文档介绍：慢性不愈伤口的处理
个案讨论
湘雅医院胃肠外科ET 张其健
Wound Bed Preparation 伤口床准备
The (TIME) acronym outlines the framework principles
字母缩写理解管理原则的框架:
T = Tissue management 软组织的处理
I = Infection or inflammation control
控制感染或炎症
M = Moisture Balance 湿润平衡
E = Edge of Wound 伤口边缘
11
(By 2002 WCET meeting)
T = Tissue Management 软组织的处理
Assessment of the wound for non-viable tissue & wound characteristics. 评估非存活组织和伤口特性
Wound Debridement is the Principle Intervention
伤口清创是基本的处理原则
Methods 方法:
保守的外科清创Conservation sharp wound debridement
外科清创或锐利刀片Surgical or Sharp
酶——使用酶制剂促进坏死组织、血块和纤维组织溶解Enzymatic – use of enzymatic agents to promote lysis of necrotic tissue, bld clots & fibrinous tissue
1
2
3
4
5
6
7
自溶清创
——使用水合或保湿敷料
Autolytic –use of rehydrating or moisture retention dressings
机械清创
——干或湿的敷料,加压冲洗Mechanical – wet to dry dressing, irrigation under pressure
化学性清创——含碘产品
Chemical –Cadexomer iodine products
生物/寄生虫清创——虫卵治疗Biological/parasitic – larval therapy
I = Infection or Inflammation Control 感染或炎症
The degree of bacterial involvement in wounds is classified as either 伤口内细菌侵害的程度可分为:
Contamination – the presence of
non-replicating bacteria in a wound
does not inhibit wound healing
污染——伤口内存在着非复制的细
菌,但不影响伤口愈合
(Chin et al., 2003)
Colonization – presence of
replicating anism, but no
host reaction
定植——存在可复制的微生物,但
没有引起宿主的反应
(Sibbald et al., 2003)
I = Infection or Inflammation Control 感染或炎症
Critical Colonization – an increased in
the bacterial burden of the wound &
healing is inhibited.
严重定植——伤口内细菌负荷增长,
愈合过程受影响。
Tissue characteristics 软组织特性:
Static healing 愈合停止
Increased exudation 渗出增加
Pale gray or deep red
colored granulation tissue
灰白或深红色肉芽组织
Friable granulation that bleeds
on contact
肉芽脆弱,接触就会出血
Hypergranulation 肉芽过度增生
Tissue bridging 组织坍塌
Rolled wound edges
创缘由锐利变钝
M = Moisture Balance 湿润平衡
Excessive fluid in chronic wound can interfere with the activities of important cell mediators such as growth factors in the tissue (Falanga 2004)
慢性伤口的过多渗出液会干扰重要的细胞