Krasner D
Johns Hopkins University School of Nursing, Center for Nursing Research, Baltimore, MD, USA.
Ostomy Wound Manage. 1998 Apr;44(4):56-8, 60-2, 64 passim.
The management of lower extremity diabetic ulceration exacts enormous emotional and economic costs from patients, their family members and caregivers, and society. A team approach to wound healing has proved effective, but efforts at prevention have been less successful. The etiology of lower extremity diabetic ulcers includes injury complicated by underlying neuropathy, ischemia, or both. Prevention of primary and recurrent ulcers can be increased through programs to educate patients and caregivers. Proper management begins with thorough assessment and continues with various forms of medical and surgical therapy, and timely referral to specialists when appropriate. The use of recombinant growth factors is becoming more widespread as more is learned about their essential role in wound healing. Monitoring the wound while it is being treated is as important as initial assessment. Across the United States and Canada, wound care clinics are being established to provide intensive care directed by specially trained multidisciplinary care teams. Less populated areas must rely on proper education of ET nurses, home care nurses, visiting nurses, podiatrists/chiropodists, and allied healthcare professionals. Challenges for the future include the development of protocols for comprehensive assessment and care, better methods of prevention, a greater understanding of the role of growth factors in wound healing, and optimizing wound care.
下肢糖尿病溃疡的治疗给患者、其家庭成员及护理人员以及社会带来了巨大的情感和经济成本。团队协作的伤口愈合方法已被证明是有效的，但预防工作却不太成功。下肢糖尿病溃疡的病因包括由潜在神经病变、缺血或两者共同导致的损伤。通过对患者及护理人员进行教育的项目，可以提高对原发性和复发性溃疡的预防。恰当的治疗始于全面评估，接着是各种形式的药物和手术治疗，并在适当时及时转诊至专科医生处。随着对重组生长因子在伤口愈合中重要作用的了解越来越多，其使用也越来越广泛。在伤口治疗过程中进行监测与初始评估同样重要。在美国和加拿大各地，正在设立伤口护理诊所，由经过专门培训的多学科护理团队提供重症护理。人口较少的地区必须依靠对造口治疗师护士、家庭护理护士、上门护理护士、足病医生/手足病医生以及相关医疗保健专业人员进行恰当的教育。未来面临的挑战包括制定综合评估和护理方案、更好的预防方法、更深入了解生长因子在伤口愈合中的作用以及优化伤口护理。
