Physiology of wound healing and risk factors that impede the healing process

In the critically ill patient, wound repair can be impeded by processes inherent to the illness, its treatment, and the critical care environment. This vulnerability to wound complications increases patient morbidity and mortality as well as length of stay, resource consumption, and hospital cost. The physiology of wound healing and factors that impede wound repair are discussed. Those factors commonly seen in critical illness include advanced age, diabetes mellitus, compromised immunocompetence, inadequate perfusion, and oxygenation, infection, malnutrition, obesity, and preoperative illness. Knowledge of management of the physiologic factors that affect wound healing enables the nurse to maximize tissue repair and prevent wound complications.     

湿性愈合原理在手术切口二期愈合护理中的应用

目的探讨手术切口二期愈合的护理方法。方法对2002～2006年外科手术后二期愈合切口24例患者共29处切口的护理进行回顾。所有切口经评估后,选择适当的清创方法,选用合适的敷料。结果本组29处切口无须Ⅱ期缝合,15例16处切口9～29d内愈合,5例9处切口1～3月内愈合,1处切口未愈合前因切口周围癌症复发而患者出院;有1处切口经过2个月切口处理,在肉芽填平、切口缩小时,患者带切口出院;2例乳腺癌术后患者切口呈2cm×2cm红色肉芽,分别每2周和3周化疗一次,切口都表现为反复复发,经过3个月处理,在化疗结束时愈合。结论最佳的切口处理除了取决于仔细的切口评估、选用适当的清创方法外,还要根据切口愈合原理运用适当的敷料。     

Nutrition for wound healing

The importance of the role of nutrition in wound healing is an area that has been widely explored over the last decade. It is well recognised that both macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins, minerals and trace elements) play important parts in the healing of both chronic wounds and acute injuries. The term 'wound' encompasses many different situations from leg ulcers to laparostomy wounds. This article provides an overview of the role of different nutrients in the healing of wounds and guidance to nurses on first-line assessments, which can be used to ensure the patient is receiving adequate nutrition for successful wound healing. It will focus on commonly seen wounds in primary and secondary care but will not cover specialist wound management, such as laparostomy sites and burns, as these must always be cared for by experienced and specialist multidisciplinary teams.     

创面愈合的评价指标

为建立客观、准确地评价创面愈合的标准,该文对近年来国内外有关文献进行检索,总结和筛选了创面愈合率、创面愈合时间、组织病理学分析、巨噬细胞定量分析、羟脯氨酶含量测定、细胞增殖情况、细胞DNA含量和细胞周期分析、转化生长因子-α水平、白细胞介素-1、白细胞介素-6和肿瘤坏死因子水平、角质细胞胶原酶-1含量测定、成纤维细胞生长因子受体-1水平、单核细胞化学诱导蛋白-1水平和角质细胞纤溶酶原活化抑制剂-2水平等13种创面愈合评价指标。其中创面愈合率、创面愈合时间及组织病理学分析仍是最直接而有效的创面愈合评价指标。     

Nutritional aspects of wound healing

Proper nutrition is essential to prevent the development of pressure ulcers and to support adequate and timely wound healing. Additionally, research and clinical observation suggest nutrients play a major role in wound healing. How the nutrients Vitamin A, Vitamin C, zinc, calories, protein, and fluids are used in wound healing and recommendations regarding use of supplements are discussed in this article.     

碱性成纤维细胞生长因子与小儿烧伤创面的愈合

背景：皮肤创面愈合是一个复杂的病理过程,对于创伤和创伤后感染等引起皮肤难愈合的研究一直是临床创面修复的难题,对于碱性成纤维细胞生长因子促进皮肤创面愈合的基础研究相对较多,临床应用研究较少。目的：对碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献资料趋势进行多层次分析,探讨在小儿烧伤创面愈合中的应用疗效。方法：以电子检索方式对CNKI数据库学术期刊2002-01/2011-12收录有关碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献进行分析,采用检索词为＂碱性成纤维细胞生长因子;创面愈合＂,运用数据库的分析功能和Excel软件图表的功能分析数据特征。结果与结论：CNKI数据库学术期刊2002/2011收录碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献共228篇,文献数量处于平稳发展趋势。《中国组织工程研究与临床康复》杂志收录的文献数量最多为26篇。解放军第304医院产出的文献最多。碱性成纤维细胞生长因子促进皮肤创面愈合研究文献的基金资助项目有16项,基金资助项目的文献共76篇,以国家重点基础研究发展计划（973）项目和国家自然科学基金资助项目的文献最多。碱性成纤维细胞生长因子在小儿烧伤创面愈合中应用的文献虽然较少,但实验结果均显示治疗效果较好,有促进小儿Ⅱ度烧伤创面愈合的作用,而且无不良反应出现。     

碱性成纤维细胞生长因子与小儿烧伤创面的愈合

背景:皮肤创面愈合是一个复杂的病理过程,对于创伤和创伤后感染等引起皮肤难愈合的研究一直是临床创面修复的难题,对于碱性成纤维细胞生长因子促进皮肤创面愈合的基础研究相对较多,临床应用研究较少。目的:对碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献资料趋势进行多层次分析,探讨在小儿烧伤创面愈合中的应用疗效。方法:以电子检索方式对CNKI数据库学术期刊2002-01/2011-12收录有关碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献进行分析,采用检索词为"碱性成纤维细胞生长因子;创面愈合",运用数据库的分析功能和Excel软件图表的功能分析数据特征。结果与结论:CNKI数据库学术期刊2002/2011收录碱性成纤维细胞生长因子促进皮肤创面愈合研究的文献共228篇,文献数量处于平稳发展趋势。《中国组织工程研究与临床康复》杂志收录的文献数量最多为26篇。解放军第304医院产出的文献最多。碱性成纤维细胞生长因子促进皮肤创面愈合研究文献的基金资助项目有16项,基金资助项目的文献共76篇,以国家重点基础研究发展计划(973)项目和国家自然科学基金资助项目的文献最多。碱性成纤维细胞生长因子在小儿烧伤创面愈合中应用的文献虽然较少,但实验结果均显示治疗效果较好,有促进小儿Ⅱ度烧伤创面愈合的作用,而且无不良反应出现。     

Angiogenesis in wound healing.

Angiogenesis is an essential component of wound healing. Vessel growth is controlled by the local actions of chemical mediators, the extracellular matrix, metabolic gradients, and physical forces. Manipulation of some of these factors can improve healing in experimental wounds. The clinical potential and specific application of 'angiomodulatory' strategies are discussed.