急性创面无干扰伤口愈合的护理研究进展

介绍无干扰伤口愈合的概念及其在急性创面处理中的应用现状,分析无干扰伤口愈合在急性创面愈合中的促进因素及效果评价,以期为医护人员在临床实践中重视将急性创面处于无干扰愈合环境,结合患者情况,制定最佳的创面处理方案提供参考。     

新型敷料用于小面积烧伤的效果观察

目的通过使用新型敷料治疗小面积烧伤，减少了病人的痛苦，加快了伤口的愈合。方法根据烧伤创面不同时期分别采用透明膜类敷料、水胶体、水凝胶、藻酸盐、海绵类浸润愈合。结果新型敷料对小面积烧伤的治疗取得满意疗效。结论各类新型敷料既符合现代伤口敷料的特点，在伤口愈合的不同阶段，使用不同的敷料，可为创面愈合提供最佳的环境。     

伤口处理的研究进展

伤口处理是临床上十分普遍的问题，近年来不断出现新方法的新材料，给伤口处理带来了发展。本文在伤口缝合技术、缝线材料、非缝合性口磁闭技术、伤口敷料以及生长因子在伤口愈合中的应用等作一综述。     

伤口护理新进展

对伤口愈合理论及伤口护理方法的进展进行综述。提出随着科技的进步，伤口护理手段不断更新，临床护理工作者应掌握新的伤口护理知识和技能，根据患者不同状况采用合适的换药方法和敷料，为患者提供更优质的护理服务。     

静脉性溃疡的敷料选用

随着人口老龄化,与老年病相关的慢性伤口护理越来越受重视.1962年,Winter[1]提出了湿润环境促进伤口愈合,为伤口换药奠定了现代创面换药的理论基础.20世纪80年代以来,针对各型创面研发了大量的新型敷料,如高分子薄膜敷料、泡沫敷料、水凝胶和水胶体敷料、海藻酸盐敷料、生物活性药物敷料等.正确选用敷料能加快创面修复、减少感染机会、缩短住院时间及降低医疗费用.     

异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤

目的探讨应用异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤创面的临床应用效果。方法1997年1月—2004年1月,应用异种(猪)脱细胞真皮基质一次包扎治疗50%~95%总体表面积(TBSA)、深Ⅱ度烧伤的患者67例[异种(猪)脱细胞真皮基质治疗组];同期保痂治疗的50%~95%TBSA、深Ⅱ度的患者10例(保痂治疗组),观察创面愈合时间和愈合质量及其并发症发生情况。治愈患者经过3个月~2年的随诊,观察瘢痕增生情况。结果异种(猪)脱细胞真皮基质治疗组深Ⅱ度创面中途基本不需换药,创面愈合时间缩短,平均(12.2±2.6)d,而保痂治疗组愈合时间为(27.4±3.5)d,差异具有统计学意义(P<0.05);同时,异种(猪)脱细胞真皮基质治疗组瘢痕增生情况较保痂治疗组明显减轻或者无瘢痕增生。结论一次性覆盖异种(猪)脱细胞真皮基质可有效地治疗深Ⅱ度烧伤创面,能加快创面愈合,减轻瘢痕增生,从而降低烧伤感染和炎症反应综合征的发生。     

巴克无菌敷贴治疗深Ⅱ度烧伤及愈合后瘢痕的效果评价

目的评价巴克无菌敷贴治疗深Ⅱ度烧伤及愈合后瘢痕的效果。方法按照纳入及排除标准, 采用随机数字表法将济宁医学院附属医院2016年9月至2019年9月入院治疗的深Ⅱ度烧伤患者随机分为试验组和对照组。试验组使用巴克无菌敷贴换药, 对照组使用磺胺嘧啶银乳膏换药, 每2～3天换药1次。比较两组患者创面愈合时间、换药次数、换药时疼痛评分及二次创伤评分、创面愈合后1、3、6个月的温哥华瘢痕量表(VSS)评分, 以及出院时和创面愈合6个月时患者满意度的差异。根据资料的数据类型, 以±s、M(Q₁, Q₃)或频数(百分数)表示, 分别以t检验、Mann-WhitneyU检验或χ²检验进行分析。结果试验组和对照组各纳入132例烧伤患者。试验组男115例, 女17例, 年龄(34.5±11.1)岁, 烧伤面积占(15.87±8.66)%;对照组男107例, 女25例, 年龄(32.4±14.1)岁, 烧伤面积占(16.31±7.06)%。试验组愈合时间明显短于对照组[(17.65±5.87) d vs. (23.06±8.78) d, P&l...     

白塞病及其消化道病变的外科处理

目的总结白塞病及其消化道病变的临床特征和外科治疗时机。方法对19例白塞病和有消化道病变病例的临床资料进行回顾性分析。对无外科并发症的病例按内科常规治疗。回肠穿孔1例行小肠部分切除术后转ICU治疗;结肠白塞病并慢性阑尾炎1例行阑尾切除术,因患者合并白血病术后转血液科;结肠白塞病无外科并发症1例确诊后转皮肤科治疗。结果白塞病确诊病例19例,除转ICU治疗的1例2d后自动出院外,其余18例均得到治愈或缓解,无死亡病例,其中15例(88．24％)得到随访,随访时间1个月～4年,死亡2例(合并白血病死亡1例,肺部感染致多器官功能衰竭死亡1例),其余13例中自塞病症状复发12例(92．31％),无外科并发症发生。结论白塞病内科治疗有效,但病情多反复发作,消化道病变少见,临床表现多样且不典型．发生穿孔者病情严重,临床应予重视,适时采取手术治疗。     

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。     

Randomized trial comparing dressing to no dressing of surgical wounds in a tropical setting

OBJECTIVE: to see whether there was a difference in the risk of local infection for surgical wounds in a tropical setting depending on whether a wound was dressed or left open beyond 48 hours post-operatively. METHOD: Over a four month period, 102 patients undergoing intra-abdominal surgery classified as clean or clean-contaminated were randomized into two equal groups. The "with dressing" group underwent a wound dressing change and re-application every two days. In the "without dressing" group, the wound was left open to the air after a first dressing change at 48 hours. RESULTS: There was no difference in post-operative temperature curve; post-operative wound infection rate was 2% in each group. Suture removal was performed two days earlier in the "without dressing" group and hospital stay was decreased by two days. The expense of repeated dressing changes was also lessened. CONCLUSION: There is no benefit to leaving a wound dressing in place longer than 48 hours after surgery; costs related to prolonged hospitalization and expenses of dressing changes are decreased by a policy of leaving incisions undressed after 48 hours.     

A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds

Purpose  

This prospective and semi-randomized study was conducted to clarify the effectiveness of a new hydrocolloid dressing placed over median sternotomy wounds using an occlusive dressing technique.     

Bacterial growth on adhesive dressing tapes used for the closure of surgical wounds

Sterile Steri-Strip tape is now commonly used to support sutured closure of skin edges in the operating theatre. This tape is more expensive than non-sterile 3M Micropore tape, which had been used without any evidence of increased wound infections. This prospective clinical trial compared bacterial growth on the two tapes after their application to the intact skin of 21 healthy volunteers from the Plastic and Reconstructive Surgery Department at a District General Hospital. Using an aseptic technique and following chlorhexidine skin preparation, two Steri-Strip adhesive tapes and two measured lengths of 3M Micropore tape were applied to the intact skin of the volunteer’s upper arms, then removed after 7 days, and cultured on blood agar plates. The mean numbers of colony forming units grown from Micropore tape was 24.07 ± 4.10 and for Steri-Strips 19.77 ± 3.30. Coagulase negative staphylococci and Micrococcus species were the main organisms isolated from the cultures. The plates were blinded to the microbiologist counting the colony forming units with the tapes removed after incubation. No adverse skin reactions were noted for either tape and only one Micropore tape demonstrated loss of adhesion. On the skin of healthy volunteers, there was no significant difference between the bacterial growth on either tape. A clinical trial should now be completed to confirm the results of this study that non-sterile 3M Micropore tape can safely be used for the closure of surgical wounds.     

Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing

BACKGROUND: A blinded randomized clinical trial was undertaken to evaluate the effect of applying ointment to a wound before occlusive dressing, in comparison with no ointment or sterile paraffin. METHODS: Some 778 patients with 1801 surgical wounds following excision of skin lesions were enrolled in the trial. No ointment was placed on 510 sutured wounds of 247 patients, paraffin ointment was put on 729 wounds (269 patients) and mupirocin ointment on 562 wounds (262 patients). Wound infection, scar, haemorrhage, dehiscence and other complications were assessed at suture removal. At 6-9 months after surgery, patients were surveyed to assess the wounds, with a response rate of 74.0 per cent. RESULTS: There were no significant differences in outcome for all endpoints evaluated. The infection rate was 1.4 per cent with no ointment, 1.6 per cent for paraffin and 2.3 per cent for mupirocin (P = 0.490). Total complication rates were 3.5, 4.7 and 4.8 per cent for no ointment, paraffin and mupirocin respectively (P = 0.590). Some 10.9, 10.3 and 8.2 per cent of patients respectively had a neutral or negative perception of their wounds at 6-9 months after surgery (P = 0.650). There was no difference in postoperative pain, degree of inconvenience or overall level of satisfaction with treatment. CONCLUSION: Putting ointment on a surgical wound before occlusive dressing does not benefit the patient. In view of the risk of antibiotic resistance, mupirocin ointment is not indicated for clean surgical wounds.     

The ideal dressing for clean wounds

A dressing of petrolatum jelly spread over a wound, covered with a film of cellulose and then dry gauze pads is the ideal dressing for a clean postoperative wound because:

• 1.1. It promotes oozing from the wound by virtue of its anticoagulant, antievaporant properties.
• 2.2. It seals the wound to accidental spilling of infected material and prevents contamination of the wound with infected gases.
• 3.3. It facilitates the inspection of the wound whenever infection is suspected.
• 4.4. It relieves the patient of pain and saves the surgeon's time when the dressing is changed.
• 5.5. It prevents the pulling off of growing epithelium and fresh granulations when removed.
     

An advanced transparent hydropolymer wound dressing for undisturbed post‐op management of surgical wounds following hip and knee replacement: A prospective observational series

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are standardised surgical procedures for patients with complex comorbidities. The enhanced recovery after surgery (ERAS) protocol has shown reduced lengths of hospital stay and reduced postoperative complications. Currently, there is a paucity of recommendations in regards to dressing selection for postoperative wound care within the ERAS protocol. The aim of this study was to investigate the usefulness of a transparent hydropolymer wound dressing in suit for 14 days in 20 orthopaedic patients following hip or knee arthroplasty under the ERAS protocol. The majority of participants (90%) had a wear time of 14 days without the need for dressing removal. Clinicians rated the dressing very easy to apply with very good visibility of the incision line (100%). All participants reported the dressing to be ‘very comfortable’ (95%, n = 19) or ‘comfortable’ (5%, n = 1). Overall, the transparent hydropolymer dressing provided sufficient incision site visibility, reducing the need for dressing changes. To the best of our knowledge, this is the first study to show that the use of a transparent hydropolymer dressing in situ for 14 days to allow undisturbed wound healing.