泡沫敷料联合银敷料治疗糖尿病合并Ⅱ期压疮的疗效观察

目的:探讨泡沫敷料与银敷料联合治疗糖尿病合并Ⅱ期压疮的临床效果.方法:将78例符合2型糖尿病诊断标准、Ⅱ期压疮诊断标准的患者按入院先后顺序分为对照组、观察组各39例(98处).两组常规用生理盐水清洁伤口后蘸干,在此基础上,对照组内层敷料使用软聚硅硐泡沫敷料美皮康贴敷伤口,外层用美固固定.观察组内层敷料使用优拓S.S.D(主要成分为磺胺嘧啶银)贴敷伤口,中层敷料使用软聚硅硐泡沫敷料美皮康,外层用美固固定.分别观察两组治愈率、总有效率、换药次数、愈合时间及直接费用.结果:观察组治愈率、总有效率高于对照组;愈合时间、换药次数和直接费用低于对照组,且差异均有统计学意义(P＜0.05).结论:泡沫敷料联合银敷料治疗糖尿病合并Ⅱ期压疮可缩短创面愈合时间,减少换药次数和治疗费用,提高治愈率.     

A systematic review of foam dressings for partial thickness burns

BackgroundPartial thickness burns are the most common form of thermal burns. Traditionally, dressing for these burns is simple gauze with silver sulfadiazine (SSD) changed on a daily basis. Foam dressings have been proposed to offer the advantage of requiring less frequent dressing change and better absorption of exudates.ObjectiveTo compare the impact of silver-containing foam dressing to traditional SSD with gauze dressing on wound healing of partial thickness burns.MethodsWe performed a systematic literature search using PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library database and Google Scholar for trials comparing traditional SSD dressings to that of silver-containing foam dressing on wound healing in partial thickness burns <25% of the body surface area. We excluded studies that enrolled burns involving head, face, and genitals; burns older than or equal to 36 h, non-thermal burns, and immunocompromised patients. Quality of trials was assessed using the GRADE criteria. The main outcome, complete wound healing, is reported as percentages of wound with complete epithelialization after the follow up period. Relative risks of complete healing are also reported with respective 95% CI. Time to healing and pain score before, during, and after dressing change at each follow up visit are compared between the groups (means with standard deviation or medians with quartiles).ResultsWe identified a total of 877 references, of which three randomized controlled trials (2 combined pediatric and adult trials and 1 adult trial) with a total of 346 patients met our inclusion criteria. All three trials compared silver-containing foam dressing to SSD and gauze on partial thickness burns. Moderate quality evidence indicated no significant difference in wound re-epithelialization between the groups across all three trials as confidence intervals for the relative risks all crossed 1. Although pain scores favored foam dressing at the first dressing change (7 days), there was no significant difference between the groups at the end of the treatment period at 28 days. Time to wound healing was also similar across the three trials with no statistical difference. Infection rates favored the foam-dressing group, but data were inconsistent.ConclusionModerate quality evidence indicates that there is no significant difference in wound healing between silver-containing foam dressing and SSD dressing. However, foam has the added benefit of reduced pain during the early treatment phase and potentially decreased infection rates.     

美皮康敷料治疗Ⅱ期、浅Ⅲ期压疮的疗效观察

目的：观察美皮康敷料治疗Ⅱ期、浅Ⅲ期压疮临床疗效。方法：将92例压疮病人随机为观察组和对照组各46例,观察组使用美皮康泡沫敷料治疗,对照组使用凡士林纱布治疗,两组均按压疮护理常规护理,分别观察两组患者治疗有效率、愈合时间。结果：观察组治疗压疮有效率高于对照组,两组比较差异有统计学意义（P〈0．05）。结论：美皮康泡沫敷料治疗Ⅱ期、浅Ⅲ期压疮可缩短创面愈合时间,减少换药次数,提高治愈率,值得临床推广。     

Safety and efficacy of TransCyte for the treatment of partial-thickness burns.

Standard treatment for extensive partial-thickness burns in the United States and in much of the world involves the application of topical antimicrobial agents and repetitive wound débridements and dressing changes. We evaluated a new biologic wound covering, TransCyte (Advanced Tissue Sciences, La Jolla, Calif, formerly marketed as Dermagraft-Transitional Covering), for the treatment of partial-thickness burns. This material is composed of human newborn fibroblasts which are then cultured on the nylon mesh of Biobrane (Dow B. Hickam, Inc, Sugarland, Tex); the thin silicone membrane bonded to the mesh provides a moisture vapor barrier for the wound. A prospective, randomized, comparison study of silver sulfadiazine and TransCyte was performed with the use of paired wound sites on 14 patients. Wounds treated with TransCyte healed more quickly (mean 11.14 days to 90% epithelialization vs 18.14 days, P = .002). A noncomparison evaluation was then done for an additional 18 patients, and it confirmed excellent wound healing and an absence of infections. There were no infections in the 32 wound sites treated with TransCyte. In the first study group, late wound evaluations (3, 6, and 12 months postburn) were performed with use of the Vancouver Scar Scale. The results indicated that wound sites treated with TransCyte healed with less hypertrophic scarring than sites treated with silver sulfadiazine (P < .001 at 3 and 6 months, P = .006 at 12 months).     

美皮康贴膜预防无创正压机械通气患者面部压疮的效果观察

目的探讨美皮康贴膜预防无创正压机械通气（non-invasive positive pressure ventilation,NPPV）患者面部压疮的效果。方法选择2008年1月～2010年3月需行NPPV的患者102例,随机分为对照组53例与观察组49例。对照组采用传统方法护理面部受压皮肤,观察组在传统方法护理基础上,使用美皮康贴膜保护面部受压皮肤。观察两组患者面部压疮发生率。结果对照组面部压疮发生率为44.9%,观察组面部压疮发生率为9.4%,两组比较,P〈0.01,差异具有统计学意义。结论美皮康贴膜能保护NPPV患者的面部皮肤,有效防止面部压疮的发生,值得临床推广应用。     

复方磺胺嘧啶锌涂膜与磺胺嘧啶银霜治疗小儿Ⅱ度烧伤创面的比较研究

目的：观察复方磺胺嘧啶锌涂膜治疗小儿Ⅱ度烧伤创面的疗效和安全性，探讨其在小儿烧伤治疗中的应用价值。方法：133例患儿随机分为复方磺胺嘧啶锌涂膜组70例（甲组）和磺胺嘧啶银霜组63例（乙组），比较两组患儿创面愈合时间、愈合率、药物抗感染效果及不良反应。结果：甲组创面愈合时间较乙组提前（P〈0．05），细菌检出率甲组小于乙组（P〈0．05）。用药后甲组未见加深现象，乙组出现加深现象，两组均无其他不良反应。结论：复方磺胺嘧啶锌涂膜治疗小儿烧伤安全、有效，可促进创面愈合，尤其适用于小儿Ⅱ度创面的治疗。     

德莫林及美皮康联合氧疗对压疮的治疗效果

目的探讨德莫林及美皮康联合氧疗对压疮的疗效。方法将60例由于各种原因所致压疮的老年血液肿瘤病患者随机分成两组，观察组30例，采用德莫林及美皮康联合氧疗的方法治疗处理；对照组30例，采用定时红外线灯照射及常规外科方法处理。比较两组治疗后压疮的恢复情况。结果观察组压疮的有效率为100％明显高于对照组60％，差异有统计学意义（x^2=17．78，P〈0．01），两组患者瑚压疮的治愈时间以及换药次数比较，差异有统计学意义[（11．4±1．13）h比（3．9±1．13）h，（21．2±1．39）次比（2．8±0．71）分；t分别为3．403，3．411；P〈0.01]。结论德莫林及美皮康联合氧疗的方法对各种原因引起的压疮有良好的治疗效果。     

美皮康敷料治疗老年患者一、二期压疮疗效观察

目的观察美皮康敷料治疗老年患者一、二期压疮的效果。方法对2010年发生一、二期压疮的123例老年患者随机分为对照组和观察组。对照组使用传统的压疮治疗方法,观察组应用美皮康敷料治疗,比较两组患者压疮治疗有效率和压疮治愈时间。结果观察组压疮治疗有效率（98．28％）高于对照组（84．62％）,且观察组患者一期压疮治愈时间较对照组缩短,差异有统计学意义（P〈0．05）。结论美皮康敷料能显著提高老年患者一、二期压疮治疗效果。     

泡沫敷料治疗Nd：YAG激光术后创面的效果

目的评价湿性泡沫敷料治疗Nd：YAG激光术后创面的疗效。方法选择40例面部太田痣行Nd：YAG激光术后患者，采用随机数字表法，将其随机分为观察组（20例）及对照组（20例），观察组创面使用泡沫敷料，对照组采用传统干性愈合方法，比较两组创面的愈合效果。结果观察组创面的平均愈合时间为（4．8±1．2）d，明显优于对照组（9．6±1．4）d，两组比较，差异有统计学意义（t=11．8，P〈0．01）。观察组创面愈合后红斑持续时间（7．2±1．8）d，明显少于对照组（15．3±1．3）d，两组比较，差异具有统计学意义（t=16．8，P〈0．001）。观察组患者满意度得分（8．3±1．1）高于对照组（5．6±0．8），两组比较，差异具有统计学意义（x2=8．6，P〈0．01）。两组患者在瘢痕和色素沉着发生率方面比较，差异无统计学意义（P〉0．05）。结论泡沫敷料在处理Nd：YAG激光术后创面上优于传统方法，具有加速创面愈合、减少红斑持续时间的优点。     

麦卢卡蜂蜜治疗Ⅱ～Ⅲ期压疮效果及护理材料成本-效果分析

目的探讨麦卢卡蜂蜜与美皮康敷料治疗Ⅱ~Ⅲ期压疮的效果,并进行护理材料成本-效果分析。方法按照入选标准,选取某市3家三级甲等医院压疮患者38例62处Ⅱ~Ⅲ期压疮,按照随机数字表法,将62处压疮分为两组,即麦卢卡蜂蜜敷料组(蜂蜜组)32处、美皮康敷料组(美皮康组)30处,比较两种方法治疗效果及进行护理材料成本-效果分析。结果两种方法的治疗效果及压疮好转率差异无统计学意义;两种治疗方法的护理材料成本-效果分析,蜂蜜组费用相对低,且结果经敏感度分析具有稳定性。结论麦卢卡蜂蜜与美皮康敷料治疗Ⅱ~Ⅲ期压疮效果基本相同,但麦卢卡蜂蜜敷料的治疗费用相对较低。     

新型敷料在乳癌根治术后伤口换药中的应用

目的：探讨新型敷料（美盐联合亲水性纤维含银敷料和渗液吸收贴）在乳癌根治术后伤口换药中的疗效。方法将60例乳癌根治术后需伤口换药的患者随机分为观察组和对照组各30例。观察组釆用美盐和亲水性纤维含银敷料填敷伤口,再用渗液吸收贴覆盖于创面上;对照组根据药敏试验结果采用敏感药物纱条填敷伤口,再用无菌纱布覆盖创面上。结果观察组较对照组更易于揭除敷料,患者疼痛程度轻于对照组,创面愈合时间、换药次数均少于对照组。结论新型敷料（美盐联合亲水纤维含银敷料和渗液吸收贴）用于乳癌根治术后伤口换药临床疗效明显优于传统方法。     

湿性愈合敷料结合红外线照射治疗烫伤的效果

目的探讨采用湿性愈合敷料结合红外线照射治疗浅表小面积烫伤的效果,以及患者的依从性和医疗费用。方法将24例患者分为观察组和对照组各12例,观察组使用软聚硅酮泡沫吸收敷料,对照组使用传统的凡土林敷料,两组均结合红外线照射。结果观察组愈合天数、处理次数均较对照组少,疼痛计分较对照组低,依从性较对照组好,差异均有统计学意义;医疗费用两组差异没有统计学意义。结论湿性敷料结合红外线照射治疗浅表小面积烫伤效果良好,患者依从性较高,且费用与传统敷料基本持平。     

Pressure ulcer management in home health care: efficacy and cost effectiveness of moisture vapor permeable dressing

This prospective randomized study was conducted in the home care setting to compare healing rates and costs of two different dressings for pressure ulcers: the gauze and tape dressing and the transparent moisture vapor permeable dressing (MVP). Demographic variables, healing rates, and cost of treatment were statistically analyzed for 77 pressure ulcers (48 patients). Each wound was randomly assigned to either a gauze dressing or a MVP dressing. Initial ulcer grade (Shea criteria) and measurements were determined at the start of treatment and weekly for an eight-week period. Photographs of the wound were taken at the beginning and end of treatment. The same protocol for irrigating the wound and relieving pressure was followed for both dressing groups. The median improvement for the grade II group was 100% for the MVP (n = 22) and 52% for gauze (n = 12), p less than 0.05 (Wilcoxon rank sum test). The healing rates for grade III ulcers were not significantly different in the two dressing groups. The mean (eight-week) labor and supply cost per ulcer using the MVP was $845, while that for gauze treatments was $1359, p less than 0.05 (Wilcoxon rank sum test). The cost difference for grade III ulcers was not significant in the two dressing groups. The MVP improved the healing rate and was more cost effective for grade II ulcers. Both gauze and MVP dressings proved effective for the treatment of grade III ulcers.     

A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial-thickness burns: which method is less painful?

Despite recent improvements in analgesia, pain control during dressing changes continues to be a major challenge in patients with burns. We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change. Patients with partial-thickness burns that required only topical wound care were assigned randomly to treatment with Acticoat (Smith and Nephew USA, Largo, FL) or silver sulfadiazine (AgSD). The outcome variable was pain during wound care, which was measured using visual analog pain scores. The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9, respectively (P < .0001; paired Student's t-test). In 41 of the 47 paired pain score observations, the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat. Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns.     

磺胺嘧啶银脂质水胶敷料结合负压封闭引流治疗深部感染创面的效果评价

目的：观察磺胺嘧啶银脂质水胶敷料结合负压封闭引流（VSD）治疗深部感染创面的临床效果。方法选择2010年4月-2012年12月间伤口门诊患者44例,按随机数字表法分为治疗组24例和对照组20例,治疗组采用磺胺嘧啶银脂质水胶敷料结合VSD进行治疗;对照组采用普通无菌纱布结合VSD进行治疗。比较两组患者换药时疼痛程度、相同时间点两组细菌清除率、创面清洁时间、堵管次数、换引流管的次数等指标。结果两组患者换药时的疼痛感比较,治疗组较对照组患者疼痛程度轻,差异有统计学意义（Z＝-4．036,P＜0．05）。治疗组患者的细菌清除率、创面平均清洁时间、堵管率、换引流管的次数分别为94％,12 d,0％,3．2次,明显优于对照组的73％,28 d,70％,9．1次,差异有统计学意义（χ2＝21．32,P＜0．05）。结论磺胺嘧啶银脂质水胶敷料结合VSD能提高细菌的清除率,防止引流管堵塞,减少引流管的更换次数,缩短创面的清洁时间,能减轻患者的疼痛程度,缩短患者住院时间。     

Hydrocolloid versus saline-gauze dressings in treating pressure ulcers: a cost-effectiveness analysis.

The cost effectiveness of using hydrocolloid dressings versus nonsterile saline-gauze wet-to-moist dressings for treatment of pressure ulcers in a long-term care setting was evaluated. During 21 months, 39 subjects were enrolled, and treatment was randomly assigned. Eighty-nine percent of the hydrocolloid subjects and 86% of the saline-gauze subjects healed. Median healing time was shorter for the hydrocolloid group (nine days) than for the saline-gauze group (11 days), although the difference did not reach statistical significance (p = .12). Presence of exudate at baseline was associated with a prolonged time to healing. For the hydrocolloid treatment, the median nursing time was one eighth that of the saline-gauze treatment, but its materials cost was 3.3 times higher. Using local nursing wages, median total cost for treatment with hydrocolloid dressing was $15.58; for the saline gauze, it was $22.65. Using national nursing wages, these costs were $15.90 and $25.31, respectively. The cost savings of the hydrocolloid treatment using local wages did not reach statistical significance. However, using national wages, the cost of the hydrocolloid treatment was significantly less expensive. Nursing home treatment of pressure ulcers was inexpensive overall. Consequently, the absolute cost savings of using hydrocolloid dressings instead of nonsterile saline-gauze dressing, although real, was relatively modest. Physicians can use local nursing wages to calculate the magnitude of savings in their area.     

藻酸盐银联合水凝胶敷料对慢性创面愈合的作用

背景:研究发现藻酸盐及水凝胶敷料等均可促进创面愈合,而新型敷料藻酸盐银联合水凝胶敷料,对于难治慢性创面的愈合作用尚不清楚。目的:观察藻酸盐银联合水凝胶敷料对慢性创面治疗的作用。方法:选择江苏省人民医院烧伤整形科住院慢性创面患者34例,随机分为2组:治疗组应用藻酸盐银联合水凝胶敷料序贯换药;对照组采用1%磺胺嘧啶银冷霜抹在凡士林纱布上外敷,于治疗后7,10,14,17,21d进行创面分泌物细菌培养、观察创面愈合情况及速度、药物不良反应、换药时创面痛感、肉芽破坏等情况。结果与结论:治疗组创面细菌检出率明显低于对照组(P<0.05)。治疗组创面愈合时间比对照组平均缩短约6d,创面愈合速度较对照组明显加快(P<0.05)。两组均无药物不良反应,治疗组创面换药时无明显疼痛感,肉芽组织无明显破坏。提示藻酸盐银联合水凝胶敷料序贯治疗慢性创面具有显著抗菌及促进创面肉芽组织和上皮再生、促进创面愈合的作用,且无不良反应。     

下肢静脉溃疡应用湿性愈合护理加高压氧治疗的效果观察

目的探讨下肢静脉溃疡应用湿性愈合护理加高压氧治疗的效果。方法便利抽样法选择2007年3月至2011年12月在解放军海军总医院门诊伤口护理中心换药的下肢静脉溃疡患者60例为研究对象。按随机数字表法将其分为对照组和观察组,每组30例;对照组患者采用常规湿性愈合敷料护理下肢静脉溃疡,观察组患者采用湿性愈合护理加高压氧治疗下肢静脉溃疡。比较两组患者治疗护理后总疗效、显效及治愈时间和所需医疗费用等。结果观察组患者疗效明显优于对照组,差异有统计学意义（x2=5．455,P〈0．05）。观察组患者显效和愈合时间明显短于对照组,差异均有统计学意义（均P〈0．05）。观察组患者所需医疗费用明显少于对照组,差异有统计学意义（P〈0．05）。结论湿性愈合敷料换药加高压氧治疗是一种良好的治疗下肢静脉溃疡的方法,其疗效优于单纯湿性愈合敷料换药,值得推广应用。     

亲水性纤维含银敷料覆盖肛瘘术后创面的作用

背景：亲水性纤维含银敷料在其他创面治疗中目前已取得较多临床证据,但其对肛瘘患者术后创面康复的作用研究较少。目的：观察亲水性纤维含银敷料覆盖对肛瘘患者术后创面康复的作用。方法：将 57 例肛瘘术后患者随机分为试验组 29 例和对照组 28 例,试验组在术后给予亲水性纤维含银敷料换药,3 d 1次,对照组术后给予无菌凡士林纱布换药,1 次/d,观察两组患者的首次换药创面疼痛程度、渗液明显减少时间、换药次数、创面康复时间及换药费用等指标。结果与结论：试验组首次换药时创面疼痛程度明显轻于对照组（P 〈 0.05）,渗液明显减少时间、换药次数、创面康复时间明显少于对照组（P 〈 0.05）;但试验组换药费用明显高于对照组（P 〈 0.05）。表明亲水性纤维含银敷料覆盖于肛瘘患者术后创面可减少刺激,明显减轻疼痛,提供湿性修复环境,加速创面愈合,减少换药次数,提高患者满意度。     

藻酸盐银联合水凝胶敷料对慢性创面愈合的作用

背景：研究发现藻酸盐及水凝胶敷料等均可促进创面愈合,而新型敷料藻酸盐银联合水凝胶敷料,对于难治慢性创面的愈合作用尚不清楚。目的：观察藻酸盐银联合水凝胶敷料对慢性创面治疗的作用。方法：选择江苏省人民医院烧伤整形科住院慢性创面患者34例,随机分为2组：治疗组应用藻酸盐银联合水凝胶敷料序贯换药;对照组采用1%磺胺嘧啶银冷霜抹在凡士林纱布上外敷,于治疗后7,10,14,17,21d进行创面分泌物细菌培养、观察创面愈合情况及速度、药物不良反应、换药时创面痛感、肉芽破坏等情况。结果与结论：治疗组创面细菌检出率明显低于对照组（P〈0.05）。治疗组创面愈合时间比对照组平均缩短约6d,创面愈合速度较对照组明显加快（P〈0.05）。两组均无药物不良反应,治疗组创面换药时无明显疼痛感,肉芽组织无明显破坏。提示藻酸盐银联合水凝胶敷料序贯治疗慢性创面具有显著抗菌及促进创面肉芽组织和上皮再生、促进创面愈合的作用,且无不良反应。