关键。     

Evaluation of a New High-viscosity Octylcyanoacrylate Tissue Adhesive for Laceration Repair: A Randomized, Clinical Trial

OBJECTIVE: Tissue adhesives have recently been approved for skin closure. Their low viscosity may result in inadvertent migration. The authors compared the tendency of the adhesive to migrate after laceration closure with a high- or low-viscosity octylcyanoacrylate (OCA). METHODS: This was a randomized, clinical trial set in university and community-based emergency departments. Participants included patients with simple traumatic lacerations. Patients were randomized to laceration closure with low- or high-viscosity OCA tissue adhesive. The outcome measured was immediate adhesive migration (interobserver agreement, kappa = 0.90). Data analysis was performed with proportions compared with chi-square and Fisher's exact tests. RESULTS: Eighty-four patients were randomized to low- (n = 42) or high- (n = 42) viscosity OCA tissue adhesive. Groups were similar in baseline patient and wound characteristics. The high-viscosity OCA was less likely to migrate than the lower-viscosity agent (21% vs. 78%, p < 0.001; odds ratio = 0.3, 95% confidence interval = 0.1 to 0.5). The proportion of patients who noted a sensation of heat during OCA application was higher in the high-viscosity groups (44% vs. 26% respectively, p = 0.11); however, all such patients in both groups would use the device again. At 14 days, there were no wound infections in either group. There was one dehiscence in the high-viscosity group. CONCLUSIONS: The high-viscosity OCA tissue adhesive was less likely to migrate than the lower-viscosity device. Wound dehiscence and infection rates were acceptably low in both treatment groups.     

小肠黏膜下层对大鼠创伤皮肤愈合的实验研究

【目的】为研究小肠黏膜下层对创伤皮肤愈合过程的影响。【方法】制备了小肠黏膜下层片剂。用SD大鼠建立全层皮肤缺损的创伤模型,分成小肠黏膜下层组、络合碘凡士林纱条组以及空白对照组,分阶段取材,宏观观察及组织学观察以上三组大鼠愈合过程。【结果】小肠黏膜下层贴附皮肤不引起排斥反应,无伤口感染。小肠黏膜下层组在愈合速度方面快于络合碘凡士林纱条,空白对照组最慢,小肠黏膜下层组愈合无瘢痕,皮肤附件生长良好,而其余二组瘢痕愈合,皮肤附件仅生长于伤口边缘处。【结论】小肠黏膜下层具有消炎、促肉芽组织生长和上皮组织生长作用,应用于皮肤创伤且能无疤愈合。     

持续低负压吸引在四肢软组织损伤创面护理中的应用

目的探讨持续低负压吸引应用于四肢软组织损伤清创术后的护理效果。方法方便性抽样选取上海市第六人民医院骨科行四肢软组织缺损清创负压封闭引流（vacuum sealing drainage,VSD）术后3d内的患者129例。2009年1—10月间患者41例采用传统间断式吸引方式即间断吸引组,上肢、下肢损伤患者负压吸引压力分别为200～300kPa、330～450kPa之间;2009年11月至2011年1月间患者88例采用持续低负压吸引方式即持续吸引组,上肢、下肢损伤患者负压吸引压力分别为126～210kPa、250－330kPa之间。比较两组患者在疼痛、管道堵塞及通管次数等方面的差异。结果两组患者初始疼痛评分无差异（P〉0．05）;但持续吸引组患者术后各时间点疼痛程度均轻于间断吸引组（均P〈0．01）,且术后72h内管道堵塞、通管次数以及负压调控次数均低于间断吸引组（均P〈0．01）。结论对于四肢软组织损伤清创术后患者,在保证有效吸引的同时选取持续低负压吸引,可以提高患者舒适度,降低疼痛程度,减少护理工时,促进伤口的良好生长。     

内镜下组织黏合剂联合埃索美拉唑治疗上消化道溃疡出血的疗效

目的探讨内镜下注射组织黏合剂联合埃索美拉唑治疗上消化道溃疡出血的疗效。方法 96例上消化道溃疡出血患者,按照入院先后顺序分为观察组(M组)和对照组(N组),每组48例。M组给予内镜下注射组织黏合剂联合埃索美拉唑,N组给予静脉点滴埃索美拉唑联合口服去甲肾上腺素。比较2组首次止血成功率和再出血率及并发症发生情况。结果 M组首次止血成功率(100.0%)明显高于N组(87.5%),再出血率(2.1%)明显低于N组(10.4%)(均P<0.05);2组均无异位栓塞、胃食管穿孔发生,均无死亡病例。结论内镜下注射组织黏合剂联合埃索美拉唑治疗上消化道溃疡出血,效果显著,操作简单,并发症少。     

Efficacy of Tissue Glue for Laceration Repair in an Animal Model

OBJECTIVE: To compare the efficacy of butyl-2-cyanoacrylate tissue glue (TG) for the repair of skin lacerations in rats with the efficacy of standard closure with sutures. METHODS: In a prospective study, eight rats were anesthetized and an 8-cm dorsal incision was made on each side of the midline. One wound was closed with a single layer of interrupted 5-0 Prolene suture and one by application of TG. The time required to close each wound was recorded. Sutures were removed at seven days; the TG was allowed to fall off spontaneously. The animals were sacrificed after 20 days and the wounds were judged for cosmetic outcome. Four I x 3-cm strips of skin were excised from each wound; one strip for histologic analysis and three for load extension testing using a tensiometer. Specimens were loaded to wound failure while displacement (D) and energy absorption (EA) were recorded. The paired t-test was used for comparisons and reported as mean +/- SE. No significant difference between TG and suture was found in D (6.5 +/- 0.4 vs 5.2 (1.4 mm), EA (0.18 +/- 0.01 vs 0.17 +/- 0.03 kg x mm/cm2), or histologic features. The closure time was significantly less using TG (66 +/- 5 vs 401 +/- 17 sec; p < 0.0001). CONCLUSIONS: 1) Sutures and TG in rat skin repair result in similar wound strengths (EA), amounts of stretch (D), and histologic feasures. 2) Wound closure is accomplished much more rapidly with TG.     

短期内反复内镜治疗难治性食管静脉曲张破裂大出血

目的：探讨食管静脉曲张破裂大出血急诊硬化治疗术后仍持续出血的再次内镜下处理。方法：52例食管静脉曲张破裂大出血首次硬化术后仍出血不止或于1周内再次大出血患者,插入二腔一囊管后牵拉,再次进行硬化或（和）组织黏合剂黏堵治疗。结果：再次硬化治疗41例,黏堵加硬化治疗11例,无效转外科手术1例,死亡2例。急诊止血率为94.2%。发生较重并发症7例。结论：内镜下反复硬化或（和）黏堵治疗是控制难治性食管静脉曲张破裂大出血的首选抢救措施。     

Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials.

OBJECTIVE: To summarize the best available evidence for the effect of tissue adhesives (TAs) in managing traumatic lacerations in children and adults. METHODS: A search was conducted using the Cochrane Controlled Trials Register, Medline, and EMBase for relevant studies. The authors also searched the citations of selected studies and contacted relevant authors and manufacturers. The search included randomized controlled trials (RCTs) comparing a TA versus standard wound closure (sutures, staples, adhesive strips) (SWC) or two TAs for acute, linear, low-tension, traumatic lacerations in an emergency or primary care setting. Data were extracted by one reviewer and checked for accuracy by a second reviewer. Two reviewers independently assessed masked copies for quality. Outcomes of cosmesis (subgroups of age, wound location, and need for deep sutures), pain, procedure time, ease of use, and complications were analyzed separately for two comparisons: 1). TA versus SWC; and 2). TA versus TA. RESULTS: Eight studies compared a TA with SWC. No significant difference was found for cosmesis at any time point examined. Subgroup analysis was possible only for age; no significant difference was found. Pain scores [Parent Visual Analogue Scale weighted mean difference (VAS WMD) = -15.7 mm; 95% CI = -21.9 to -9.5] and procedure time (WMD = -5.7 minutes; 95% CI = -8.2 to -3.1) significantly favored TAs. Small, statistically significant risk differences were found for dehiscence [favoring SWC; number needed to harm (NNH) = 25; 95% CI = 14 to 100] and erythema (favoring TAs; NNH = 8; 95% CI = 4 to 100). Only one study compared two TAs (butylcyanoacrylate versus octylcyanoacrylate) for pediatric facial lacerations. No significant difference was found for cosmesis, pain, procedure time, or complications. CONCLUSIONS: TAs are an acceptable alternative to SWC for simple traumatic lacerations. No difference in cosmesis was found between TAs and SWC, or between different TAs. Tissue adhesives offer the benefits of decreased procedure time and less pain, compared with SWC. A small increased rate of dehiscence with TAs must be considered when choosing the closure method (NNH = 25).