（优质医学）慢性伤口处理

1、wound cleaning -Techniques伤口清洁-技术,Components which need to be removed from wound bed 需要从创面去除的部分 Surplus exudate多余渗出物 Necrotic tissue坏死组织 Dead cells 死亡细胞 Breading ground for bacteria and components which might be supportive to the development of biofilms. 细菌滋养环境以及可能会促进生物被膜形成的成分,1,wound cleaning伤口清洁,General goal 总体目标 To remove debries and froeign bodies.去除碎屑与异物 Necrotic tissue坏死组织 Dead cells死亡细胞 Fibrin纤维蛋白 Toxins，MMP毒素，MMP Foreign bodies (for instance remains for previously used dressings) 异物（例如先前

2、使用的敷料）,2,Wound cleaning-Techniques伤口清洁-技术,Requirements on wound rinsing solutions 对伤口冲洗液的要求 Should be sterilie 无菌 Not colored 无色 Gentel to cells/non toxic 细胞温和型/无毒 Body temperature(cooling down wound bed reduces or inactivates cell activity) 28 no function 体温（冷却创面、减少细胞活性或使其灭活）28 无效,3,Wound cleaning 伤口清洁,Ways 方法 Basic cleanning of wound bed,wound edges and surrounding area 对伤口创面、边缘以及周围进行基本清洗 Antibacteira cleanning 抗菌剂清洗 Wound rinsing伤口冲洗 Wound cleaning Wet to dry 干燥清洗伤口 Debridement 清创术 Negtive pr

3、essure负压,4,Wound cleaning 伤口清洁-技术,Cleanig with Rinsing solution 采用冲洗溶液进行清洗 Saline 生理盐水 Ringer solution林格氏液 Indication:Cleaning wound 适应症：清洁伤口 Non touch technique非接触技术,5,Wound cleaning 伤口清洁-技术,Cleanning with antiseptic solution 采用消毒溶液进行清洗 Octenidin-di-hydrochlorid奥替尼啶盐酸化合物 Polyhexanid 聚已缩胍 Iodine 碘 Indication:Infected and contaminated wound 适应症：感染伤口和污染伤口 Non touch technique:From outside to center of wound in order to avoid further spreading of bacteria to the surrounding area. 非接触技术：从外围向中间清洗以避免细菌

4、向周围进一步播散,6,Wound cleaning -Antiseptic solution伤口清洁-消毒溶液,Octenidin-di-hydrochlorid奥替尼啶盐酸化合物 Polyhexanid 聚已缩胍 Advantages优点 not colored,not inacticated by body fluids无色、不会被体液灭活 do not initiate resistance ,skin irritation and allergies不会引起抗药性、皮肤刺激或过敏 Disadvantages缺点 not available and reimbursed in many countries在许多地区不能使用而且不能报销 不能采用高压将奥替尼啶注入腔内加以应用 Both should not be applied on cartilage and in contact with internal organs(abdominal cavity)二者均不能在软骨上运用，且不能与内部器官接触（腹腔）,7,Wound cleaning -Antiseptic soluti

5、on伤口清洁-消毒溶液,Iodine Advantages优点 Effevtive against Gram postive and Gram negtive bacteria 可有效对抗革兰阳氏和阴性菌 Available in different forms for application(ointment,lotions) 可以采用不同形式加以运用（软膏、洗液） Disadvantages 缺点 Colored(makes wound assessment difficult )有色（难以对伤口进行评估） Inactivated by body fluids会被体液灭活 Sensitivity might occur 可能会发生过敏 Systemic side effects due to absortion吸收会导致全身副作用,8,Wound debridement清创术,In case of a chronic,difficult to heal wound cleaning can be supported with different ways of debridemen

6、t 在慢性、难愈合性伤口的清洁中可才采用不同的清创术进行支持治疗 Requirements要求： As gentle as possible 尽可能温柔 As thorough as possible 尽可能彻底 As soon as possible尽早,9,Debridement opportunity清创时机,病情许可，越早越好 Illness permission,the sooner ,the better 无明显感染表现，均可清创 No apparent infection,debridement performance 已有感染，但伤口有异物或较多坏死组织，也可清创，清创后伤口暂不缝合 If the Wound is infected,but have a foreign body or much necrotic tissue,we can also debridement,and do not wound closure after debridement 急性伤口理想时间：伤后8小时以内，头面、手部伤口12小时以内 The ideal time:8 hours af

7、ter the wound,and the head ,hand within 12 hours after the wound,10,Debridement methods伤口清创方法,机械清创（伤口清洗和伤口浴，水下低频超声波处理、聚氨酸脂类软性泡沫复合物产品等） Mechanical debridement 外科清创（剪刀、手术刀、锋利勺、刮器）Surgical debridement 酶清创（蛋白质、肽类）Enzymatic debridement 生物清创Bio surgical debridement 自溶性清创（内活性伤口敷料、如水胶体、水凝胶）Autolytic debridement,11,Wound debridemen清创术,Mechanical 机械性清创 Wipe(mechancialy clean)the wound with sterile gauze 无菌纱布擦拭伤口（机械型清洗） Gauze can be moist or dry可以采用湿性或干性纱布 Cave:might be painful for patient孔洞：可能造成患者疼痛 Atern

8、ative选择 Soaked gauze is applied to wound and should be removed gently.Every time some of wound debris will remain in gauze. 对伤口使用浸湿纱布，而且去除纱布时动作应当轻柔。每次都会有一些伤口碎屑留在纱布内。,12,Wound debridemen清创术,Surgical 手术清创 Removal of debris with curette,abrasor or scapel采用刮匙、刮除器或手术刀去除碎屑 Usually performed by surgeon or specially trained nurses under supervision of surgeon.通常由外科医生执行清创或者在外科医生的监督下由护士进行清创。 Cave 空洞 Might be painful for patient可能会引起患者疼痛 Chance of bleeding可能会出血 In severe cases int must be conducted in OR严重

9、时必须采用手术进行处理,13,Wound debridemen清创术,Enzymatic 酶解清创术 Removal of debris with emzymes 采用酶法 Have to be renewed frequently 必须经常更新 Need a moist and body warm environment to be effective 需要保肢潮湿和体温环境才能产生作用 Have to be applied at the area of debris 必须在清创区域使用 Colleges Santy1Z*Ointment(胶原酶Santy1) Enzymatic debriding agent(清创酶),14,Wound debridemen清创术,Bio surgical with maggots采用蛆进行生物手术 Serratia marcecens沙雷杆菌 Advantage优点 Very selective cleaning/Antiseptic effect选择性清洁/防腐作用 Stimulate granulation刺激肉芽生长 Almost pain free 几乎无痛 Disadvantage缺点 Not always easy to apply and keep in place不容易使用而且不容易固定。 Ethical aspects need consideration.需要对伦理学方面加以考虑。,15,Wound debridement 清创术,Autolytic 自熔性清创术 Facilitate body owns of mechanism of debridement moist dressing 采用适当的湿性敷料促进机体自身清创机制 Advantage优点 Cell friendly细胞亲和性 Almost pain free几乎无痛 Easy to do容易操作 Disadvantage缺点 Tasks more time than for instance surgical debridement比手术清创方法花费更多时间 Needs to be adapted to the individual requirements of woun

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