慢性不愈伤口处理.pptVIP

湘雅医院 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 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: 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 micro-organism, 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介质（如生长因子）的正常活动 The management goal is to promote moisture balance in wounds to choose an appropriate Dressing. 处理的目标在于：促进伤口的湿润平衡，选择适合的敷料 E = Edge of wound 伤口边缘 Epithelialisation of the wound edges resurfacing is retarded when the wound is desiccated, there is debris build-up at the wound edges or scab formation. 伤口干燥时，伤口边缘的上皮化和再修复就会迟缓，伤口边缘就会出现坏死组织和结痂。 Hypergran