Krasner D
Ostomy Wound Manage. 1995 Jan-Feb;41(1):22-6, 28, 30; quiz 31-2.
Chronic wounds present tremendous challenges to the healthcare team. Unlike acute wounds that usually progress neatly in a timely manner through the inflammation, proliferation and maturation phases of the healing process, chronic wounds deviate from the predictable sequence of regeneration and repair. To aid the healing process, there are five questions a nurse should ask when assessing a wound: "What is it?" "At what stage in the wound healing process is this wound?" "Is this wound healing at the expected rate?" "What local factors exist that may be delaying the healing process of this wound?" and "What systemic factors exist that may be delaying the healing process of this wound?" At various points in the process, specific concerns then need to be targeted. Initially, prevent or control infection. Then optimize exudate control and remove foreign bodies. Finally, prevent premature wound closure or contracture, especially in infected or undermining wounds. When the five assessment questions are answered and specific concerns have been addressed, the wound should proceed through the normal phases of the wound healing process. Throughout the process, attention to factors such as nutrition, systemic conditions, and perfusion is essential if healing is to be optimized.
慢性伤口给医疗团队带来了巨大挑战。与急性伤口不同，急性伤口通常会在愈合过程的炎症、增殖和成熟阶段及时顺利进展，而慢性伤口则偏离了可预测的再生和修复顺序。为了促进愈合过程，护士在评估伤口时应问五个问题：“这是什么伤口？”“这个伤口处于伤口愈合过程的哪个阶段？”“这个伤口是否以预期速度愈合？”“存在哪些可能延迟该伤口愈合过程的局部因素？”以及“存在哪些可能延迟该伤口愈合过程的全身因素？”在这个过程的不同阶段，需要针对特定问题进行处理。首先，预防或控制感染。然后优化渗出液控制并清除异物。最后，防止伤口过早闭合或挛缩，尤其是在感染或潜行性伤口中。当回答了这五个评估问题并解决了特定问题后，伤口应进入伤口愈合过程的正常阶段。在整个过程中，如果要优化愈合，关注营养、全身状况和灌注等因素至关重要。
