慢性难愈合创面住院患者回顾性调查

目的 了解慢性难愈合创面形成原因及患者相关情况,为该类创面的治疗、研究提供方向,为国家相关部门制定健康保障策略提供依据.方法收集2008年武汉市第三医院全院共12 161例次住院患者病历资料.以皮肤组织缺损经1个月治疗未愈合为判定标准,筛选出慢性难愈合创面患者病历,回顾性调查患者创面形成原因、性别、年龄、治疗情况、平均住院日.对数据行x2检验和方差分析.结果 12 161例次住院患者中,慢性难愈合创面患者397例次占3.3%.(1)创面的主要形成原因为烧伤占59.9%(238/397)、糖尿病占15.6%(62/397)、压疮占10.8%(43/397),其次为手术、感染、静脉曲张等.各种原因引起慢性难愈合创面患者例次比较,差异有统计学意义(x2=136.21,P=0.001).(2)慢性难愈合创面患者男、女比例为2.0∶1.0;年龄(44±23)岁,高发年龄段为大于或等于70岁,各年龄段创面患者例次比较,差异有统计学意义(x2=24.12,P=0.025).各种原因引起的慢性难愈合创面患者各年龄段例次比较,差异均有统计学意义(x2值为7.86～28.31,P值均小于0.05).(3)分别有60.5%(240/397)和86.4%(343/397)的慢性难愈合创面患者接受了手术与抗生素治疗,所有患者均采用传统敷料治疗.(4)慢性难愈合创面患者平均住院日为(38±27)d,较同期所有住院患者明显延长[(15±7)d,F=22.82,P=0.012].烧伤引起的慢性难愈合创面患者平均住院日[(47±27)d]最长,各种原因引起的慢性难愈合创面患者平均住院日比较,差异有统计学意义(F=24.06,P=0.036).结论烧伤及糖尿病引起的慢性难愈合创面较多,创面患者老龄化明显、住院时间明显长于其他疾病患者.有必要加大转化医学研究力度,促进国家相关政策制定,使慢性难愈合创面得到科学合理的治疗.

Abstract：

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

慢性难愈合创面住院患者回顾性调查

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

体表慢性难愈合创面的研究进展

体表慢性难愈合创面（俗称溃疡）,也叫慢性伤口或慢性创面,其定义目前尚未统一界定。国际伤口愈合学会对于慢性创面的定义为：无法通过正常有序而及时的修复过程达到解剖和功能上完整状态的创面。这些创面常常延迟愈合甚至不愈合,存在特定的病因,如糖尿病、缺血、压力等。     

负压封闭治疗慢性难愈合创面

目的 :评价负压封闭对慢性难愈合创面的治疗效果。方法 :对 2 8例慢性难愈合创面应用负压封闭治疗。结果 :负压治疗后创面清洁迅速 ,5例创面经负压治疗后直接上皮化愈合 ,2 0例创面经植皮愈合 ,3例创面经局部皮瓣转移愈合 ,治愈率 1 0 0 %。结论 :负压封闭技术是一种安全、简便、有效的处理慢性难愈合创面的新方法。     

短波紫外线治疗老年人慢性难愈合创面的疗效观察及剂量分析

目的：观察短波紫外线（UVC）疗法对老年人慢性难愈合创面的疗效,并初步分析影响其剂量和疗效的相关因素。方法：选择老年慢性难愈合创面患者58例共106个创面,患者年龄73～91岁。紫外线治疗剂量为36～1800mJ／cm^2,每日或隔日1次,直至创面完全上皮化。观察不同部位和不同分期创面的愈合情况和愈合时间,分析UVC治疗剂量和创面部位与创面愈合状态的关系。结果：经UVC治疗后,创面愈合77例,显效25例,无效4例,总有效率96．2％。不同部位创面UVC治疗剂量差异显著,手足区〉肛周会阴区〉头颈区〉四肢区〉躯干区（P〈0．01）;不同部位创面愈合总有效率差异不显著（P=0．4724）,但不同部位治疗次数和创面愈合时间差异显著,肛周会阴区〉躯干区〉手足区〉四肢区〉头颈区（P〈0．01）。在93个压力性溃疡创面中,52个Ⅱ期创面治疗次数[（2．71±0．68）次]及愈合时间[（7．78±2．12）d]均少于41个Ⅲ期创面[分别为（4．09±0．84）次和（13．96±2．38）d],创面愈合率（92．3％）和总有效率（100．0％）也均高于Ⅲ期创面（愈合率为61．0％,总有效率为90．2％,P〈0．01）。结论：UVC治疗老年人慢性难愈合创面疗效显著,病灶部位是影响UVC治疗剂量的重要因素,而病变分期是影响创面愈合效果和时间的主要因素。     

微环境对慢性创面愈合影响的研究进展

慢性创面的治疗是目前亟待解决的医疗难题之一.影响慢性创面愈合的因素包括患者自身的健康状况、创面产生的原因以及外部微环境的变化等.其中外部微环境的变化与慢性创面愈合关联性很强.影响创面微环境的因素有很多,了解这些因素对创面愈合过程中病理生理的具体影响,对于完善慢性创面治疗方法有重要的指导意义.局部微环境的变化对于创面愈合...     

局部氧疗促进下肢慢性创面愈合临床观察

目的:观察局部氧疗辅助治疗下肢慢性创面愈合的临床疗效。方法:2004年4月～2009年11月,50例下肢慢性创面不愈合患者,随机分成常规治疗组(A组)和常规治疗加局部氧疗组(B组)。A组30个患者42个创面,给予常规治疗;B组20个患者30个创面,在常规治疗的基础上每天局部氧疗1次,持续90min,每周治疗5天,4周一疗程。比较两组创面愈合所需的时间,创面愈合百分率,治疗有效率,并作统计学分析。结果:A组创面愈合时间分别为(25.3±7.6)天,B组为(18.2±5.8)天;A组创面愈合百分率为(71.8±12.1)%,B组(96.1±5.6)%;A组创面治疗有效率为71.4%,B组为100%;所有对比项目在两组之间的差异均有统计学意义(P0.05)。结论:局部氧疗可以加速慢性创面的愈合,并且简单易行,没有全身性的副作用。     

中国人群体表慢性难愈合创面病原微生物学特征分析

目的:研究体表慢性难愈合创面病原微生物学特征,为选择正确的创面抗感染治疗方法提供依据.方法:采用多中心横断性病例回顾调查研究的方法,对2007-2008年我国17家医院中因体表慢性难愈合创面住院治疗患者的住院病历中有关细菌病原学特征进行记录,分析其规律.结果:共有1 488 201个病案被纳入观察对象,从中获得符合入选...     

安信医用抗菌贴加速慢性难愈合创面愈合

目的 观察安信医用抗菌贴对慢性难愈合创面（溃疡）的促修复作用并探讨其修复机制。方法 34例共44个慢性难愈合创面,其中创伤性溃疡15例（23个创面）,压迫性溃疡9例（11个创面）,糖尿病溃疡5例,放射性溃疡5例。所有创面经清创后用安信医用抗菌贴外敷于创面,每2－3天更换一次。结果 所有经安信医用抗菌贴治疗的创面都明显愈合,其中2周内愈合26个创面,3周内愈合7个创面,4周内愈合9个创面,超过4周愈合2个创面。4周内总愈合率炎95．5％。结论 安信医用抗菌贴可以显著地加速慢性难愈合创面的愈合,其机制为广谱速效杀菌,改善局部微循环,有效激活并促进组织细胞生长。     

自体富血小板血浆治疗1例血友病A患者膝关节术后慢性难愈合创面

2017年12月22日,1例35岁左膝关节术后继发慢性难愈合创面的血友病A男性患者从茂名市人民医院血液内科转入该院烧伤整形科。体格检查见其左膝关节肿胀,关节外侧有4 cm×4 cm大小的全层皮肤缺损创面,基底有大量暗红色血凝块。予静脉滴注血浆、冷沉淀和人凝血因子Ⅷ控制创面出血,常规清创换药至创面感染控制、坏死组织清除后...     

慢性伤口患者基础疼痛及换药相关疼痛的调查分析

目的了解慢性伤口患者基础疼痛及换药相关疼痛情况,以采取针对性措施减轻患者痛苦。方法采用自行设计的慢性伤口相关疼痛经历评估表对192例慢性伤口患者进行调查。结果 87.5%慢性伤口患者存在伤口基础疼痛;不同类型慢性伤口基础疼痛评分比较,差异有统计学意义(P0.01),其中下肢动脉溃疡患者疼痛评分最高;镇痛药、分散注意力和采取舒适体位是减轻基础疼痛比较有效的措施。94.3%慢性伤口患者存在换药相关疼痛;慢性伤口不同换药阶段疼痛评分比较,差异有统计学意义(P0.01),其中清洗伤口和清创时疼痛评分最高;换药过程中短暂休息、分散注意力和换药时有支持关系存在等是缓解换药相关疼痛有效的措施。结论慢性伤口患者普遍存在基础疼痛和换药相关疼痛,医务人员需要在全面评估患者疼痛情况的基础上制定个性化的镇痛方案,以减轻患者疼痛程度。     

Biofilm therapy for chronic wounds

Chronic wounds have been a major factor of serious harm to global public health. At present, it is known that almost all chronic wounds contain biofilms, which seriously hinder the healing process. Removal of biofilms can effectively promote the healing of chronic wounds. As the study of wound biofilms deepens, many new treatment methods have emerged, thus bringing revolutionary means for the treatment of chronic wound biofilm. This review summarizes various methods for the treatment of chronic wound biofilm worldwide to provide a theoretical summary and practical basis for the selection of suitable wound biofilm treatment methods in clinical practice.     

Treatment of chronic wounds with polyurethane sponges impregnated with boric acid particles: A randomised controlled trial

The objective of this study was to investigate the effectiveness of the sponge with boric acid particles combined with the negative pressure wound treatment (NPWT) system for chronic wounds with tissue defects. Our study was designed as a prospective randomised study. One hundred patients who were planned to have NPWT due to chronic wounds were included in this study from Orthopaedics and Traumatology and Plastic Surgery clinics. Patients were divided into two groups. In the first group, a new method, boric acid impregnated sponge, combined with the NPWT system, was used, and in the second group, sponge with silver nitrate was used. Besides the wide‐broad spectrum antibacterial properties of silver nitrate, the antimicrobial, angiogenetic, and epithelial effects of boric acid were aimed to investigate by macroscopically and histopathologically. Thirty‐six patients in the silver nitrate group and 44 patients in the boric acid group completed the study. A decrease in wound size and granulation was observed in both groups. Macroscopically, a decrease in wound size reduction, epithelialization and granulation were more prominent in the first group in which boric acid impregnated sponge was used than the second group in which silver sponge was used. Moreover, microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1. In this clinical study, the broad‐spectrum antimicrobial properties of boric acid and its positive effect on the cells responsible for wound healing were found to be more pronounced compared to silver nitrate sponges. A combination of boric acid sponges with the NPWT system may be an alternative method for chronic wounds.     

TIME伤口床准备联合封闭式负压引流用于慢性伤口护理

目的探讨基于TIME原则的伤口床准备联合封闭式负压引流治疗慢性伤口的效果。方法将80例患者随机分为观察组和对照组各40例。观察组采用TIME原则进行伤口床准备,并应用封闭式负压引流,对照组在TIME原则指导下采用传统清创联合无菌敷料换药方法进行伤口护理。比较两组干预前和干预后7d、14d、21d的伤口面积缩小率、深度缩小率、局部症状体征以及观察期内伤口愈合率及所有愈合伤口的愈合时间、伤口换药时数、伤口换药费用。结果观察组伤口面积、深度缩小率和局部症状体征改善显著优于对照组(均P0.01);观察组90d内伤口愈合率显著高于对照组,伤口愈合时间、护理时数和换药费用显著低于对照组(均P0.01)。结论基于TIME原则的伤口床准备联合封闭式负压引流能够显著促进慢性伤口愈合,减少护理工作量及患者经济负担。     

Infected chronic wounds show different local and systemic arginine conversion compared with acute wounds

BACKGROUND: Several experimental studies have shown the importance of arginine in wound healing. However, little is known about its role in human wound healing. In this study, we investigated arginine metabolism in impaired wound healing. MATERIALS AND METHODS: Twenty patients with chronic wounds and 10 patients with acute wounds were included in a prospective study. Amino acids, nitrate/nitrite, and arginase concentrations were determined in plasma and wound fluid using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Chronic wounds were divided into two groups: noninfected chronic wounds (n = 11) and infected chronic wounds (n = 9), based on quantitative bacterial analysis of wound fluid samples. RESULTS: Plasma arginine levels, next to total plasma amino acid levels, were significantly decreased in patients with infected chronic wounds compared with patients having acute or noninfected wounds. Citrulline and ornithine levels were significantly increased in infected chronic wounds and related to decreased nitrate/nitrite levels, whereas wound fluid arginine levels were similar in all groups. In addition, wound fluid arginase levels of infected chronic wounds were significantly enhanced. CONCLUSIONS: This study demonstrates that patients with infected chronic wounds have decreased plasma arginine levels and suggests enhanced arginine conversion in the wound. In contrast to noninfected chronic wounds, arginine seems to be mainly metabolized by arginase in infected chronic wounds. In conclusion, our hypothesis is that impaired wound healing is related to an altered arginine usage.     

Psychometric evaluation of the Wound-QoL questionnaire to assess health-related quality of life in Chinese people with chronic wounds

Chronic wounds are very common wound types in clinics which have a prolonged and painful healing process. Chronic wounds affect health-related quality of life (HRQoL) on patients. However, there is no specific instrument to measure the HRQoL in Chinese patients with chronic wounds. Wound-QoL is a questionnaire targeted the experience of health-related life to patients with chronic wounds. The study aims to translate and cross-culturally adapt the Wound-QoL into Chinese and to evaluate its psychometric properties (validity, reliability, floor, and ceiling effect) in a convenience sample of 203 Chinese outpatients with chronic wounds. Reliability was good, with internal consistency of 0.798–0.960 and test–retest reliability of 0.720–0.838. Criterion-related validity was assessed by the correlation coefficient between Wound-QoL and generic European QoL instrument- EQ-5D-5L, which was found statistically significant (P<.001). No signs of floor or ceiling effect could be detected. Further, confirmatory factor analysis (CFA) was used to verify the reliability and validity of the instrument in this study. In conclusion, the Chinese Wound-QoL is a valid and reliable tool for measuring HRQoL in populations with chronic wounds.     

负压封闭结合局部氧疗用于创伤性慢性伤口的效果研究

目的评价负压封闭结合局部氧疗用于创伤性慢性伤口除菌抑菌和改善伤口微环境的效果。方法将64例创伤性慢性伤口患者随机分为两组,每组32例。对照组给予负压封闭伤口治疗;观察组在负压封闭伤口治疗基础上24h局部给氧,持续12d。12d后两组继续按湿性疗法处理伤口或手术治疗,直至愈合或3个月止。两组干预3、6、9、12d评估测量伤口渗液pH、伤口温度,干预前和12d分泌液细菌培养监测伤口细菌阳性率;3个月内的治愈率和愈合时间。结果干预后12d观察组细菌阳性率显著低于对照组(P0.01),两组渗液pH随治疗时间延长而下降,观察组下降更明显(P0.01)。伤口温度随治疗时间增加而升高,观察组升高更明显(P0.01)。观察组治愈率显著高于对照组(P0.05),愈合时间显著短于对照组(P0.01)。结论负压封闭结合局部氧疗治疗优化了伤口微环境,强化了除菌抑菌作用,有助于提高伤口治愈率和缩短愈合时间。     

纳米微囊-VEGF复合体转染对慢性创面愈合影响的研究

目的：研究纳米微囊-VEGF复合体转染对慢性创面愈合的影响。方法：以VEGF为目的基因，构建真核表达载体pcDNA3．1／myc—hisA—VEGF165，纳米微囊包裹后作用于兔耳慢性创面，于术后14天通过创面观察以及组织学染色、显微测量，观察其对创面的影响。结果：转基因组创面肉芽生长及上皮爬行速度明显快于慢性创面组；HE染色转基因组肉芽组织中大量的成纤维细胞聚集，微血管数量增多；新生上皮生长NEG在非缺血创面组最高，慢性创面组最低，其中前者较后者增加249％，而转基因组较慢性创面组增加了165％；肉芽组织厚度PH转基因组较慢性创面组增加了70％，而非缺血创面组较慢性创面组增加了46％；肉芽组织体积NGTV在转基因组及非缺血创面组与慢性创面组比较，分别增加了317％、302％。结论：非病毒载体纳米微囊-VEGF复合体能明显促进慢性创面愈合。