在儿科中使用麦芽糊精和海藻酸银化合物促进气管造口伤口愈合：一项初步研究。

Enhanced tracheostomy wound healing using maltodextrin and silver alginate compounds in pediatrics: a pilot study.

作者信息

Hartzell Larry D, Havens Tara N, Odom Brian H, Stillman Tanya G, Boswell Jessica L, Bower Charles M, Richter Gresham T

机构信息

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital.

College of Medicine, University of Arkansas for Medical Sciences.

出版信息

Respir Care. 2014 Dec;59(12):1857-62. doi: 10.4187/respcare.02822. Epub 2014 Aug 5.

DOI:10.4187/respcare.02822

PMID:25096405

Abstract

BACKGROUND

Tracheostomy wounds are commonly encountered in children but rarely reported. Relatively few treatments are available or have been investigated to manage this problem. Healing times for pediatric tracheostomy wounds are often unpredictable and protracted. Recent use of maltodextrin gel (MD) and a silver alginate sponge (AG) at our institution has demonstrated expedited healing and interest in this novel treatment for tracheostomy wounds.

METHODS

We conducted an 11-month retrospective review of children with wound complications following tracheostomy placement at a tertiary care facility. Wounds were evaluated and rated based upon the National Pressure Ulcer Advisory Panel staging system. Subjects identified with stage 2 or greater tracheostomy-related ulcers treated with MD and/or AG were included. Subject characteristics and wound healing rates were tabulated in a database that included age, wound site, initial and final wound stage, type of treatment, length of treatment, and complications. Tracheostomy wounds treated as an out-patient were excluded from the study.

RESULTS

Eighteen subjects, which included both in-patients and out-patients, were treated with AG and/or MD during the study period for tracheostomy-related wounds. Of the 26 subjects with tracheostomies performed during the study period, 10 (38.5%) were treated for postoperative wounds. A total of 11 subjects completed their in-patient wound treatment and were thus included in the study. Average subject age was 5.3 y (range 0.25-15.6 y). Wound locations were as follows: infrastomal region (n = 8), stoma (n = 2), and lateral neck (n = 1). Six subjects had stage 2 wounds, 4 had stage 3 wounds, and 1 had a stage 4 ulcer. All wounds achieved complete epithelialization following treatment with MD and/or AG. The average length of treatment was 12.8 d (range 6-28 d). No adverse effects were identified.

CONCLUSIONS

Postoperative tracheostomy wounds are common. The use of MD and AG provides an effective and safe treatment for tracheostomy-related ulcers.

摘要

背景

气管造口伤口在儿童中很常见，但很少有报道。目前可用于处理这一问题的治疗方法相对较少，或尚未得到充分研究。小儿气管造口伤口的愈合时间往往难以预测且迁延不愈。近期，我院使用麦芽糊精凝胶（MD）和藻酸盐银海绵（AG）治疗气管造口伤口，显示出能加速伤口愈合，且这种新型治疗方法受到关注。

方法

我们对一家三级医疗机构中气管造口术后出现伤口并发症的儿童进行了为期11个月的回顾性研究。根据国家压力性损伤咨询小组的分期系统对伤口进行评估和分级。纳入接受MD和/或AG治疗的2期或更严重的气管造口相关溃疡患者。将患者的特征和伤口愈合率记录在一个数据库中，内容包括年龄、伤口部位、初始和最终伤口分期、治疗类型、治疗时长及并发症。门诊治疗的气管造口伤口被排除在研究之外。

结果

在研究期间，共有18名患者（包括住院患者和门诊患者）接受了AG和/或MD治疗气管造口相关伤口。在研究期间进行气管造口术的26名患者中，10名（38.5%）接受了术后伤口治疗。共有11名患者完成了住院伤口治疗，因此被纳入研究。患者平均年龄为5.3岁（范围0.25 - 15.6岁）。伤口部位如下：造口下方区域（n = 8）、造口处（n = 2）和颈部外侧（n = 1）。6名患者为2期伤口，4名患者为3期伤口，1名患者为4期溃疡。所有伤口在接受MD和/或AG治疗后均实现完全上皮化。平均治疗时长为12.8天（范围6 - 28天）。未发现不良反应。