2022年医学专题—慢性伤口处理(1).ppt

wound cleaning-Techniques伤口清洁(qngji)-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(zzh)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,第一页，共九十五页。,wound cleaning伤口(shngku)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，MMPForeign bodies(for instance remains for previously used dressings)异物（例如先前(xinqin)使用的敷料）,第二页，共九十五页。,Wound cleaning-Techniques伤口清洁(qngji)-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(twn)（冷却创面、减少细胞活性或使其灭活）28 无效,第三页，共九十五页。,Wound cleaning 伤口(shngku)清洁,Ways 方法Basic cleanning of wound bed,wound edges and surrounding area对伤口创面、边缘(binyun)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 pressure负压,第四页，共九十五页。,Wound cleaning 伤口清洁(qngji)-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(qngji)伤口Non touch technique非接触技术,第五页，共九十五页。,Wound cleaning 伤口(shngku)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(zhngjin)清洗以避免细菌向周围进一步播散,第六页，共九十五页。,Wound cleaning-Antiseptic solution伤口清洁-消毒(xio d)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(gumn)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）,第七页，共九十五页。,Wound cleaning-Antiseptic solution伤口(shngku)清洁-消毒溶液,IodineAdvantages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(rungo)、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,第八页，共九十五页。,Wound debridement清创术,In case of a chronic,difficult to heal wound cleaning can be supported with different ways of debridement在慢性、难愈合性伤口的清洁中可才采用(ciyng)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,第九页，共九十五页。,Debridement opportunity清创时机(shj),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(xiosh)以内，头面、手部伤口12小时(xiosh)以内The ideal time:8 hours after the wound,and the head,hand within 12 hours after the wound,第十页，共九十五页。,Debridement methods伤口(shngku)清创方法,机械清创（伤口(shngku)清洗和伤口(shngku)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,第十一页，共九十五页。,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(shngku)（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Aternative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。,第十二页，共九十五页。,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(huzh)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严重时必须采用手术进行处理,第十三页，共九十五页。,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(twn)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),第十四页，共九十五页。,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(qudin)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。,第十五页，共九十五页。,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