Dearlove J L
Department of Surgery, State University of New York Health Science Center, Syracuse, USA.
Surg Clin North Am. 1996 Oct;76(5):1095-109. doi: 10.1016/s0039-6109(05)70499-0.
The basic objectives of skin care management of GI fistulas are the prevention and management of skin breakdown and the promotion of healing of an open wound with a draining fistula by the containment of effluent. Skin or wound care management is one component of the overall medical-surgical management of patients with GI fistulas. This component plays a significant role in promoting patient comfort and well-being and mechanical control of unwanted drainage on the skin. When these objectives are achieved through the use of various products and methods discussed, nutritional and medical management can proceed until an optimal time when surgical repair or spontaneous closure is possible. If surgical repair or spontaneous closure is not an expectation, as in a patient with enterocutaneous fistula secondary to an abdominal tumor and metastatic disease, skin care management without resolution of the problem may continue for some time. In this case skin care management and patient comfort may be the primary focus. Short-term or long-term wound care management must incorporate not only desirable patient care outcomes but also cost and availability issues. Effective use of the caregivers' time, whether it is nursing or other family members, must be taken into consideration. ineffectual skin care rituals that consume excessive time and expense without good patient outcomes must be eliminated. Availability of knowledge regarding basic skin or wound care principles and products, creativity, and availability of products for management are other significant factors that impact on successful skin care management. Effective skin and wound care management is derived from a systematic approach that incorporates an accurate assessment of the fistula and surrounding skin or wound. An accurate assessment of the individual's needs and expected outcomes is also a part of the systematic approach. The simplicity or complexity of an effective wound care management plan must be communicated so that others may duplicate the procedures and thus maintain continuity of care and achievement of patient care objectives.
胃肠道瘘皮肤护理管理的基本目标是预防和处理皮肤破损，通过收集引流液促进伴有引流瘘的开放性伤口愈合。皮肤或伤口护理管理是胃肠道瘘患者整体医疗手术管理的一个组成部分。这一组成部分在提高患者舒适度和幸福感以及对皮肤上不必要的引流进行机械控制方面发挥着重要作用。当通过使用所讨论的各种产品和方法实现这些目标后，营养和医疗管理即可继续进行，直至达到能够进行手术修复或自然闭合的最佳时机。如果手术修复或自然闭合无法实现，例如对于因腹部肿瘤和转移性疾病导致肠皮肤瘘的患者，在问题未解决的情况下，皮肤护理管理可能会持续一段时间。在这种情况下，皮肤护理管理和患者舒适度可能是主要关注点。短期或长期伤口护理管理不仅必须纳入理想的患者护理结果，还必须考虑成本和可及性问题。必须考虑有效利用护理人员的时间，无论是护士还是其他家庭成员。必须摒弃那些消耗过多时间和费用却没有良好患者效果的无效皮肤护理程序。有关基本皮肤或伤口护理原则和产品的知识可及性、创造力以及用于管理的产品可及性，是影响成功皮肤护理管理的其他重要因素。有效的皮肤和伤口护理管理源自一种系统方法，该方法包括对瘘管以及周围皮肤或伤口进行准确评估。对个体需求和预期结果的准确评估也是系统方法的一部分。必须传达有效伤口护理管理计划的简单或复杂程度，以便其他人能够重复这些程序，从而保持护理的连续性并实现患者护理目标。
