Williams Dean Thomas, Harding Keith
Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK.
Crit Care Med. 2003 Aug;31(8 Suppl):S547-57. doi: 10.1097/01.CCM.0000081430.34066.1D.
Many aspects of the care and underlying pathologies in patients suffering critical illness can detrimentally influence the normal healing processes of skin and soft tissues. Although a great diversity of pathologies exists, some aspects of the diseases and their treatments are common in critically ill patients. We aimed to identify some features, both common and specific, that could influence wound healing and the mechanisms by which they may do so.
In this review, we first outline the biology of normal skin and muscle healing and then explore how critical illness may influence the normal healing cascade.
The healing of skin and skeletal muscle in critical illness is influenced by both underlying disease processes and the intensive care environment. Local and systemic factors can contribute to impaired healing, with the potential to prolong functional disability and increase the likelihood of wound complications. The frequency and number of soft tissue injuries derived from accidental injury, surgical intervention, and the need for invasive monitoring and therapies in the intensive care unit setting are likely to compromise the innate immunity and potentially further jeopardize the patient's ability to heal. Alterations in coagulation, tissue perfusion, inflammation, immune functioning, metabolism, nutrition, and drug therapies will influence healing responses by modifying the biological responses to tissue disruption. Locally, wound contamination, sepsis, tissue hypoxia, edema, and excessive or prolonged local pressure all have the potential to compromise soft tissue healing. One or more of these factors may be present at any time.
The skin and soft tissues are vulnerable to both injury and compromised healing when a patient is critically ill and exposed to a critical care environment. The identification of risk factors may aid in forming and modifying treatment strategies when caring for the critically ill patient with soft tissue injuries.
危重症患者护理的诸多方面及其潜在病理状况会对皮肤和软组织的正常愈合过程产生不利影响。尽管存在多种病理状况，但这些疾病及其治疗的某些方面在危重症患者中较为常见。我们旨在确定一些可能影响伤口愈合的共同特征和特定特征，以及它们可能产生影响的机制。
在本综述中，我们首先概述正常皮肤和肌肉愈合的生物学过程，然后探讨危重症如何影响正常的愈合级联反应。
危重症患者皮肤和骨骼肌的愈合受到潜在疾病过程和重症监护环境的影响。局部和全身因素均可导致愈合受损，有可能延长功能残疾时间并增加伤口并发症的发生可能性。在重症监护病房环境中，意外伤害、手术干预以及侵入性监测和治疗需求导致的软组织损伤的频率和数量，可能会损害先天免疫力，并可能进一步危及患者的愈合能力。凝血、组织灌注、炎症、免疫功能、代谢、营养和药物治疗的改变将通过改变对组织损伤的生物学反应来影响愈合反应。在局部，伤口污染、脓毒症、组织缺氧、水肿以及局部压力过大或持续时间过长，均有可能损害软组织愈合。这些因素中的一种或多种可能在任何时候出现。
当患者处于危重症状态并暴露于重症监护环境时，皮肤和软组织容易受到损伤且愈合受损。识别危险因素可能有助于在护理有软组织损伤的危重症患者时制定和调整治疗策略。
