Erickson C A, Lanza D J, Karp D L, Edwards J W, Seabrook G R, Cambria R A, Freischlag J A, Towne J B
Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
J Vasc Surg. 1995 Nov;22(5):629-36. doi: 10.1016/s0741-5214(95)70051-x.
A nurse-managed/physician-supervised treatment program for venous ulceration was evaluated to determine the influence of venous hemodynamics, comorbidities, patient behavior, and ulcer characteristics on time to healing and time to recurrence.
The clinical course and long-term follow-up of 71 patients with 99 venous ulcers diagnosed between November 1981 and August 1994 were analyzed by a retrospective review of clinic records. Demographic data, severity of venous insufficiency, ulcer characteristics, and patient compliance were studied. Outcome variables were time to complete ulcer healing and time to first recurrence.
Ninety-one percent of the ulcers healed completely at a median 3.4 months. There were 52 (57%) recurrences at a median 10.4 months. Ulcers on limbs with a venous refill time of 10 seconds or less demonstrated a significantly longer time to complete healing (p < or = 0.03); however, no effect on time to recurrence was observed. Patients who were in strict compliance with the treatment regimen (n = 32) had significantly faster healing (p < or = 0.02) and fewer recurrences (p < or = 0.004) compared with patients who were less compliant (n = 67).
Most venous ulcers can be expected to heal when patients are enrolled in a nurse-managed/physician-supervised ambulatory ulcer clinic. Photoplethysmography-derived venous refill time of 10 seconds or less predicted delayed healing. Strict compliance with the treatment protocol significantly decreased the time to healing and prolonged the time to recurrence.
评估一项由护士管理/医生监督的静脉溃疡治疗方案，以确定静脉血流动力学、合并症、患者行为及溃疡特征对愈合时间和复发时间的影响。
通过回顾1981年11月至1994年8月间确诊的71例患者99处静脉溃疡的临床病程及长期随访情况，对临床记录进行回顾性分析。研究人口统计学数据、静脉功能不全的严重程度、溃疡特征及患者依从性。观察指标为溃疡完全愈合时间和首次复发时间。
91%的溃疡在中位时间3.4个月时完全愈合。52处（57%）溃疡复发，中位复发时间为10.4个月。静脉充盈时间为10秒或更短的肢体上的溃疡，其完全愈合时间显著延长（p≤0.03）；然而，未观察到对复发时间有影响。与依从性较差的患者（n = 67）相比，严格遵守治疗方案的患者（n = 32）愈合速度明显更快（p≤0.02），复发次数更少（p≤0.004）。
当患者参加由护士管理/医生监督的门诊溃疡诊所时，大多数静脉溃疡有望愈合。通过光电容积描记法测得静脉充盈时间为10秒或更短预示愈合延迟。严格遵守治疗方案可显著缩短愈合时间并延长复发时间。
