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慢性伤口的管理:诊断、准备、治疗及随访

Management of Chronic Wounds: Diagnosis, Preparation, Treatment, and Follow-up.

作者信息

Gupta Subhas, Andersen Charles, Black Joyce, de Leon Jean, Fife Caroline, Lantis Ii John C, Niezgoda Jeffrey, Snyder Robert, Sumpio Bauer, Tettelbach William, Treadwell Terry, Weir Dot, Silverman Ronald P

机构信息

Loma Linda University, Loma Linda, CA.

Madigan Army Medical Center, Tacoma, WA.

出版信息

Wounds. 2017 Sep;29(9):S19-S36.

Abstract

Management of chronic wounds remains challenging in terms of prevalence and complexity. Considerable progress has been made in understanding the science of wound healing during the past decade, sparking volumes of publications and the development of hundreds of dressing and therapy options. There is a need for a simpli ed overview of evidence-based criteria to assist in the accurate diagnosis and appropriate management of chronic wounds in all care settings. An expert panel of 11 wound healing specialists experienced in various care settings convened to discuss best practices and recommended guidelines for managing major chronic wound types. Prior to the meeting, panel members reviewed 8 preselected peer-reviewed articles and 1 white paper containing treatment algorithms for all major chronic wound types. During the meeting, each panelist presented current evidence-based guidelines regarding a specific chronic wound type and case studies to illustrate concepts in the guidelines. This publication is a result of the panel discussion and presents an overview of literature- and experience- based criteria to help guide chronic wound diagnosis, assessment, treatment, and follow-up. A cycle of steps is presented as a framework to guide holistic care for all patients with chronic wounds, including de- hisced surgical wounds, diabetic foot ulcers, venous leg ulcers, arterial insu ciency ulcers, and pressure ulcers/injuries. Emphasis is placed on criteria to assist accurate diagnosis and dressing/therapy selection, holistic elements of patient and wound bed preparation, interventions to achieve patient adherence to a care plan, and follow-up to help prevent wound recurrence.

摘要

慢性伤口的管理在患病率和复杂性方面仍然具有挑战性。在过去十年中,我们对伤口愈合科学的理解取得了显著进展,引发了大量的出版物以及数百种敷料和治疗方案的开发。需要一个基于证据的标准的简化概述,以协助在所有护理环境中对慢性伤口进行准确诊断和适当管理。一个由11名在各种护理环境中经验丰富的伤口愈合专家组成的专家小组召开会议,讨论管理主要慢性伤口类型的最佳实践和推荐指南。在会议之前,小组成员审查了8篇预先选定的同行评审文章和1篇包含所有主要慢性伤口类型治疗算法的白皮书。在会议期间,每位小组成员介绍了关于特定慢性伤口类型的当前基于证据的指南以及案例研究,以说明指南中的概念。本出版物是小组讨论的结果,概述了基于文献和经验的标准,以帮助指导慢性伤口的诊断、评估、治疗和随访。文中提出了一个步骤循环作为框架,以指导对所有慢性伤口患者的整体护理,包括手术切口裂开、糖尿病足溃疡、下肢静脉溃疡、动脉供血不足性溃疡和压疮/损伤。重点在于有助于准确诊断和敷料/治疗选择的标准、患者和伤口床准备的整体要素、促使患者遵守护理计划的干预措施以及有助于预防伤口复发的随访。

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