康复新液湿润疗法在溃疡期压疮中的应用效果观察

目的:探讨康复新液湿润疗法在溃疡期压疮中的应用效果。方法:将我院2007年1月～2009年4月内科系统收治的32例溃疡期压疮病人作为对照组,将2009年8月～2011年12月内科系统收治的32例溃疡期压疮病人作为观察组。观察组用生理盐水清洗创面及周围皮肤后再用康复新液湿性换药,对照组用碘伏消毒创面及周围皮肤,再用TDP灯照射20～30 min,然后用康复新液换药。结果:两组总有效率及压疮治愈时间比较差异有统计学意义(P=0.003)。结论:用康复新液湿润疗法效果显著,可提高压疮治愈好转率及缩短压疮愈合时间,节省护理人力资源,因此,在溃疡期压疮病人中可优先选用。     

负压封闭引流联合自体游离皮片移植术治疗多发性小腿静脉性顽固性溃疡

目的:观察负压封闭引流(vacuum sealing drainage,VSD)联合自体游离皮片移植术治疗多发性小腿静脉性顽固性溃疡的临床效果。方法:7例(16处)下肢静脉曲张并发多发性小腿顽固性溃疡的患者在经血管外科治疗原发病后,对溃疡创面进行清创并采用VSD技术封闭创面,7~10 d后视情况行VSD联合自体游离皮片移植术修复创面。结果:7例患者的溃疡创面均愈合,术后予以弹力绷带加压包扎,随访半年,无复发。结论:对于下肢静脉曲张所致多发性小腿静脉性顽固性溃疡,及时行VSD联合自体游离皮片移植术修复创面并在创面治愈后进行加压包扎,能有效提高治愈率,降低复发率。     

14例四肢皮肤软组织缺损病人行封闭负压引流术治疗创面的护理

[目的]总结四肢皮肤软组织缺损病人行封闭负压引流术治疗创面的护理。[方法]对14例四肢皮肤软组织缺损病人行封闭负压引流术治疗创面,同时加强术前护理、术后体位护理、病情观察、饮食护理、负压的维持与观察、康复锻炼等。[结果]14例病人创面肉芽生长良好,经二期游离植皮,创面均愈合,无并发症发生。[结论]加强四肢皮肤软组织缺损病人行封闭负压引流术治疗创面的护理,有利于创面愈合。     

Care of patients with leg ulcers: A nursing perspective

Care of patients with leg ulcers is challenging as well as rewarding. Recent advances in scientific knowledge about healing should be incorporated in the nursing care of leg ulcer patients. This article provides an update on the state of the science in the care of leg ulcers in geriatric patients, and focuses on assessment and local care of such ulcers. Ulcer assessment provides the basis for selecting therapies to maximize healing. Wound cleansing and appropriate dressings are essential to good patient outcomes. Furthermore, healing is enhanced when these interventions are combined with strategies that maximize oxygen to the ulcer, promote appropriate levels of activity, optimize perfusion through physiological positioning, and reduce mechanical shear through selection of proper footwear. Care of patients with leg ulcers provides the nurse an opportunity to apply pathophysiology, utilize scientific data, and function as an integral player on the wound care team.     

加味祛腐生肌膏外敷联合艾条回旋灸治疗Ⅲ、Ⅳ期压疮的临床疗效及对愈合时间的影响

目的探讨加味祛腐生肌膏外敷结合艾条回旋灸治疗Ⅲ、Ⅳ期压疮的临床疗效及对患者压疮愈合时间的影响。方法选取2019年1月至2020年6月宝安中医院康复科、骨伤科以及脑病科收治的符合入组标准的64例Ⅲ、Ⅳ期压疮患者为实验对象,应用数字表法随机将其分成实验组32例和对照组32例。对照组给予患者常规清创处理、抗菌敷料填塞、藻酸盐填塞以及换药等治疗,实验组在此基础给予患者加味祛腐生肌膏外敷联合艾条回旋灸治疗,观察两组患者皮肤肉芽组织生长时间、压疮创面愈合时间、疗效、生活质量情况。结果实验组患者的总有效率显著高于对照组,差异有统计学意义(P<0.05);实验组患者的皮肤肉芽组织生长时间、创面愈合时间均显著短于对照组,差异有统计学意义(均P<0.05);实验组GQOL-74生活质量评分明显高于对照组,差异有统计学意义(P<0.05)。结论加味祛腐生肌膏外敷联合艾条回旋灸治疗Ⅲ、Ⅳ期压疮效果佳,有效缩短患者创面愈合时间及肉芽组织生长时间,提高其生活质量,极具应用价值。     

数字化钛网颅骨修补术病人的护理和健康教育

目的:探讨数字化钛网颅骨修补术的护理方法及健康教育。方法:对20例颅骨缺损病人施行数字化钛网颅骨修补术,术前做好心理护理及充分的术前准备,术后密切观察护理及贯穿整个康复过程的健康教育。结果:20例病人修复良好,切口愈合佳,修复体在位,无并发症发生。结论:颅骨缺损行数字化钛网颅骨修补,方法简单,并发症少。科学的护理及健康教育是手术成功的重要保障。     

闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面护理中的应用价值

目的探讨闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面护理中的应用价值。方法选取2018年4月至2020年4月收治的70例老年慢性难愈创面患者,将其随机分为对照组和观察组,各35例。对照组护理中予以闭合式负压引流结合生理盐水冲洗,观察组护理中予以闭合式负压引流结合成纤维细胞生长因子冲洗。比较两组创面面积、创面愈合时间、2周肉芽生长评分、瘢痕面积、皮肤感觉功能和汗腺功能恢复情况。结果治疗后,观察组创面面积小于对照组(P<0.05)。观察组创面愈合时间短于对照组,2周肉芽生长评分高于对照组,瘢痕面积小于对照组(P<0.05)。观察组皮肤感觉功能及汗腺功能恢复效果优于对照组(P<0.05)。结论闭合式负压引流结合成纤维细胞生长因子在老年慢性难愈创面患者护理中的应用价值较高,其能够有效促进创面愈合及肉芽生长,缩小创面面积,提高感觉功能及汗腺功能恢复效果。     

Therapeutic effect of autologous concentrated growth factor on lower-extremity chronic refractory wounds: A case report

BACKGROUNDManagement of chronic refractory wounds is one of the toughest clinical challenges for surgeons. Because of poor blood supply, less tissue coverage, and easy exposure, the lower leg is a common site for chronic refractory wounds. The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs. Concentrated growth factor (CGF) is a novel blood extract that contains various growth factors, platelets, and fibrins to promote wound healing process. However, there has been little research reported on the treatment of lower extremity wounds with CGF.CASE SUMMARYA 37-year-old man, without any past medical history, presented an ulcerated chronic wound on his right lower leg. The skin defect exhibited clear boundaries, with a size of 2.0 cm × 3.5 cm. The depth of wound was up to the layer of deep fascia. Staphylococcus aureus was detected by bacterial culture. The final diagnosis was right lower extremity ulcers with infection. Cefathiamidine, silver sulfadiazine, and mupirocin cream were applied to control the infection. CGF gel was prepared from the patient’s blood sample, and was used to cover the wound after thorough debridement. The skin wound was successfully healed after three times of CGF treatment.CONCLUSIONCGF displays an excellent wound healing promoting effect in patients with lower-extremity chronic refractory wounds.     

Healing of advanced pressure ulcers by a generic total contact seat: 2 randomized comparisons with low air loss bed treatments

DESIGN: Randomized prospective cohort study. SETTING: Long-term care facilities. PARTICIPANTS: Two hundred seven subjects with stage III or IV pressure ulcers. INTERVENTION: Two separate randomized control studies of advanced pressure ulcers that compared wound healing on 3 different support surfaces. Subjects were allocated to low air loss bed, upgraded bed overlay (only in study 1), or 4h/d sitting on an experimental generic total contact seat. The seat was designed using prosthetics principles aimed at distributing pressure off bony prominences onto less pressure-sensitive areas. Subjects were followed for 6 months or until they were totally healed. MAIN OUTCOME MEASURES: Number of subjects who totally healed, time to total healing, and pressure ulcer status score after 4 weeks of treatment. Interface pressures and functional capacity were also measured at 4 weeks. RESULTS: In study 1, 3 subjects worsened on the bed overlay condition and were withdrawn from the study. None worsened on low air loss or generic total contact seat. At 4 weeks in both studies, pressure ulcer status score was lowest for the generic total contact seat (P<.0001), compared with the other surfaces. Subject populations were similar, so to analyze total healing, results from both studies were combined. Total healing of pressure ulcers occurred as early as 4 weeks in some subjects using the generic total contact seat. Even at 8 weeks, total healing was primarily seen with use of that seat, on which interface pressures, function, and seating tolerance were best. CONCLUSIONS: Faster healing and better function indicate that treatment using the generic total contact seat is superior to low air loss bed therapy, which is standard care for advanced pressure ulcers.     

保留皮肤的乳腺癌改良根治术后即时乳房再造的围术期护理

目的：探讨保留皮肤的乳腺癌改良根治术后即时应用下腹部横行腹直肌皮瓣进行乳房再造术的围术期护理。方法：对26例乳腺癌改良根治术后即时乳房再造术的患者做好术前心理护理,术中密切配合,术后移植皮瓣的观察护理及康复锻炼。结果：26例患者手术均获成功,除2例患者皮瓣部分坏死外,其他切口均一期愈合,再造乳房形态良好。结论：加强围手术期护理是确保乳腺癌改良根治术后即时乳房再造手术成功的关键。     

改良备皮法在外科临床中的应用及意义

目的 探讨推广术前“改良备皮法”的可能性 方法 选择普外科上腹部择期手术病人120例,随机分为研究组和对照组各60例,分别予改良备皮法和常规备皮法;选择胸外科和骨科120例择期手术病人随机分为研究组和对照组各60例,分别予改良备皮法和常规备皮法。观察两组备皮完后及术后24小时皮肤细菌培养结果,比较两组手术后切口感染率及愈合情况。 结果 采用改良备皮法术后患者的切口感染率较低,愈合情况较好。结论 改良备皮法降低切口感染率, 愈合情况较好,改良术前备皮法值得临床应用。     

Bacterial nosocomial infections in urology: defective wound healing

The highest incidence of defective wound healing in all surgical disciplines is observed after urological operations. Wound infections occur in more than 8% of all urological patients. Defective wound healing appears in about 17% of unselected nephrectomy cases, rising to 50% when pyonephrosis is present. Simple adenomectomy is associated with wound infection rates of between 8 and 12% in preoperatively uninfected patients and up to 50% in patients with preoperative bacteriuria. Numerous factors may influence wound healing, e.g. age, obesity, cachexia, chronic infectious and non-infectious diseases, anaemia, thrombopathy, faulty asepsis and antisepsis, preoperative showering and shaving, skin preparation, hand degerming, skin draping, duration of hospitalization, traumatic operative technique, suture material, diathermy, timing and length of operation, duration of hospitalization, and antibiotic regimen. Strict attention has to be paid to these factors if the incidence of postoperative wound infection is to be kept within reasonable limits.     

65例眼睑恶性肿瘤切除联合Ⅰ期眼睑修复术的护理

总结了65例眼睑恶性肿瘤切除联合Ⅰ期眼睑修复术的围手术期护理。术前做好皮肤准备,术后注重切口包扎技术、眼部换药、用药与观察、预防感染、健康教育等。患者均切口Ⅰ期愈合,眼睑修复效果良好,无并发症发生。     

10例白血病患者并发伤口溃烂的护理

目的 为促进白血病并发伤口溃烂患者的伤口愈合。方法 根据溃烂伤口的局部情况，采用全身治疗方法及不同的护理方法综合处理。结果 本组10例患者，历经最长35天，最短10天的综合处理，伤口全部愈合，除1例因多脏器功能衰竭而死亡外，其余9例均先后不同时间出院。结论 通过全身治疗方法及根据溃烂伤口局部情况采用不同的护理方法处理，能够促进创面修复，提高创面愈合质量，缩短伤口的愈合时间。而贝复济在伤口修复过程中起了重要作用。     

成纤维细胞生长因子治疗老年慢性难愈合创面的研究

目的探讨成纤维细胞生长因子治疗老年慢性难愈合创面的有效性。方法选取2013年6月-2015年6月我院骨科门诊及住院部慢性难愈合创面老年患者60例,分别给予成纤维细胞生长因子(观察组30例)和凡士林油纱贴敷创面(对照组30例),比较两组治疗后反映创面愈合治疗效果和皮肤功能恢复的相关指标的差异,并比较观察组不同病因患者疗效差异。结果观察组2周时肉芽生长评分、残余创面面积4周内愈合率。创面最终平均愈合时间、疤痕面积均优于对照组(P0.005)。观察组针刺感、轻触觉和温度觉的恢复率和对照组相比无差异(P0.05),但两点辨别觉优于对照组(P=0.038),汗腺再生方面优于对照组(P=0.028)。观察组不同病因患者的创面愈合时间比较,糖尿病患者明显长于压迫性溃疡患者(P=0.001)和创伤性溃疡患者(P=0.003),压迫性溃疡患者和创伤性溃疡患者之间无差异(P=0.238)。结论成纤维细胞生长因子比凡士林油纱的常规治疗能更有效的促进老年慢性难愈合创面愈合和皮肤功能的恢复,但对不同病因的患者疗效有差异。     

注射器代替负压吸引装置在伤口愈合中的临床价值研究

目的 分析注射器代替负压吸引装置对伤口愈合的临床价值.方法 选取2013年1月至2014年1月在我院伤口护理中心就诊的70例患者,随机分为观察组和对照组,每组35例患者,对照组采用负压吸引装置进行伤口护理,观察组采用注射器对伤口愈合进行护理,观察并对比两组患者的护理效果.结果 治疗后3周观察组伤口温度显著低于对照组,差异有统计学意义,P<0.05;治疗后3周观察组伤口pH值显著低于对照组,差异有统计学意义,P<0.05;观察两组伤口愈合时间和自拟症状评分的情况,发现观察组伤口愈合时间短于对照组而治疗后自拟症状评分显著高于对照组,差异有统计学意义,P<0.05.对比两组患者康复时间以及治疗费用情况,结果发现观察组康复时间与对照组无显著性差异,治疗费用却显著少于对照组,差异有统计学意义,P<0.05.结论 注射器代替负压吸引装置对伤口愈合进行护理,减少了伤口与外界接触的面积,防止感染,有利于减少并发症的产生,促进患者早日康复.     

Managing and caring for a patient with a complicated wound

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.     

一期内固定结合置管冲洗负压封闭引流技术治疗下肢开放性骨折的护理

目的：探讨一期内固定结合置管冲洗负压封闭引流（vacuum sealing drainage,VSD）治疗下肢开放性骨折的临床护理疗效。方法：对2008-05-2010-05我院收治的27例下肢开放性骨折患者行一期清创,骨折采用髓内钉或锁定接骨板内固定,伤口内置管冲洗,创面用VSD材料封闭,持续负压引流的方法进行治疗,做好术前护理、术后一般护理、保持冲洗及引流通畅和有效负压吸引,观察治疗效果。结果：27例患者中19例术后创面获得一期愈合,8例患者行二期植皮或皮瓣修复获得愈合,25例患者获得随访,通过6～18个月的随访,23例患者如期愈合,2例延迟愈合,无一例发生骨髓炎。结论：正确合理的护理措施能确保一期内固定结合置管冲洗负压封闭引流技术治疗下肢开放性骨折（Gustilo-AndersonⅢ型）的成功。     

Two‐Dimensional and Three‐Dimensional Ultrasound of Artificial Skin

Wound healing may be a difficult problem, and variable types of artificial skin prototypes have been developed for supporting this process. Using ultrasound, we studied 4 cellulose‐derived artificial skin prototypes and assessed their two‐dimensional and three‐dimensional morphology. These prototypes were identified on ultrasound both on in vitro and in vivo studies. They allowed the sonographic observation of deeper layers on different types of surfaces of the body with good definition on the in vivo examinations performed on healthy skin and cutaneous ulcers. The ultrasound detection of these artificial biomaterials may potentially support the noninvasive monitoring of wound healing.