伤口护理的方法及其效果观察

目的优选对伤口损伤小、疗效好、费时少的伤口护理方法。方法将63例病人计77处伤 口(褥疮、糖尿病足溃疡、烫伤、药物性溃疡)分为A、B、C 3组,采用“生理盐水涡流式冲 洗”或“双氧水 涡流式冲洗+生理盐水涡流式冲洗”清洁伤口后,分别给予自制敷料封闭胰岛素湿敷+口 服常用量维生素C和自制敷料/进口敷料封闭胰岛素湿敷+口服大剂 量维生素C进行对比治疗,观察了疗效并比较了自制敷料和进口敷料的效果及费用。 结果进口敷料封闭胰岛素湿敷加服大剂量维生素C组的Ⅱ期伤口愈合率高且平均愈 合时间短,换药次数及时间明显减少而平均费用无明显增加。结论采用“涡流式水流冲 洗伤口”后,用进口敷料封闭胰岛素湿敷,加服大剂量维生素C,可缩短各类伤口的愈 合时间,节省护理时间而不增加病人费用。     

皮肤溃疡的护理方法及研究

目的：探讨临床常见皮肤溃疡的最佳护理方法。方法：将55例病人计67处溃疡按基本条件相当原则随机分成A、B、C三组，A组18例22处伤口采用清创冲洗后，给予自制油纱敷料封闭外敷，同时口服或鼻饲维生素C片，1．5dd；B组18例21处．伤口采用口服或鼻饲维生素C片，0．3g/d．其它同A组；C组19例24处，伤口采用碱性成纤维细胞生长因子外喷溃疡面处，其它方法同A组。结果：C组愈合率最高，且平均显效时间和愈合时间均较A、B两组明显缩短；C组伤口愈合所需费用与A组相近，但明显少于B组。结论：采用清创冲洗后用碱性成纤维细胞生长因子加自制油纱敷料封闭，糖尿病足外用胰岛素，加用大剂量维生素C有助于各种皮肤溃疡愈合的最佳方法。     

4类皮肤伤口护理的方法学及其疗效研究

优选临床常见的４类皮肤伤口的最佳护理方法。方法：将５５例病人计６７处４类伤口按基本条件相当原则分为Ａ、Ｂ、Ｃ３组，Ａ组１８例２２处伤口采用生理盐水涡流式冲洗／双氧水冲洗＋生理盐水涡流式冲洗后，给予１２－３６＾ｕ胰岛纱用自制封闭敷料封闭外敷，同时口服／鼻饲Ｖｉｔｃ１．５ｇ／ｄ。     

伤口护理中不同敷料的疗效观察

目的 观察合成封闭敷料与自制棉纱封闭敷料在伤口愈合中的作用及其成本效益。方法 将44例计53处四类伤口按基本条件相当原则分为A、B两组,A组伤口采用自制棉纱敷料封闭,B组则采用合成敷料封闭。采用统一标准观察并比较两组刨面的显效时间、愈合时间、换药次数及时间,并分别进行成本核算。结果 B组伤口Ⅱ期愈合率和总愈合率均有提高,平均显效时间、愈合时间及换药次数与时间明显少于A组,两组费用接近。结论 在有效处理伤口的基础上,合成敷料更有助于伤口愈合且不增加患负担,可替代自制棉纱敷料。     

腐殖酸钠加胰岛素外敷治疗糖尿病足的临床观察及护理

[目的]探讨糖尿病足溃疡换药治疗的最佳方案,观察腐植酸钠加胰岛素换药治疗糖尿病足溃疡的临床疗效.[方法]将64例(66处溃疡)糖尿病足病人随机分为3组.清创后A组采用生理盐水20 mL加胰岛素8 U冲洗,再用1%腐植酸钠纱布湿敷溃疡处;B组采用1%腐植酸钠纱布湿敷溃疡处;C组采用0.1%依沙吖啶(利凡诺)纱布湿敷,换药过程中观察伤口情况,并分别于治疗前及治疗后1周、2周、3周、4周、5周观察创面面积变化情况,比较3组创面愈合时间、面积变化及疗效.[结果]A组创面面积显著小于B组、C组,A组创面愈合时间显著短于B组、C组(均P<0.05);3组创面愈合率、总有效率差异有统计学意义(P<0.05),且无一例加重或发展成坏疽.[结论]胰岛素加腐植酸钠对糖尿病足溃疡的治疗效果好,可以缩短治疗时间,增加治疗效果.     

腐殖酸钠加胰岛素外敷治疗糖尿病足的临床观察及护理

[目的]探讨糖尿病足溃疡换药治疗的最佳方案,观察腐植酸钠加胰岛素换药治疗糖尿痛足溃疡的临床疗效。[方法]将64例（66处溃疡）糖尿病足病人随机分为3组。清创后A组采用生理盐水20mL加胰岛素8U冲洗,再用1％腐植酸钠纱布湿敷溃疡处;B组采用1％腐植酸钠纱布湿敷溃疡处;C组采用0．1％依沙吖啶（利凡诺）纱布湿敷,换药过程中观察伤口情况,并分别于治疗前及治疗后1周、2周、3周、4周、5周观察创面面积变化情况,比较3组创面愈合时间、面积变化及疗效。[结果]A组创面面积显著小于B组、C组,A组创面愈合时间显著短于B组、C组（均P〈0．05）;3组创面愈合率、总有效率差异有统计学意义（P〈0．05）。且无一例加重或发展成坏疽。[结论]胰岛素加腐植酸钠对糖尿病足渍疡的治疗效果好,可以缩短治疗时间,增加治疗效果。     

不同敷料对糖尿病慢性伤口疗效的对比研究

目的 观察自配敷料与交互式敷料在糖尿病伤口愈合中的作用。方法 将58例计67处伤口分为A、B两组,两组伤口分别采用交互式敷料和自配敷料。采用同一标准观察两组伤口的显效时间、愈合时间及换药次数。结果 A组伤口Ⅱ期愈合率及总愈合率均高于B组,伤口愈合的显效时间、愈合时间及换药次数均明显小于B组。结论 在有效处理伤口的基础上,交互式敷料较自配敷料更有助于伤口愈合。     

含银敷料辅助治疗糖尿病足溃疡感染的效果观察

目的观察评价含银敷料辅助治疗糖尿病足溃疡感染的有效性。方法2012年5月一2014年4月对人选的105例糖尿病足溃疡患者随机分为A、B两组：患者在整体干预的基础上,A组使用进口的银离子藻酸盐敷料,B组使用国产纳米银敷料,在设定治疗时间内,通过观察创面细菌转阴率和伤口愈合计分评价含银敷料处理糖尿病足溃疡的效果。结果两组创面细菌转阴率基本一致（P〉0．05）,伤口愈合计分随着治疗时间的延长均呈下降趋势,但A组伤口愈合计分下降较B组明显（P〈0．01）。结论两种含银敷料辅助治疗糖尿病足溃疡创面感染均有效,但银离子藻酸盐抗菌敷料的促愈效果更佳;细菌转阴率和伤口愈合计分评价含银敷料的治疗效果是客观可行的观察指标。     

双黄连粉外敷配合高压氧治疗慢性皮肤溃疡36例效果观察与护理

目的：探讨双黄连粉外敷配合高压氧治疗慢性皮肤溃疡的效果及护理方法。方法：将65例（106处）慢性皮肤溃疡患者分为观察组36例（56处）和对照组29例（50处）。对照组采用传统的治疗方法,即清创、换药、敷料覆盖及包扎,每日换药2～3次。观察组行生理盐水冲洗、外科清创后,用蜂蜜做基质将双黄连粉调成糊状涂于创面,敷料覆盖包扎,每日换药2～3次,然后配合高压氧治疗。观察、比较两组患者治疗效果、溃疡愈合时间。结果：两组患者整体治疗效果比较差异有统计学意义（P〈0.01）。观察组患者溃疡愈合时间较对照组短（P〈0.01）。结论：采用双黄连粉外敷配合高压氧治疗慢性皮肤溃疡效果满意,值得临床推广应用。     

双黄连粉外敷配合高压氧治疗慢性皮肤溃疡36例效果观察与护理

目的:探讨双黄连粉外敷配合高压氧治疗慢性皮肤溃疡的效果及护理方法.方法:将65例(106处)慢性皮肤溃疡患者分为观察组36例(56处)和对照组29例(50处).对照组采用传统的治疗方法,即清创、换药、敷料覆盖及包扎,每日换药2～3次.观察组行生理盐水冲洗、外科清创后,用蜂蜜做基质将双黄连粉调成糊状涂于创面,敷料覆盖包扎,每日换药2～3次,然后配合高压氧治疗.观察、比较两组患者治疗效果、溃疡愈合时间.结果:两组患者整体治疗效果比较差异有统计学意义(P<0.01).观察组患者溃疡愈合时间较对照组短(P<0.01).结论:采用双黄连粉外敷配合高压氧治疗慢性皮肤溃疡效果满意,值得临床推广应用.     

Management of radiation-induced moist skin desquamation using hydrocolloid dressing

Moist skin desquamation has been of concern to radiation oncologists, nurses and patients since the inception of this mode of therapy. As radiation treatment machines became more sophisticated, severe reactions became less of a problem. However, with the increasing use of chemotherapy and radiation as combined modalities, moist skin reaction is occurring with greater frequency. A noncomparative study of 20 patients using a hydrocolloid occlusive dressing (Duoderm) was initiated. The purpose of the study was to determine whether moist occlusive healing would be beneficial. The dressing was evaluated on the basis of healing time, safety, wound temperature, bacterial growth, and comfort. Data were collected using photographs, bacterial cultures, temperature probes, and patient evaluations. Eighteen patients completed the study. All patients' skin reactions healed. There were no wound infections evident. Mean healing time was 12 days, with mean wound temperature relative to body core -0.8 degree C on day 1 and -1.2 degrees C on the healed site. Patient results on comfort were: 8 of 18 excellent, 7 of 18 good, 3 of 18 fair, and 0 of 18 poor. The results of this study indicate that a hydrocolloid occlusive dressing can be effective in the healing process of moist skin reaction that is due to radiation therapy.     

水胶体敷料结合丹参酮注射液湿敷治疗慢性伤口的疗效观察

目的观察水胶体敷料结合丹参酮注射液湿敷慢性伤口的疗效。方法将96例慢性伤口患者随机分为试验组与对照组,每组各48例。试验组在伤口常规消毒后用丹参酮注射液冲洗并湿敷,外用水胶体敷料固定;对照组在伤口常规消毒后用传统敷料覆盖创面。定期观察并记录创面一般情况(包括换药疼痛、创面颜色、异味、渗液及感染)及创面愈合速度。结果试验组创面红润48例(100%),换药疼痛0例,渗液4例(8%),异味伤口4例(8%),而对照组创面红润25例(52%),渗液16例(33%),异味伤口12例(25%),两组间比较,差异有统计学意义(P<0.05)。两组均无继发感染,试验组的愈合时间比对照组缩短12²8d(P<0.05)。结论应用水胶体敷料结合丹参酮注射液湿敷创面能有效清除创面坏死组织,促进肉芽生长,减少伤口疼痛,加速创面愈合。     

Collagen powder dressings in the healing of secondary intention wounds. Report of a case

The wounds mean not only an important bio-psico-social problem for the patient who suffers them, but also an important economic burden for the sanitary system. One of the many wounds classifications allows us to differentiate between acute wounds (slight traumatism, surgical wounds...) and chronic wounds (pressure ulcers, vascular ulcers...), this differentiation allows us to distinguish between wound healing by primary intention (that occurs in acute wounds where filling of cavity is not needed). And wound repair by secondary intention (the way by which chronic wounds are normally solved), a long process in time that needs the filling of the cavity with a neoformation tissue, the granulation tissue. In the present article we described the use of a new dressing of exogenous collagen (Catrix) in the healing of wounds by secondary intention, as well as the actions of this dressing in the different phases of healing. For all it, we supported by a clinical case treated in our unit that corresponds to the healing by second intention of a post-surgical wound secondary to debride by a suppurative hydrosadenitis, that was admitted to our unit waiting for skin graft.     

Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings

Aims and objectives. To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze‐based) in surgical patients after hospital dismissal. Background. The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze‐based dressings, which appears especially useful for homecare patients and could save costs. Methods. We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non‐parametric bootstrapping. Results. Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0·6/day) was significantly (p = 0·008) lower than in the gauze group (1·1/day). Mean daily material costs of modern dressings were €5·31 vs. €0·71 in the gauze group. Mean difference; €4·60 (95% CI, €2·68–€6·83) while daily total (material plus nursing) costs showed no difference between the groups; mean €2·86 (95% CI, €?6·50–€10·25). Wound healing in the gauze‐treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log‐rank p = 0·060). Conclusions. The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home. Relevance to clinical practice. District nurses should reconsider using gauze‐based dressings, particularly in surgical patients with exudating wounds.     

不同换药方式对糖尿病模型小鼠和正常小鼠创面愈合影响的实验研究

[目的]比较生理盐水、4%硼酸溶液、0.5%碘伏＋3%过氧化氢3种临床常用护理换药方式对糖尿病小鼠和正常小鼠创面愈合的影响,以期探索最适合糖尿病难愈性创面的护理换药方式。[方法]取雄性8周龄C57BL/6J小鼠30只,设糖尿病组与对照组小鼠各15只,糖尿病小鼠以链脲佐菌素（STZ诱导）在背部制作3个同等大小的全层皮肤创面后,每日1次分别以生理盐水（A处理）、4%硼酸溶液（B处理）和0.5%碘伏＋3%过氧化氢溶液（C处理）对创面换药,记录创面结痂及感染情况并计算创面愈合率。[结果]在同一时相点、A处理换药方式下,糖尿病组小鼠的创面愈合率明显低于对照组小鼠;对照组小鼠在3种不同换药处理方式下,其创面愈合率差异无统计学意义（P〉0.05）;糖尿病小鼠应用B处理的创面愈合率显著高于应用A和C处理法（P〈0.05）。[结论]正常小鼠创面应用3种换药方式对创面的愈合率无显著影响;糖尿病小鼠创面使用硼酸溶液换药较其他换药方式更有利于伤口愈合。     

Occlusive dressings

Occlusive dressings reduce or eliminate wound pain, increase the speed of reepithelialization in acute wounds and stimulate debridement and healing of chronic ulcers. During the first 10 to 14 days, a large amount of fluid may accumulate under the dressing, but this fluid is seldom the result of infection. Films, foams, hydrocolloids and hydrogels have different properties that commend them in different settings.     

天然蜂蜜联合珍珠粉用于压疮伤口换药的疗效观察

目的 探讨天然蜂蜜加珍珠粉在促进压疮伤口愈合中的应用效果。方法 选取笔者所在医院脑病科住院的50例压疮患者,按随机数字表法将患者分为对照组和观察组,各25例。对照组根据伤口情况选择相应的新型敷料,观察组在创面涂抹2∶1配比的蜂蜜加珍珠粉混合液,观察2组伤口愈合情况和治疗效果。结果 观察组伤口愈合情况和疗效均好于对照组(F_组间=189.722,P＜0.001;Z=-2.608,P=0.007)。结论 蜂蜜加珍珠粉用于压疮伤口换药疗效显著,值得临床推广应用。     

An investigation of the benefits of Aquacel Hydrofibre wound dressing

Aquacel wound dressing, produced by ConvaTec, uses the main ingredient of the hydrocolloid dressing in a new way to produce a hydrofibre dressing. Aquacel is designed for use in moderate to heavily exuding wounds as it absorbs exudate directly into its fibres. It has been shown to be effective in pressure sores, leg ulcers and surgical wounds, producing warm, moist, local wound conditions for optimum wound healing. Aquacel can lock exudate away thus protecting the surrounding skin.