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含银水凝胶敷料对慢性伤口浅表创面床及细菌平衡的影响。

The effect of a silver-containing Hydrofiber dressing on superficial wound bed and bacterial balance of chronic wounds.

作者信息

Coutts Pat, Sibbald R Gary

机构信息

Toronto Wound Healing Clinics, Toronto, Ontario, Canada.

出版信息

Int Wound J. 2005 Dec;2(4):348-56. doi: 10.1111/j.1742-4801.2005.00150.x.

Abstract

The treatment of chronic wounds represents a major cost to society and has a profound effect on the participant's quality of life. Chronic wounds may have an increased bacterial burden that can impair healing without all the clinical signs of infection. Silver dressings may provide an alternative topical method to control bacterial burden. The primary aim of this study was to evaluate the clinical improvement in chronic wounds through the effect on wound size, maceration, resolution of surface slough and conversion to healthy granulation during a 4-week application of the silver-containing Hydrofiber dressing. This was a single centre, open-label case series study which included a total of 30 evaluable participants: four with diabetic neuropathic foot ulcers, 13 venous stasis ulcers, four pressure ulcers and nine miscellaneous wounds that did not fit any of the previous categories. All participants had adequate vascular supply, indicating the potential to heal. The wounds were stalled or had the signs and symptoms consistent with critical colonisation. The underlying cause of the ulceration was identified and corrected, or the symptoms and signs were treated. This was followed by the application of silver-containing Hydrofiber dressings for a period of 4 weeks. The majority of wounds treated decreased in size (70%) with decreased exudate, decreased purulence and resolution of surface slough (75%). There was an increased quality and quantity of healthy granulation tissue. Unlike some silver dressings, the Hydrofiber and silver combination dressing was unlikely to cause burning and stinging on application. Peri-wound maceration was present in 54% of participants at baseline, and 85% of these resolved with this dressing. A desloughing action was seen in those patients with pre-existing slough at baseline and its removal will lower the bacterial burden of the wound.

摘要

慢性伤口的治疗给社会带来了巨大成本,并对患者的生活质量产生深远影响。慢性伤口可能存在细菌负荷增加的情况,这会在没有所有感染临床体征的情况下损害愈合。银敷料可能提供一种控制细菌负荷的替代局部治疗方法。本研究的主要目的是通过在为期4周的含银水凝胶敷料应用过程中,观察其对伤口大小、浸渍、表面腐肉溶解以及向健康肉芽组织转化的影响,来评估慢性伤口的临床改善情况。这是一项单中心、开放标签的病例系列研究,共纳入30名可评估的参与者:4例糖尿病神经性足部溃疡患者、13例静脉淤滞性溃疡患者、4例压疮患者以及9例不属于上述任何一类的其他伤口患者。所有参与者均有充足的血供,表明有愈合的潜力。伤口处于停滞状态或具有与严重定植一致的体征和症状。确定并纠正溃疡的潜在病因,或治疗症状和体征。随后应用含银水凝胶敷料4周。大多数接受治疗的伤口大小减小(70%),渗出物减少、脓性分泌物减少且表面腐肉溶解(75%)。健康肉芽组织的质量和数量均有所增加。与一些银敷料不同,水凝胶与银的组合敷料在应用时不太可能引起灼烧和刺痛。基线时,54%的参与者伤口周围存在浸渍,其中85%通过使用这种敷料得到缓解。在基线时已有腐肉的患者中观察到了去腐作用,腐肉的清除将降低伤口的细菌负荷。

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本文引用的文献

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A dressing history.一份换药史。
Int Wound J. 2004 Apr;1(1):59-77. doi: 10.1111/j.1742-4801.2004.0009.x.
2
Development of an experimental model of infected skin ulcer.感染性皮肤溃疡实验模型的建立。
Int Wound J. 2004 Apr;1(1):49-55. doi: 10.1111/j.1742-481x.2004.00006.x.
3
Five levels of the bacterial chronic wound relationship.细菌与慢性伤口关系的五个级别。
Int Wound J. 2004 Jun;1(2):142-3. doi: 10.1111/j.1742-4801.2004.00040a.x.
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Silver dressings in clinical practice.临床实践中的银敷料
Ostomy Wound Manage. 2004 Sep;50(9A Suppl):11S-15S.
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The truth about silver.关于银的真相。
Ostomy Wound Manage. 2004 Sep;50(9A Suppl):1S-10S.
8
Clinical and financial advantages of moist wound management.湿性伤口处理的临床及经济优势
Home Healthc Nurse. 2004 Sep;22(9):586-90. doi: 10.1097/00004045-200409000-00003.

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