Situm Mirna, Kolić Maja, Spoljar Sanja
Acta Med Croatica. 2016 Mar;70(1):61-3.
Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.
伤口意味着皮肤的解剖学和生理连续性遭到破坏。就愈合过程而言，伤口可分为急性伤口和慢性伤口。生活质量主要受慢性伤口的影响。如果根据伤口的病因和部位，在预期时间内未愈合，则该伤口被视为慢性伤口。慢性伤口可分为典型和非典型两类。大多数伤口（95%）是典型伤口，包括缺血性、神经营养性和坠积性溃疡以及两个独立的类型：糖尿病足和压疮。80%位于小腿的慢性伤口是慢性静脉功能不全的结果，5% - 10%的病因是动脉性的，其余大多是神经性溃疡。慢性伤口给患者、医护人员和整个医疗保健系统带来了沉重负担。慢性伤口影响老年人群，据估计西方人口中有1% - 2%患有慢性伤口。由于老年人口增加以及糖尿病和肥胖症的流行，这一估计数预计还会上升。世界卫生组织对健康的定义是“一种身体、心理和社会的完全良好状态，而不仅仅是没有疾病或虚弱”。基于这一定义，与健康相关的生活质量可定义为“患者所感知到的疾病及其后续治疗对患者的功能影响”。促成这种影响的领域包括身体、心理和社会功能。研究发现，患者自身对疾病的认知在解释生活质量方面起着重要作用。慢性伤口通过多种方式显著降低生活质量，如行动不便、疼痛、异味、睡眠障碍、社交孤立和沮丧以及无法履行日常职责。对包括慢性伤口在内的慢性疾病最常见的心理反应包括抑郁、焦虑、攻击性和沮丧。心理因素不仅可能是愈合延迟的结果，还可能影响伤口愈合。焦虑和抑郁对内分泌和免疫功能有直接影响。关于疾病对生活质量的影响以及个人对疾病的认知，有问卷和方法来进行分析，但挑战在于从专注于伤口管理转向在患者生活背景下理解每个个体的特定需求。
