Kunimoto B, Cooling M, Gulliver W, Houghton P, Orsted H, Sibbald R G
Division of Dermatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Ostomy Wound Manage. 2001 Feb;47(2):34-46, 48-50.
Chronic venous insufficiency is the most common cause of leg ulcers. Its incidence increases as the population ages. Managing venous leg ulcers involves treating the cause, optimizing local wound care, and addressing patient-centered concerns. The cornerstone of the diagnosis of chronic venous insufficiency includes demonstrating venous disease. The clinician must rule out significant coexisting arterial disease by performing a thorough clinical assessment and obtaining an ankle brachial pressure index. The most important aspect of treatment is resolving edema through high compression therapy for those individuals with an ankle brachial pressure index greater than or equal to 0.8. Other components of successful chronic venous insufficiency management include increasing mobility and medical management. Selected patients may respond to surgery, biologicals, adjunctive therapies, and lifestyle enhancements. Twelve recommendations are made incorporating current best clinical practices and expert opinion with available research. The approach to venous disease is best accomplished through a multidisciplinary team that revolves around the active participation of patients and their families. The authors' intent is to provide a practical, easy-to-follow guide to allow healthcare professionals to provide best clinical practices.
慢性静脉功能不全是腿部溃疡最常见的病因。其发病率随人口老龄化而增加。处理静脉性腿部溃疡包括治疗病因、优化局部伤口护理以及解决以患者为中心的问题。慢性静脉功能不全诊断的基石包括证实存在静脉疾病。临床医生必须通过全面的临床评估和获取踝肱压力指数来排除显著并存的动脉疾病。对于踝肱压力指数大于或等于0.8的患者，治疗的最重要方面是通过高压力治疗消除水肿。成功管理慢性静脉功能不全的其他要素包括增加活动能力和药物治疗。部分患者可能对手术、生物制剂、辅助治疗及生活方式改善有反应。结合当前最佳临床实践、专家意见及现有研究提出了十二条建议。处理静脉疾病最好通过一个围绕患者及其家庭积极参与的多学科团队来完成。作者的目的是提供一份实用、易于遵循的指南，以使医疗保健专业人员能够提供最佳临床实践。
