慢性傷口處置培訓課件

woundcleaning傷口清潔Generalgoal總體目標Toremovedebriesandfroeignbodies.去除碎屑與異物Necrotictissue壞死組織Deadcells死亡細胞Fibrin纖維蛋白Toxins，MMP毒素，MMPForeignbodies(forinstanceremainsforpreviouslyuseddressings)異物（例如先前使用的敷料）9/13/20231慢性傷口處置woundcleaning傷口清潔GeneralgoalWoundcleaning--Techniques

傷口清潔-----技術Requirementsonwoundrinsingsolutions對傷口沖洗液的要求Shouldbesterilie無菌Notcolored無色Genteltocells/nontoxic細胞溫和型/無毒Bodytemperature(coolingdownwoundbedreducesorinactivatescellactivity)>28℃nofunction體溫（冷卻創(chuàng)面、減少細胞活性或使其滅活）>28℃無效9/13/20232慢性傷口處置Woundcleaning--Techniques

傷口清Woundcleaning傷口清潔

Ways方法Basiccleanningofwoundbed,woundedgesandsurroundingarea對傷口創(chuàng)面、邊緣以及周圍進行基本清洗Antibacteiracleanning抗菌劑清洗Woundrinsing傷口沖洗WoundcleaningWettodry干燥清洗傷口Debridement清創(chuàng)術Negtivepressure負壓

9/13/20233慢性傷口處置Woundcleaning傷口清潔

Ways7/28/Woundcleaning傷口清潔

----技術CleanigwithRinsingsolution采用沖洗溶液進行清洗Saline生理鹽水Ringersolution林格氏液Indication:Cleaningwound適應癥：清潔傷口Nontouchtechnique非接觸技術9/13/20234慢性傷口處置Woundcleaning傷口清潔

----技術CleaWoundcleaning傷口清潔

----技術Cleanningwithantisepticsolution采用消毒溶液進行清洗Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid聚已縮胍Iodine碘Indication:Infectedandcontaminatedwound適應癥：感染傷口和污染傷口Nontouchtechnique:Fromoutsidetocenterofwoundinordertoavoidfurtherspreadingofbacteriatothesurroundingarea.非接觸技術：從外圍向中間清洗以避免細菌向周圍進一步播散9/13/20235慢性傷口處置Woundcleaning傷口清潔

----技術CleaWoundcleaning--Antisepticsolution

傷口清潔--消毒溶液Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid聚已縮胍Advantages優(yōu)點notcolored,notinacticatedbybodyfluids無色、不會被體液滅活donotinitiateresistance,skinirritationandallergies不會引起抗藥性、皮膚刺激或過敏Disadvantages缺點notavailableandreimbursedinmanycountries在許多地區(qū)不能使用而且不能報銷不能采用高壓將奧替尼啶注入腔內(nèi)加以應用Bothshouldnotbeappliedoncartilageandincontactwithinternalorgans(abdominalcavity)二者均不能在軟骨上運用，且不能與內(nèi)部器官接觸（腹腔）9/13/20236慢性傷口處置Woundcleaning--AntisepticsoWoundcleaning--Antisepticsolution

傷口清潔--消毒溶液IodineAdvantages優(yōu)點EffevtiveagainstGrampostiveandGramnegtivebacteria可有效對抗革蘭陽氏和陰性菌Availableindifferentformsforapplication(ointment,lotions)可以采用不同形式加以運用（軟膏、洗液）Disadvantages缺點Colored(makeswoundassessmentdifficult)有色（難以對傷口進行評估）Inactivatedbybodyfluids會被體液滅活Sensitivitymightoccur可能會發(fā)生過敏Systemicsideeffectsduetoabsortion吸收會導致全身副作用9/13/20237慢性傷口處置Woundcleaning--AntisepticsoWounddebridement清創(chuàng)術Incaseofachronic,difficulttohealwoundcleaningcanbesupportedwithdifferentwaysofdebridement在慢性、難愈合性傷口的清潔中可才采用不同的清創(chuàng)術進行支持治療Requirements要求：Asgentleaspossible盡可能溫柔Asthoroughaspossible盡可能徹底Assoonaspossible盡早9/13/20238慢性傷口處置Wounddebridement清創(chuàng)術IncaseofDebridementopportunity清創(chuàng)時機病情許可，越早越好Illnesspermission,thesooner,thebetter無明顯感染表現(xiàn)，均可清創(chuàng)Noapparentinfection,debridementperformance已有感染，但傷口有異物或較多壞死組織，也可清創(chuàng)，清創(chuàng)后傷口暫不縫合IftheWoundisinfected,buthaveaforeignbodyormuchnecrotictissue,wecanalsodebridement,anddonotwoundclosureafterdebridement急性傷口理想時間：傷后8小時以內(nèi)，頭面、手部傷口12小時以內(nèi)Theidealtime:8hoursafterthewound,andthehead,handwithin12hoursafterthewound9/13/20239慢性傷口處置Debridementopportunity清創(chuàng)時機病情許Debridementmethods傷口清創(chuàng)方法機械清創(chuàng)（傷口清洗和傷口浴，水下低頻超聲波處理、聚氨酸脂類軟性泡沫復合物產(chǎn)品等）Mechanicaldebridement外科清創(chuàng)（剪刀、手術刀、鋒利勺、刮器）Surgicaldebridement酶清創(chuàng)（蛋白質(zhì)、肽類）Enzymaticdebridement生物清創(chuàng)Biosurgicaldebridement自溶性清創(chuàng)（內(nèi)活性傷口敷料、如水膠體、水凝膠）Autolyticdebridement9/13/202310慢性傷口處置Debridementmethods傷口清創(chuàng)方法機械清創(chuàng)（Wounddebridemen清創(chuàng)術Mechanical機械性清創(chuàng)Wipe(mechancialyclean)thewoundwithsterilegauze無菌紗布擦拭傷口（機械型清洗）Gauzecanbemoistordry可以采用濕性或干性紗布Cave:mightbepainfulforpatient孔洞：可能造成患者疼痛Aternative選擇Soakedgauzeisappliedtowoundandshouldberemovedgently.Everytimesomeofwounddebriswillremainingauze.對傷口使用浸濕紗布，而且去除紗布時動作應當輕柔。每次都會有一些傷口碎屑留在紗布內(nèi)。9/13/202311慢性傷口處置Wounddebridemen清創(chuàng)術MechanicalWounddebridemen清創(chuàng)術Surgical手術清創(chuàng)Removalofdebriswithcurette,abrasororscapel采用刮匙、刮除器或手術刀去除碎屑Usuallyperformedbysurgeonorspeciallytrainednursesundersupervisionofsurgeon.通常由外科醫(yī)生執(zhí)行清創(chuàng)或者在外科醫(yī)生的監(jiān)督下由護士進行清創(chuàng)。Cave空洞Mightbepainfulforpatient可能會引起患者疼痛Chanceofbleeding可能會出血InseverecasesintmustbeconductedinOR嚴重時必須采用手術進行處理9/13/202312慢性傷口處置Wounddebridemen清創(chuàng)術Surgical手術Wounddebridemen清創(chuàng)術Enzymatic酶解清創(chuàng)術Removalofdebriswithemzymes采用酶法Havetoberenewedfrequently必須經(jīng)常更新Needamoistandbodywarmenvironmenttobeeffective需要保肢潮濕和體溫環(huán)境才能產(chǎn)生作用Havetobeappliedattheareaofdebris必須在清創(chuàng)區(qū)域使用CollegesSanty1Z**Ointment(膠原酶Santy1)Enzymaticdebridingagent(清創(chuàng)酶)9/13/202313慢性傷口處置Wounddebridemen清創(chuàng)術Enzymatic酶Wounddebridemen清創(chuàng)術Biosurgicalwithmaggots采用蛆進行生物手術Serratiamarcecens沙雷桿菌Advantage優(yōu)點Veryselectivecleaning/Antisepticeffect選擇性清潔/防腐作用Stimulategranulation刺激肉芽生長Almostpainfree幾乎無痛Disadvantage缺點Notalwayseasytoapplyandkeepinplace不容易使用而且不容易固定。Ethicalaspectsneedconsideration.需要對倫理學方面加以考慮。9/13/202314慢性傷口處置Wounddebridemen清創(chuàng)術BiosurgicaWounddebridement清創(chuàng)術Autolytic自熔性清創(chuàng)術Facilitatebodyownsofmechanismofdebridementmoistdressing采用適當?shù)臐裥苑罅洗龠M機體自身清創(chuàng)機制Advantage優(yōu)點Cellfriendly細胞親和性Almostpainfree幾乎無痛Easytodo容易操作Disadvantage缺點Tasksmoretimethanforinstancesurgicaldebridement比手術清創(chuàng)方法花費更多時間Needstobeadaptedtotheindividualrequirementsofwound需要適合傷口的個體要求Notalwayseffectiveforinstanceincaseofthicknecroticlayer在諸如壞死層較厚的情況下9/13/202315慢性傷口處置Wounddebridement清創(chuàng)術AutolyticTheevolutionandapplicationofdressingsGauze

OilYam、stickingHydrocolloiddressingsAntibacterialdressings干紗布油砂、敷貼水膠體抗菌敷料、生物活性敷料9/13/202316慢性傷口處置TheevolutionandapplicationWounddressings-General

傷口敷料—總體Requirements要求Maintainmoistenvironment保持環(huán)境濕潤Sterile無菌Removeexcessexudate去除多余滲出物Nontoxic無毒性Nonsenstizing無過敏性Protectthewoundfromfurthertrauma保護傷口防止進一步損傷Allownontraumaticremoval去除時不會產(chǎn)生損傷Protectfrommigrationofbacteria保護傷口防止細菌遷移Keepwoundatbodytemperature(Isulation)保護傷口處于體溫下（絕緣）Allowgaseousexchange允許空氣交換Comfortable舒適Economical/requireinfrequentchanges經(jīng)濟/不需要經(jīng)常更換9/13/202317慢性傷口處置Wounddressings-General

傷口敷料—總Wounddressings-Requirements

傷口敷料—要求Keyfunctions主要作用Keepwoundbedmoist保持創(chuàng)面濕潤Keepwoundsurroundingskindry保持傷口周圍皮膚干燥Avoidcoolingdownofwoundtemperature避免傷口溫度降低Protectfrominfection預防感染Shouldnotleaveresidualsinwound傷口內(nèi)不應留下殘余物9/13/202318慢性傷口處置Wounddressings-Requirements

傷Wounddressings-Requirements

傷口敷料—要求Keyfunctions主要作用Keepwoundbedmoist保持創(chuàng)面濕潤Keepwoundsurroundingskindry保持傷口周圍皮膚干燥Avoidcoolingdownofwoundtemperature避免傷口溫度降低Protectfrominfection預防感染Shouldnotleaveresidualsinwound傷口內(nèi)不應留下殘余物9/13/202319慢性傷口處置Wounddressings-Requirements

傷Wounddressings-DifferentkindsCriteriaforselection選擇標準Woundsite傷口位置Exudate滲出物Signsofinfection感染跡象Conditionofwoundsurroundingskin傷口周圍皮膚狀況Pain疼痛9/13/202320慢性傷口處置Wounddressings-DifferentkindWounddressings-Requirements

傷口敷料—要求Occlusiveornonocclusivedressings封閉型或非封閉型敷料Occlusiveenvironmentissupportiveforwoundhealing封閉環(huán)境有助于傷口愈合Attention注意Incaseofinfection,severecontaminationexposedtendon,bone,fistualsanocclusioncanbedangerous.在肌腱、骨骼暴露以及瘺管存在感染或嚴重感染時，封閉可能具有危險Keepwoundsurroundingskindry保持傷口周圍皮膚干燥9/13/202321慢性傷口處置Wounddressings-Requirements

傷Wounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Description說明Hydroactivedressingpadforwettherapy采用水活化性敷料墊用于濕潤療法Madeofhighlyabsorbingpolyacrylate采用高吸水性聚丙烯酸酯制造Activeabsorbingandrinsingeffect具有有效吸收和沖洗作用AlreadyactivatedversionplusseparateRingersolutionavailable可以采用已活化型或者未活化型外加林格氏液。9/13/202322慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWetKeyobjectivesforapplication使用的主要目的Hydrationofwoundbedfor24hours使創(chuàng)面保濕24小時Initiationandsupportofautolyticdebridement引發(fā)或有助于自溶性清創(chuàng)ReleaseofRingersolutionintowoundbed將林格氏液釋放至創(chuàng)面Absorptionofwoundexudate吸收傷口滲出液9/13/202323慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleaning清潔Cleaning+Granulation清洗+肉芽形成Granulation肉芽形成Rehydratesescharsupportautolyticmechanisms再次水化焦痂有助于自溶機制ReduceMMP減少MMPProtectsandmaintainsclean保持并維持清潔9/13/202324慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Mainindication主要適應癥Infectedwounds(deepandsuperficial)感染傷口（深部和表淺）Necroticwounds(deepandsuperficial)壞死傷口（深部和表淺）Woundswithstagnatinghealing愈合停止的傷口9/13/202325慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Contraindication禁忌癥Escharduetountreatedarterialulceration由未經(jīng)治療的動脈性潰瘍所導致的焦痂Exercisecaution注意Contactofdressingwithwoundbedmustbesecured敷料和創(chuàng)面必須牢固接觸9/13/202326慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Handing操作Protectwoundsurroundingarea保護傷口周圍區(qū)域Mustbechangedafter24hours24小時后必須更換GreenstripesofTenderWet24arefacingawayfromwoundbed在創(chuàng)面使用德濕威24時，應將綠色條紋面朝外。Dressingmustnotbecut不要對敷料進行裁減9/13/202327慢性傷口處置Wounddressings-Wettherapy(TeWounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤療法（德濕威TenderWet）Fixation固定Fixationwithnonabsorbentdressing,bandageornonwovenadhesive以非吸收性敷料、繃帶或非編織型膠帶進行固定。9/13/202328慢性傷口處置Wounddressings-Wettherapy(TeWounddressings—Alginates

傷口敷料—藻酸鹽類敷料Alginatefromoriginatefrombetweenalgae海藻纖維源于褐藻Alginateturnintogetwhenincontactwithwoundexudate藻酸鹽類敷料與傷口接觸時可變成凝膠Alginatescanabsorbasignificantamountmorethantheirweightofwoundfluids藻酸鹽類敷料可以吸收顯著高于其自身重量的傷口滲出液9/13/202329慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Alginates

傷口敷料—藻酸鹽類敷料Keyobjectivesforapplication使用的主要目的Woundfilling填充傷口Supportofautolyticdebridementduetogetinformation凝膠形成有助于自溶性清創(chuàng)Absorptionofwoundexudate吸收傷口滲出液Embedbacteriaandtoxininstructure將細菌和毒物包裹在凝膠中Haemostaticeffect具有止血作用9/13/202330慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Alginates

傷口敷料—藻酸鹽類敷料Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleaning清潔Granulation肉芽形成Especiallyfordeepsmallcavitywounds尤其用于較深而且較小的孔腔性潰瘍Rarely很少9/13/202331慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Alginates

傷口敷料—藻酸鹽類敷料Mainindication主要適應癥Infectedwounds(deepandsuperficial)感染傷口（深部和表淺）Necroticwounds(deepandsuperficial)壞死傷口（深部和表淺）Woundswithstagnatinghealing愈合停止的傷口Woundswiithtendencyforbleeding存在出血傾向的傷口9/13/202332慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Alginates

傷口敷料—藻酸鹽類敷料Contraindication禁忌癥Dryorcrustedwounds干燥或結(jié)痂傷口Drynecrosis干性壞死Third-degreeburnsorhigher3度或3度以上燒傷Exercisecaution注意Pressurereleaseswoundexudateagain壓力解除傷口會再次滲出RemoveAlginatesresidual-free去除藻酸鹽類敷料時不應留有殘余（dangerofinfection）(具有危害性或感染性)Donotapplywithpressure不應加壓使用Avoidoverlappingwoundedges避免與傷口邊緣重疊9/13/202333慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Alginates

傷口敷料—藻酸鹽類敷料Fixation固定Alginatesneedtobecoveredbyasecondarydressing藻酸鹽類敷料需要采用次級敷料加以覆蓋Non-infectedwoundFineporedfoamdressing:hydrocolloidorfilmdressing非感染性傷口：細孔泡沫敷料、水膠敷料或薄膜敷料InfectedwoundElasticgauzebandages:tubularbandagesornonwovenfixationproducts感染性傷口：彈力繃帶、筒形繃帶或非編織性固定產(chǎn)品9/13/202334慢性傷口處置Wounddressings—Alginates

傷口敷料Wounddressings—Hydrofiberdressings

傷口敷料—親水性材料Description說明Madeof“Natriumcarboxymethycellulose”由羧甲基纖維素制成Highabsorptioncapacity吸收性能較高Turnsintotransparentgetwhenincontactwithwoundexudate垂直吸收創(chuàng)面滲出液9/13/202335慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Hydrofiberdressings

傷口敷料—親水性材料Keyobjectives使用主要目的Absorptionofwoundexudate吸收傷口滲出液Inclusionofwoundexudateevenunderpressure(compressiontherapy)即使可以在壓力作用下（加壓治療）也可以吸入傷口滲液Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing:Exudingsloughedwounds清潔：排除傷口腐肉Granulation:肉芽形成：很少9/13/202336慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Hydrofiberdressings

傷口敷料—親水性材料Mainindication主要適應癥Highlysecretingwounds高分泌型傷口Acuteandchronicwounds急性和慢性傷口Postoperativewounds術后傷口First–andsecond-degreeburns1度或2度燒傷Incaseofproblematic(indangertodevelopmaceration)surroundskin用于傷口周圍皮膚存在問題的情況下（具有發(fā)展成浸漬傷口的危險）9/13/202337慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Hydrofiberdressings

傷口敷料—親水性材料Contraindication禁忌癥Drywounds干燥傷口Drynecrosiswounds干性壞死Third-orforth-degreeburns3度或4度燒傷Exercisecaution注意None9/13/202338慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Hydrofiberdressings

傷口敷料—親水性材料Handling操作Dressingmaydevelopthewoundbyabout1inch敷料可以在傷口上重疊約1英寸厚Hydrofibertamponadesshouldbepokeoutofthewoundbyapproximatelyaninch水性纖維敷料填塞應高于傷口約1英寸9/13/202339慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Hydrofiberdressings

傷口敷料—親水性材料Fixation固定Hydrofiberdressingsneedtobecoveredbyassecondarydressing富含纖維敷料需要采用次級敷料加以覆蓋Absorbingpads、gauzebandagesornonwovenfixationproducts吸收墊、紗布繃帶或非編織性產(chǎn)品9/13/202340慢性傷口處置Wounddressings—HydrofiberdreWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Description說明Madeofafine(Polyurethane)foamcoveredwithasemiocclusivePolyurethanefilm由覆蓋一層封閉型聚氨基甲酯薄膜的精制泡沫構成Foamdressingshavehighabsorption泡沫敷料具有高度吸水性Airpermeablemembraneenablesgasexchange空氣可以滲入薄膜使氣體得以交換Availablewithandwithoutadhesive可以和膠帶一起應用，也可以單獨使用9/13/202341慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleaning清潔evenincaseofsloughy/necroticwounds，sometimesoninfectedwounds(withooutadhesiveborder)甚至可以用于壞死性傷口,有時可以用于感染性傷口（無粘性邊緣）Granulation肉芽形成Epithellialisation上皮形成thinfoamdressingonly只采用薄層泡沫敷料9/13/202342慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Mainindication主要適應癥Exudatingwounds滲出性傷口Ascavityindeep,underminedexudatingwounds孔腔較深的潛行性滲出傷口Incombinationwithcompressiontherapy聯(lián)合加壓治療Onslushy,fibrincoatedwounds膠凍狀纖維蛋白覆蓋性傷口9/13/202343慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Contraindication禁忌癥Infectedwounds(borderedversions)感染傷口（邊界模糊）Drywound干燥傷口Third-orforth-degreeandhigher3度或3度以上燒傷Necroticwounds.OnlyasacoverincombinationwithforinstanceHydrogelwound壞死傷口，只能與其他敷料合用坐覆蓋，如水凝膠敷料。Exercisecaution注意Possibilityofmacerationwhendressingcapacityisexhausted當敷料吸收能力達極限時具有浸漬的可能9/13/202344慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Handing操作Cavityproductsfordeepwounds孔腔產(chǎn)品用于深部傷口Dressingshouldbeoverlapping敷料應當重疊使用Dressingscansometimesbecuttofittingsize有時可將敷料裁剪成適當大小Canstayonwoundupto7days(dependingonamountofwoundexudate)可以在傷口保留長達7天（依據(jù)傷口滲出液的量）9/13/202345慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Polyurethane/Foamdressings

傷口敷料—聚氨酯/泡沫敷料Fixation固定Oftennotneededduetoadhesivebordersofdressingpads由于敷料墊具有粘性邊緣通常不需要固定Fixationwithsemipermeablefilms,siliconecoatedfilmsorelasticbandages以半透膜、硅涂層薄膜或彈力繃帶固定9/13/202346慢性傷口處置Wounddressings—Polyurethane/FWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Description說明Semioclusive,madeofwater-repellingpolymermatrix(thinpolyurethanefilm)半封閉型采用防水性聚合物基質(zhì)形成（聚氨酯薄膜）Matrixcontainshydrocolloidsubstance基質(zhì)包含親水物質(zhì)Sometimeswithadhesivenonwovenboardersorflatterboardersforeasyapplication有時存在便于使用的粘性非編織性邊緣或更為平整的粘性邊緣9/13/202347慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Keyobjectivesforapplication使用的主要目的Supportgranulation有助于肉芽組織形成Absorptionofcelldebris吸收細胞碎屑Limitedabsorptionofwoundexudate傷口滲出液吸收有限Ensuringamoistwoundenvironment確保濕潤的傷口環(huán)境Protectionagainstexternaleffects保護傷口防止外部影響9/13/202348慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing清潔Granulation肉芽形成Epithelialisation上皮形成9/13/202349慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Mainindication主要適應癥Lowtomediumamountofwoundexudate少量到中等量的傷口滲出液Abrasions,first-andsseconddegreeburns,decubitus,legulcers擦傷、1度或2度燒傷、褥瘡、腿部潰瘍WoundsinEpithelialisationphase處于上皮形成時期的傷口Asacoverforotherwounddressings(e.g.alginates)作為其他傷口敷料的覆蓋物9/13/202350慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Contraindication禁忌癥Deepmycosis深部真菌病Highlyexudingorbleedingwounds高度滲血或出血傷口Third–orforth-degreeburns3度或4度燒傷Osteomyelitis骨髓炎Deepwoundswithbarebones,muscles,tendons深部傷口伴谷歌、肌肉、肌腱裸露Exercisecaution注意Macerationofsurroundingskinpossible傷口具有浸漬可能Hypergranulation肉芽組織過度形成Diabeticfootulcers糖尿病性足部潰瘍9/13/202351慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Handing操作Someofhydrocolloiddressingshouldhavebodytemperaturewhenapplied在使用時應將某些水膠體敷料加熱至體溫Surroundingofwoundneedstobefreeofhair傷口周圍備皮Dressingneedtobeapproximatelyaninchbiggerthanwound敷料應當大于傷口約1英寸Canstayonwoundupto7days可以在傷口上保留長達7天Dressingchangerequiredwhengetclosetoborderofdressing當凝膠接近敷料邊緣時則需要更換敷料9/13/202352慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrocolloiddressings

傷口敷料—水膠體敷料Fixation固定Nosecondarydressingorfixationneeded不需要次級敷料或固定

Hydrocolloiddressingsareoftenusedasfixationforotherwounddressings水膠體敷料通常最為其他敷料的固定物Ifneededfurtherfixationwithadhesiveproductslikefilmsect,possible如果需要，可以采取注入膠帶之類的產(chǎn)品進行固定9/13/202353慢性傷口處置Wounddressings—HydrocolloidWounddressings—Hydrogelamorphousgels

傷口敷料—無定形水凝膠敷料Contraindication禁忌癥Woundpain傷口疼痛Macerationofsurroundingskin周圍皮膚浸漬Exercisecaution注意Sensitivityagainstcomponentspossible可能會有成分過敏9/13/202354慢性傷口處置Wounddressings—HydrogelamoWounddressings—Hydrogelamorphousgels

傷口敷料—無定形水凝膠敷料Handing操作Applicationof0.3to0.5cmofgelonwound在傷口上使用0.3到0.5cm的凝膠Protectionofsurroundingskinnecessarytoavoidmaceration有必要對周圍皮膚進行保護以免發(fā)生浸漬RinsingofwoundwithRingersolutionorsalinetoremoveresidues采用林格氏液或生理鹽水沖洗去除殘余凝膠9/13/202355慢性傷口處置Wounddressings—HydrogelamoWounddressings—Hydrogelamorphousgels

傷口敷料—無定形水凝膠敷料Fixation固定Secondarydressingabsolutelynecessary絕對有必要使用次級敷料固定Hydropolymerorhydrocolloiddressingsincaseofnon-infected,moistwounds對于非感染傷口,可以采用水聚合型敷料或水膠體型敷料加以固定Semipermeablefilmsfordrywounds對于干性傷口，可以采用半透膜固定Sterilepadsornonwovenadhesivesforinfectedwounds對于感染性傷口，可以采用無菌敷料或非編織型膠帶固定9/13/202356慢性傷口處置Wounddressings—HydrogelamoWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Description說明Semiolcusive,transparentdressings半封閉性、透明敷料Applicationdirectlyonwound直接用于傷口Keepwoundmoist保持傷口濕潤Allowinspectionofwoundthroughdressing可以通過敷料檢查傷口Canstayseveraldaysonwound可以在傷口保留數(shù)日Reducepain減輕疼痛Smallamountofexudatecanbeabsorbed可以吸收少量滲出液Contain15-95%waterbutarenotabsolutelyinwater含15-95%水分但不溶于水Cushioningeffect緩沖作用9/13/202357慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Keyobjectivesforapplication使用的主要目的Superficial,drywoundsarekeptmoist保持淺表、干燥傷口的濕潤Accelerationofcellgrowth促進細胞生長Supportofautolyticdebridement有助于自溶性清創(chuàng)Coolingeffectonburns對于燒傷具有冷卻作用Painreduction減輕疼痛9/13/202358慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段CleaningRehydrateseschar，supportautolyticmechanisms清潔再次水化焦痂、有助于自溶機制Granulationprotects肉芽形成保護

Epithelialisationpreventsdessication上皮形成防止干燥9/13/202359慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Mainindication主要適應癥Useonpaper/cortisone/olderskin聯(lián)合可的松涂在紙面上用于老年人的皮膚Superficial,cleanabrasion淺表的清潔擦傷Burnsuptosecond-degree直至2度的燒傷Woundsproducinglittleexudate傷口幾乎沒有滲出物Skindonorsites皮膚供體位置9/13/202360慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Contraindication禁忌癥Escharduetoarterialulceration因動脈性可以所導致的焦痂Strongexudatiionorbleeding大量滲出液或出血Deepwounds,mycosis傷口較深或真菌病Sheetsshouldnotbeusedoninfectedwounds水凝膠片不用于感染性傷口

Exercisecaution注意Sensitivitytocomponentspossible可能對成分過敏9/13/202361慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片Handing操作Dressingshouldbeapproximatelyaninchbiggerthanwound敷料應當大于傷口約1英寸Dressingscanbecuttoidealsize可以將敷料剪至適當大小Canstayupto7daysonwound(whendressingturnsuncleardressingchangerequired)可以在傷口保留7天以上（當敷料變得不透明時，則需要更換敷料）9/13/202362慢性傷口處置Wounddressings—HydrogelsheWounddressings—Hydrogelsheets

傷口敷料—水凝膠片F(xiàn)ixation固定Productswithadhesivebordersdon’trequireadditionalfixation帶有粘性邊緣的產(chǎn)品不需要額外固定Otherwisefixationwithgauzebandageornonwovenadhesives否則采用紗布或非編織型膠帶固定9/13/202363慢性傷口處置Wounddressings—HydrogelsheWounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料Description說明Wounddressingcoatedwithsilver（e.g.woundcontactllayer,foam.alginate,hydrofiber）傷口敷料涂銀（例如,傷口接觸層、泡沫敷料、藻酸鹽敷料、水性纖維敷料）Useofbactericidalimpactofsilver利用銀離子殺菌Releaseofsilverionswhenincontactwithwoundexudate與傷口滲出液接觸時可以釋放銀離子Silveriseffectiveagainstawiderangeofbacteria銀可以有效對抗多種細菌9/13/202364慢性傷口處置Wounddressings—silvercontaWounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料Keyobjectivesforapplication使用的主要目的Killingofbacteria殺滅細菌Wideeffectivenessagainstmicroorganisms(Saphylococcusaureus,Pseudomonas,MRSA,etc.)廣譜對抗微生物（金黃色葡萄球菌、假單胞菌、MRSA等）9/13/202365慢性傷口處置Wounddressings—silvercontaWounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料Predominateuseinthefollowingphaseofwoundhealing主要應用于傷口愈合的以下階段Cleaningoninfectedwounds清潔用于感染性傷口9/13/202366慢性傷口處置Wounddressings—silvercontaWounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料Mainindication主要適應癥Secondaryhealingwoundslikepressureorlegulcer中等愈合傷口如壓迫性潰瘍或腿部潰瘍Tumorwounds,abscess,etc.腫瘤傷口、膿腫等Cleaningwoundswhichareinfected,indangerofinfectionorbadlysmelling對感染傷口或有感染危險或嚴重異味性傷口進行傷口清潔9/13/202367慢性傷口處置Wounddressings—silvercontaWounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料Contraindication禁忌癥Barefibers,bonesormuscles纖維、谷歌、或肌肉裸露Exercisecaution注意Sensitivityagainstcomponents對成分過敏Silvershouldonlybeusedaslongasindicated只要有過敏表現(xiàn)不能直接使用Releaseofsilverionsnotsufficientondrywounds在干性傷口上銀離子不能充分釋放9/13/202368慢性傷口處置Wounddressings—silvercontaHanding(Dependingontypeofdressing)操作（根據(jù)敷料類型）Dressingshouldbeaboutaninchbiggerthanwound敷料應當高于傷口約1英寸Padsshouldbeeasilyplacedinwound,directedcontactwithwoundbed墊料應當容易放入傷口，直接與創(chuàng)面接觸IncaseofdryandsuperficialwoundsdressingshouldbementionedwithRingersolutionorSalineofcombinedwithhydogel在干燥且表淺的傷口情況下，應當采用林格氏液或生理鹽水結(jié)合水凝膠對其進行濕潤Dressingcanbecuttooptimalsize可將敷料剪裁至最佳尺寸Dailydressingchangeoninfectedwounds每日更換感染性傷口的敷料Wounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷料9/13/202369慢性傷口處置Handing(DependingontypeofFixation固定Dependsoninformationofproductioncompanies按照產(chǎn)品公司所提供的信息進行固定Wounddressings—silvercontainingwounddressings

傷口敷料—含銀傷口敷9/13/202370慢性傷口處置FixationWounddressings—sil注意：Note需控制銀離子的釋放速度，保證安全性Toensuresafety,andweshouldcontrolthereleasespeedofsilverions某些銀離子使用不當會著色Someimproperuseofsilveriondressingcanshading價格相對較高Thepriceisrelativelyhigh

9/13/202371慢性傷口處置注意：Note7/28/202371慢性傷口處置Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力吸收劑的無紡布（吸收墊料）Description說明Nonwovenpadcontaining/surroundingsuperabsorber無紡布墊料，含有強力吸收劑Canabsorbhighamountofliquids可以吸收大量液體Bacteriaandcelldebriscanbeabsorbed可以吸收細菌和壞死物Moistwoundclimateiskept保持濕潤的傷口環(huán)境Smellisbound限制傷口異味9/13/202372慢性傷口處置Wounddressings—Nonwoven(aboWounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力吸收劑的無紡布（吸收墊料）Keyobjectivesforapplication使用的主要目的Keepingthewoundmoist保持傷口濕潤Absorptionofwoundexudate吸收傷口滲液Enclosureofbacteria,celldebris,etc.包裹細菌細胞碎片等Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing清潔

whenwoundproduceshighamountofexudate傷口產(chǎn)生大量滲出物時9/13/202373慢性傷口處置Wounddressings—Nonwoven(aboWounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力吸收劑的無紡布（吸收墊料）Mainindication主要適應癥Onwoundsthatproducehighamountofexudate(pressure,legulcer,etc.)傷口產(chǎn)生大量滲出液（壓迫性潰瘍、腿部潰瘍等）Contraindication禁忌癥Ondrywoundsriskthatpadstickstothewound(canharmnewganulatedtissue)干性傷口具有墊料粘附傷口的風險（可損害新生肉芽組織）9/13/202374慢性傷口處置Wounddressings—Nonwoven(aboWounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力吸收劑的無紡布（吸收墊料）Handing操作Productsmustnotbecut不能對產(chǎn)品進行裁剪Productsshouldnotbefoldedtogether產(chǎn)品不應疊放在一起Canstayonwoundforseveraldays(dependsonamountofexudate)可以在傷口上保留數(shù)日Fixation固定Fixationdependsonwoundlocationandskincondition依據(jù)傷口位置和皮膚狀況進行固定9/13/202375慢性傷口處置Wounddressings—Nonwoven(aboWounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力吸收劑的無紡布（吸收墊料）Description說明Widelyvarietyavailable應用廣泛Madeofseverallayers由數(shù)層構成Cancontainadditionalmaterialslikeanabsorptionpad可以包含附加材料，如吸收墊料Bindssmell限制異味Whenindirectedcontactwithwounditbindsproteinmoleculesandbacteria在直接接觸傷口時可以與蛋白質(zhì)分子以及細菌相結(jié)合Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing:oninfected,badlysmel