Olson Jonathan M, Raugi Gregory J, Nguyen Viet Q, Yu Onchee, Reiber Gayle E
Department of Veteran's Affairs, Health Services Research and Development, Seattle, WA 98101, USA.
Wound Repair Regen. 2009 Sep-Oct;17(5):666-70. doi: 10.1111/j.1524-475X.2009.00524.x.
This study describes the impact of 80% adherence to guideline concordant care for compression therapy, moist wound-healing environment, and debridement on venous ulcer outcomes. The retrospective cohort design included patients from a tertiary care Veterans Affairs Medical Center from October 2003 to September 2007. During this 5-year interval, 155 patients with 400 venous ulcers met study inclusion. A majority of ulcers (n=362) healed, with an average time to healing of 18.1 weeks (range 2-209 weeks, median 10.4 weeks). From the multivariate Poisson regression, the likelihood of ulcer healing increased when compression therapy was provided during at least 80% of visits (relative risk [RR], 1.93; 95% confidence interval [CI], 1.27-2.92) or when a moist wound-healing environment was provided during at least 80% of visits (RR, 1.63; 95% CI, 1.09-2.42). Debridement alone was not significantly associated with ulcer healing (RR, 1.0; 95% CI, 0.61-1.64). Patients who received all three treatments during at least 80% of their visits were more likely to heal than those who received < 80% treatment (RR, 2.52; 95% CI, 1.53-4.16). Guideline concordant venous ulcer care was significantly associated with venous ulcer healing, when provided at 80% or more of patient visits.
本研究描述了80%遵循关于加压治疗、湿性伤口愈合环境及清创的指南一致性护理对静脉性溃疡结局的影响。回顾性队列设计纳入了2003年10月至2007年9月期间来自一家三级医疗退伍军人事务医疗中心的患者。在这5年期间，155例患者的400处静脉性溃疡符合研究纳入标准。大多数溃疡（n = 362）愈合，平均愈合时间为18.1周（范围2 - 209周，中位数10.4周）。多元泊松回归分析显示，当至少80%的就诊时提供加压治疗（相对危险度[RR]，1.93；95%置信区间[CI]，1.27 - 2.92）或至少80%的就诊时提供湿性伤口愈合环境（RR，1.63；95% CI，1.09 - 2.42）时，溃疡愈合的可能性增加。单独清创与溃疡愈合无显著相关性（RR，1.0；95% CI，0.61 - 1.64）。在至少80%的就诊时接受了所有三种治疗的患者比接受治疗不足80%的患者更有可能愈合（RR，2.52；95% CI，1.53 - 4.16）。当在80%或更多的患者就诊时提供指南一致性静脉性溃疡护理时，其与静脉性溃疡愈合显著相关。
