Truchetet F, Guibon O, Meaume S
Hopital Bon Secours, Metz-Thionville, France.
J Wound Care. 2012 Dec;21(12):620, 622-5. doi: 10.12968/jowc.2012.21.12.620.
To describe motivations for using a silicone, silver-releasing dressing and the type of wounds treated with this dressing, and to evaluate its short-term impact on wound characteristics.
A French, prospective, observational study of adult patients prescribed a soft-silicone, silver releasing dressing (MepilexAg; Molnlycke Health Care) in the community. Each participating physician was asked to include the first two consecutive patients they treated with the silver dressing, reporting patient and wound characteristics, as well as the presence of I 0 local signs compatible with wound infection (abscesses, purulent or copious exudate, erythema, increase in local warmth, pain, oedema,lymphangitis or satellite adenitis, malodour and delayed wound healing). Clinicians were also asked to select from a list their rationale for prescribing the silver dressing for each patient, including treating a wound infection, to stimulate granulation tissue formation, to promote wound healing, to reduce wound exudate, and to decrease wound pain. Local and general treatment were also reported.
Overall, 794 patients (58% females), with a mean age of 69.0 ± 15.4 years, were included by 128 general practitioners, 51 dermatologists and 63 vascular specialist. Sixty-seven per cent were venous leg ulcers (VLUs), 26% were acute wounds (post-traumatic, surgical, burn wounds and animal bites) and 6.3%were other chronic wounds (pressure ulcers, diabetic foot ulcers and oncology wounds). On average 3.7 ± 1.5 local signs of infection were present and mean pain intensity (on a visual analogue scale) was 50± 24mm.According to prescribers, infection and healing delay were the primary rationale in 82% of cases,with oral antibiotics started concurrently in 19% of these wounds. Patients were followed-up at a median of 19 days, by which time all wound parameters were documented as significantly improved. Tolerability and efficiency of the silver dressing was considered as 'good'/'very good' in more than 97% of cases.
While there are some variances with the French reimbursement indication, for the clinicians surveyed in this study, the primary rationale for prescription of a silver dressing was treatment of a possible wound infection. Although this indication might not always be clinically funded, based on wound characteristics, the short-term impact of this prescription in this series was favourable.
描述使用含银硅胶敷料的动机以及使用该敷料治疗的伤口类型，并评估其对伤口特征的短期影响。
在法国进行的一项针对社区中使用软质含银硅胶敷料（美皮康银；墨尼克医疗保健公司）的成年患者的前瞻性观察研究。要求每位参与的医生纳入他们用银敷料治疗的前两名连续患者，报告患者和伤口特征，以及是否存在10种与伤口感染相符的局部体征（脓肿、脓性或大量渗出物、红斑、局部发热增加、疼痛、水肿、淋巴管炎或卫星腺炎、恶臭和伤口愈合延迟）。还要求临床医生从一份列表中选择为每位患者开具银敷料的理由，包括治疗伤口感染、刺激肉芽组织形成、促进伤口愈合、减少伤口渗出物以及减轻伤口疼痛。同时报告局部和全身治疗情况。
总体而言，128名全科医生、51名皮肤科医生和63名血管专科医生纳入了794例患者（58%为女性），平均年龄为69.0±15.4岁。67%为下肢静脉溃疡（VLUs），26%为急性伤口（创伤后、手术、烧伤伤口和动物咬伤），6.3%为其他慢性伤口（压疮、糖尿病足溃疡和肿瘤伤口）。平均存在3.7±1.5种感染局部体征，平均疼痛强度（视觉模拟评分）为50±24mm。根据开处方者的说法，感染和愈合延迟是82%病例的主要理由，其中19%的此类伤口同时开始使用口服抗生素。患者的中位随访时间为19天，此时所有伤口参数均记录为显著改善。在超过97%的病例中，银敷料的耐受性和有效性被认为“良好”/“非常好”。
虽然与法国医保报销适应症存在一些差异，但对于本研究中接受调查的临床医生而言，开具银敷料的主要理由是治疗可能的伤口感染。尽管该适应症可能并非总是有临床资金支持，但基于伤口特征，本系列中该处方的短期影响是有利的。
