Jull Andrew, Walker Natalie, Parag Varsha, Molan Peter, Rodgers Anthony
School of Nursing, University of Auckland, Private Bag 92019, Auckland Mail Centre, New Zealand.
N Z Med J. 2009 May 22;122(1295):9-18.
To compare usual care with key recommendations for venous ulcer management in the New Zealand Guidelines for Care of People with Chronic Leg Ulcers.
A cohort of participants enrolled in the usual care arm of the HALT trial had their management compared to four treatment recommendations: compression (use high compression); dressing selection (use simple dressings); pentoxifylline (trial of treatment if not tolerant of compression or failure to progress with compression alone); and compression hosiery after healing (remain in hosiery after healing to prevent recurrence).
181 participants were enrolled in the usual care arm, 25 in Auckland, 60 in Counties Manukau, 41 in Waikato, and 55 in Christchurch. Compression--all participants received high compression. Dressings--simple dressings accounted for just 29% of dressings used. Moist dressings and medicated dressings accounted for 35% and 36% of dressings respectively, but 95% of dressing costs. Pentoxifylline--only one participant used pentoxifylline when up to 97 (54%) were candidate patients. Compression after healing--70% of participants healed at 12 weeks used compression hosiery after healing with regional variation in use.
Compression use was consistent with guideline recommendations, although hosiery use after healing could improve. Dressing selection and use of pentoxifylline did not match guideline recommendations. Three of the four guideline recommendations offer opportunities for improving clinical effectiveness, with some potential for cost savings.
比较新西兰慢性腿部溃疡患者护理指南中静脉溃疡管理的常规护理与关键建议。
将参加HALT试验常规护理组的一组参与者的管理情况与四项治疗建议进行比较：加压治疗（使用高压力）；敷料选择（使用简单敷料）；己酮可可碱（若不耐受加压治疗或仅加压治疗无进展则进行治疗试验）；愈合后使用加压弹力袜（愈合后继续穿着弹力袜以防止复发）。
181名参与者进入常规护理组，其中25人来自奥克兰，60人来自曼努考郡，41人来自怀卡托，55人来自克赖斯特彻奇。加压治疗——所有参与者均接受高压力治疗。敷料——简单敷料仅占所用敷料的29%。湿性敷料和含药敷料分别占敷料的35%和36%，但占敷料成本的95%。己酮可可碱——多达97名（54%）患者符合条件，但只有一名参与者使用了己酮可可碱。愈合后加压治疗——12周时愈合的参与者中有70%在愈合后使用了加压弹力袜，且各地使用情况存在差异。
加压治疗的使用符合指南建议，尽管愈合后弹力袜的使用情况仍有待改善。敷料选择和己酮可可碱的使用与指南建议不符。四项指南建议中的三项提供了提高临床疗效的机会，还有一定的成本节约潜力。
