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静脉溃疡管理的循证临床实践要点

Evidence-Based Clinical Practice Points for the Management of Venous Ulcers.

作者信息

Jindal Ravul, Dekiwadia D B, Krishna Pinjala Rama, Khanna Ajay K, Patel Malay D, Padaria Shoaib, Varghese Roy

机构信息

1Fortis Hospital, Mohali, Punjab India.

Dekiwadia Hospital, Rajkot, Gujarat India.

出版信息

Indian J Surg. 2018 Apr;80(2):171-182. doi: 10.1007/s12262-018-1726-3. Epub 2018 Jan 27.

Abstract

Venous ulcer is an extremely common aetiology of lower extremity ulceration, which affects approximately 1% population in most of the countries, and the incidence rate increases with age and female gender. Proper assessment and diagnosis of both the patient and ulcer are inevitable in order to differentiate venous ulcers from other lower extremity ulceration and to frame an adequate and individualised management plan. Venous ulcers generally persist for weeks to many years and are typically recurrent in nature. This consensus aims to present an evidence-based management approach for the patients with venous ulcers. Various management options for venous ulcers include compression therapy, minimally invasive procedures like sclerotherapy and ablation techniques, surgical procedures, debridement and medical management with micronised purified flavonoid fraction (MPFF). Compression therapy is the mainstay treatment for venous ulcer. However, in failure cases, surgery can be preferred. Medical management with MPFF as an adjuvant therapy to standard treatment has been reported to be effective and safe in patients with venous ulcer. In addition to standard therapy, diet and lifestyle modification including progressive resistance exercise, patient education, leg elevation, weight reduction, maintaining a healthy cardiac status and strong psychosocial support reduces the risk of recurrence and improves the quality of life in patients with venous ulcer.

摘要

静脉性溃疡是下肢溃疡极为常见的病因,在大多数国家约影响1%的人口,且发病率随年龄增长和女性性别而增加。为了将静脉性溃疡与其他下肢溃疡区分开来并制定适当的个体化管理计划,对患者和溃疡进行恰当的评估与诊断是必不可少的。静脉性溃疡通常持续数周乃至数年,且本质上通常会复发。本共识旨在为静脉性溃疡患者提供一种基于证据的管理方法。静脉性溃疡的各种管理选择包括压迫治疗、硬化疗法和消融技术等微创程序、手术程序、清创以及使用微粉化纯化黄酮类成分(MPFF)的药物治疗。压迫治疗是静脉性溃疡的主要治疗方法。然而,在治疗失败的情况下,可优先选择手术。据报道,将MPFF药物治疗作为标准治疗的辅助疗法,对静脉性溃疡患者有效且安全。除标准治疗外,饮食和生活方式的改变,包括渐进性抗阻运动、患者教育、抬高腿部、减轻体重、保持心脏健康状态以及强大的社会心理支持,可降低复发风险并改善静脉性溃疡患者的生活质量。

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Evidence-Based Clinical Practice Points for the Management of Venous Ulcers.静脉溃疡管理的循证临床实践要点
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