《慢性伤口处理》PPT课件.ppt

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1、wound cleaning-Techniques伤口清洁-技术Components which need to be removed from wound bed 需要从创面去除的部分Surplus exudate多余渗出物Necrotic tissue坏死组织Dead cells 死亡细胞Breading ground for bacteria and components which might be supportive to the development of biofilms.细菌滋养环境以及可能会促进生物被膜形成的成分wound cleaning伤口清洁General goal

2、总体目标To remove debries and froeign bodies.去除碎屑与异物Necrotic tissue坏死组织Dead cells死亡细胞Fibrin纤维蛋白Toxins，MMP毒素，MMPForeign bodies(for instance remains for previously used dressings)异物（例如先前使用的敷料）Wound cleaning-Techniques伤口清洁-技术Requirements on wound rinsing solutions 对伤口冲洗液的要求Should be sterilie 无菌Not colored

3、无色Gentel to cells/non toxic 细胞温和型/无毒Body temperature(cooling down wound bed reduces or inactivates cell activity)28 no function 体温（冷却创面、减少细胞活性或使其灭活）28 无效Wound cleaning 伤口清洁Ways 方法Basic cleanning of wound bed,wound edges and surrounding area对伤口创面、边缘以及周围进行基本清洗Antibacteira cleanning 抗菌剂清洗Wound rinsing伤

4、口冲洗Wound cleaning Wet to dry 干燥清洗伤口Debridement 清创术Negtive pressure负压 Wound cleaning 伤口清洁-技术Cleanig with Rinsing solution采用冲洗溶液进行清洗Saline 生理盐水Ringer solution林格氏液Indication:Cleaning wound 适应症：清洁伤口Non touch technique非接触技术Wound cleaning 伤口清洁-技术Cleanning with antiseptic solution 采用消毒溶液进行清洗Octenidin-di-hy

5、drochlorid奥替尼啶盐酸化合物Polyhexanid 聚已缩胍Iodine 碘Indication:Infected and contaminated wound 适应症：感染伤口和污染伤口Non touch technique:From outside to center of wound in order to avoid further spreading of bacteria to the surrounding area.非接触技术：从外围向中间清洗以避免细菌向周围进一步播散Wound cleaning-Antiseptic solution伤口清洁-消毒溶液Octenid

6、in-di-hydrochlorid奥替尼啶盐酸化合物Polyhexanid 聚已缩胍Advantages优点not colored,not inacticated by body fluids无色、不会被体液灭活do not initiate resistance,skin irritation and allergies不会引起抗药性、皮肤刺激或过敏Disadvantages缺点not available and reimbursed in many countries在许多地区不能使用而且不能报销不能采用高压将奥替尼啶注入腔内加以应用Both should not be applied

7、on cartilage and in contact with internal organs(abdominal cavity)二者均不能在软骨上运用，且不能与内部器官接触（腹腔）Wound cleaning-Antiseptic solution伤口清洁-消毒溶液IodineAdvantages优点Effevtive against Gram postive and Gram negtive bacteria可有效对抗革兰阳氏和阴性菌Available in different forms for application(ointment,lotions)可以采用不同形式加以运用（软膏、

8、洗液）Disadvantages 缺点Colored(makes wound assessment difficult)有色（难以对伤口进行评估）Inactivated by body fluids会被体液灭活Sensitivity might occur 可能会发生过敏Systemic side effects due to absortion吸收会导致全身副作用Wound debridement清创术In case of a chronic,difficult to heal wound cleaning can be supported with different ways of de

9、bridement在慢性、难愈合性伤口的清洁中可才采用不同的清创术进行支持治疗Requirements要求：As gentle as possible 尽可能温柔As thorough as possible 尽可能彻底As soon as possible尽早Debridement opportunity清创时机病情许可，越早越好Illness permission,the sooner,the better 无明显感染表现，均可清创No apparent infection,debridement performance 已有感染，但伤口有异物或较多坏死组织，也可清创，清创后伤口暂不缝合I

10、f the Wound is infected,but have a foreign body or much necrotic tissue,we can also debridement,and do not wound closure after debridement急性伤口理想时间：伤后8小时以内，头面、手部伤口12小时以内The ideal time:8 hours after the wound,and the head,hand within 12 hours after the woundDebridement methods伤口清创方法机械清创（伤口清洗和伤口浴，水下低频超

11、声波处理、聚氨酸脂类软性泡沫复合物产品等）Mechanical debridement外科清创（剪刀、手术刀、锋利勺、刮器）Surgical debridement酶清创（蛋白质、肽类）Enzymatic debridement生物清创Bio surgical debridement自溶性清创（内活性伤口敷料、如水胶体、水凝胶）Autolytic debridement Wound debridemen清创术Mechanical 机械性清创Wipe(mechancialy clean)the wound with sterile gauze无菌纱布擦拭伤口（机械型清洗）Gauze can be

12、 moist or dry可以采用湿性或干性纱布Cave:might be painful for patient孔洞：可能造成患者疼痛Aternative选择 Soaked gauze is applied to wound and should be removed gently.Every time some of wound debris will remain in gauze.对伤口使用浸湿纱布，而且去除纱布时动作应当轻柔。每次都会有一些伤口碎屑留在纱布内。Wound debridemen清创术Surgical 手术清创Removal of debris with curette,

13、abrasor or scapel采用刮匙、刮除器或手术刀去除碎屑Usually performed by surgeon or specially trained nurses under supervision of surgeon.通常由外科医生执行清创或者在外科医生的监督下由护士进行清创。Cave 空洞Might be painful for patient可能会引起患者疼痛Chance of bleeding可能会出血In severe cases int must be conducted in OR严重时必须采用手术进行处理Wound debridemen清创术Enzymatic

14、 酶解清创术Removal of debris with emzymes 采用酶法Have to be renewed frequently 必须经常更新Need a moist and body warm environment to be effective需要保肢潮湿和体温环境才能产生作用Have to be applied at the area of debris必须在清创区域使用Colleges Santy1Z*Ointment(胶原酶Santy1)Enzymatic debriding agent(清创酶)Wound debridemen清创术Bio surgical with

15、maggots采用蛆进行生物手术Serratia marcecens沙雷杆菌Advantage优点Very selective cleaning/Antiseptic effect选择性清洁/防腐作用Stimulate granulation刺激肉芽生长Almost pain free 几乎无痛Disadvantage缺点Not always easy to apply and keep in place不容易使用而且不容易固定。Ethical aspects need consideration.需要对伦理学方面加以考虑。Wound debridement 清创术Autolytic 自熔性清

16、创术Facilitate body owns of mechanism of debridement moist dressing采用适当的湿性敷料促进机体自身清创机制Advantage优点Cell friendly细胞亲和性Almost pain free几乎无痛Easy to do容易操作Disadvantage缺点Tasks more time than for instance surgical debridement比手术清创方法花费更多时间Needs to be adapted to the individual requirements of wound需要适合伤口的个体要求No

17、t always effective for instance in case of thick necrotic layer在诸如坏死层较厚的情况下The evolution and application of dressingsGauze Oil Yam、sticking Hydrocolloid dressings Antibacterial dressings干纱布 油砂、敷贴 水胶体 抗菌敷料、生物活性敷料Wound dressings-General伤口敷料总体Requirements要求Maintain moist environment保持环境湿润Sterile无菌Remov

18、e excess exudate去除多余渗出物Non toxic无毒性Non senstizing无过敏性Protect the wound from further trauma保护伤口防止进一步损伤Allow non traumatic removal 去除时不会产生损伤Protect from migration of bacteria保护伤口防止细菌迁移Keep wound at body temperature(Isulation)保护伤口处于体温下（绝缘）Allow gaseous exchange 允许空气交换Comfortable 舒适Economical/require in

19、frequent changes经济/不需要经常更换Wound dressings-Requirements伤口敷料要求Key functions主要作用Keep wound bed moist保持创面湿润Keep wound surrounding skin dry保持伤口周围皮肤干燥Avoid cooling down of wound temperature避免伤口温度降低Protect from infection预防感染Should not leave residuals in wound伤口内不应留下残余物Wound dressings-Requirements伤口敷料要求Key

20、functions主要作用Keep wound bed moist保持创面湿润Keep wound surrounding skin dry保持伤口周围皮肤干燥Avoid cooling down of wound temperature避免伤口温度降低Protect from infection预防感染Should not leave residuals in wound伤口内不应留下残余物Wound dressings-Different kindsCriteria for selection选择标准Wound site 伤口位置Exudate 渗出物Signs of infection感

21、染迹象Condition of wound surrounding skin伤口周围皮肤状况Pain 疼痛Wound dressings-Requirements伤口敷料要求Occlusive or non occlusive dressings封闭型或非封闭型敷料Occlusive environment is supportive for wound healing封闭环境有助于伤口愈合Attention注意In case of infection,severe contamination exposed tendon,bone,fistuals an occlusion can be d

22、angerous.在肌腱、骨骼暴露以及瘘管存在感染或严重感染时，封闭可能具有危险Keep wound surrounding skin dry保持伤口周围皮肤干燥Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Description 说明Hydroactive dressing pad for wet therapy采用水活化性敷料垫用于湿润疗法Made of highly absorbing polyacrylate采用高吸水性聚丙烯酸酯制造Active absorbing and rinsing effect具有有

23、效吸收和冲洗作用Already activated version plus separate Ringer solution available可以采用已活化型或者未活化型外加林格氏液。Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender WetKey objectives for application使用的主要目的Hydration of wound bed for 24 hours使创面保湿24小时Initiation and support of autolytic debridement引发或有助于自溶性清创Releas

24、e of Ringer solution into wound bed将林格氏液释放至创面Absorption of wound exudate吸收伤口渗出液Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Predominate use in following phases of wound healing 主要应用于伤口愈合的以下阶段Cleaning 清洁Cleaning+Granulation清洗+肉芽形成Granulation肉芽形成Rehydrates eschar support autolytic mec

25、hanisms再次水化焦痂有助于自溶机制Reduce MMP减少MMPProtects and maintains clean保持并维持清洁Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Main indication主要适应症Infected wounds(deep and superficial)感染伤口（深部和表浅）Necrotic wounds(deep and superficial)坏死伤口（深部和表浅）Wounds with stagnating healing愈合停止的伤口Wound dressings

26、-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Contra indication禁忌症Eschar due to untreated arterial ulceration 由未经治疗的动脉性溃疡所导致的焦痂Exercise caution注意Contact of dressing with wound bed must be secured 敷料和创面必须牢固接触Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Handing 操作Protect wound surrou

27、nding area 保护伤口周围区域Must be changed after 24hours24小时后必须更换Green stripes of Tender Wet 24 are facing away from wound bed在创面使用德湿威24时，应将绿色条纹面朝外。Dressing must not be cut 不要对敷料进行裁减Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Fixation固定Fixation with nonabsorbent dressing,bandage or non wov

28、en adhesive以非吸收性敷料、绷带或非编织型胶带进行固定。Wound dressingsAlginates伤口敷料藻酸盐类敷料Alginate from originate from between algae海藻纤维源于褐藻Alginate turn into get when in contact with wound exudate藻酸盐类敷料与伤口接触时可变成凝胶Alginates can absorb a significant amount more than their weight of wound fluids藻酸盐类敷料可以吸收显著高于其自身重量的伤口渗出液 Wou

29、nd dressingsAlginates伤口敷料藻酸盐类敷料Key objectives for application使用的主要目的Wound filling 填充伤口Support of autolytic debridement due to get information 凝胶形成有助于自溶性清创Absorption of wound exudate吸收伤口渗出液Embed bacteria and toxin in structure将细菌和毒物包裹在凝胶中Haemostatic effect具有止血作用Wound dressingsAlginates伤口敷料藻酸盐类敷料Predo

30、minate use in following phases of wound healing主要应用于伤口愈合的以下阶段Cleaning 清洁Granulation 肉芽形成Especially for deep small cavity wounds尤其用于较深而且较小的孔腔性溃疡Rarely 很少Wound dressingsAlginates伤口敷料藻酸盐类敷料Main indication 主要适应症Infected wounds(deep and superficial)感染伤口（深部和表浅）Necrotic wounds(deep and superficial)坏死伤口（深部和

31、表浅）Wounds with stagnating healing 愈合停止的伤口Wounds wiith tendency for bleeding 存在出血倾向的伤口Wound dressingsAlginates伤口敷料藻酸盐类敷料Contra indication 禁忌症Dry or crusted wounds 干燥或结痂伤口Dry necrosis 干性坏死Third-degree burns or higher 3度或3度以上烧伤Exercise caution 注意Pressure releases wound exudate again压力解除伤口会再次渗出Remove Al

32、ginates residual-free 去除藻酸盐类敷料时不应留有残余（danger of infection）(具有危害性或感染性)Do not apply with pressure 不应加压使用Avoid overlapping wound edges 避免与伤口边缘重叠Wound dressingsAlginates伤口敷料藻酸盐类敷料Fixation固定Alginates need to be covered by a secondary dressing藻酸盐类敷料需要采用次级敷料加以覆盖Non-infected wound Fine pored foam dressing:h

33、ydrocolloid or film dressing 非感染性伤口：细孔泡沫敷料、水胶敷料或薄膜敷料Infected woundElastic gauze bandages:tubular bandages or non woven fixation products感染性伤口：弹力绷带、筒形绷带或非编织性固定产品Wound dressingsHydrofiber dressings伤口敷料亲水性材料Description 说明Made of“Natrium carboxymethycellulose”由羧甲基纤维素制成High absorption capacity 吸收性能较高Turn

34、s into transparent get when in contact with wound exudate 垂直吸收创面渗出液Wound dressingsHydrofiber dressings伤口敷料亲水性材料Key objectives 使用主要目的Absorption of wound exudate吸收伤口渗出液Inclusion of wound exudate even under pressure (compression therapy)即使可以在压力作用下（加压治疗）也可以吸入伤口渗液Predominate use in following phases of wo

35、und healing 主要应用于伤口愈合的以下阶段Cleansing:Exuding sloughed wounds清洁：排除伤口腐肉Granulation:肉芽形成：很少Wound dressingsHydrofiber dressings伤口敷料亲水性材料Main indication 主要适应症Highly secreting wounds 高分泌型伤口Acute and chronic wounds急性和慢性伤口Postoperative wounds 术后伤口First and second-degree burns1度或2度烧伤In case of problematic(in

36、danger to develop maceration)surround skin用于伤口周围皮肤存在问题的情况下（具有发展成浸渍伤口的危险）Wound dressingsHydrofiber dressings伤口敷料亲水性材料Contra indication禁忌症Dry wounds 干燥伤口Dry necrosis wounds 干性坏死Third-or forth-degree burns3度或4度烧伤Exercise caution 注意None Wound dressingsHydrofiber dressings伤口敷料亲水性材料Handling操作Dressing may

37、develop the wound by about 1 inch敷料可以在伤口上重叠约1英寸厚Hydrofiber tamponades should be poke out of the wound by approximately an inch水性纤维敷料填塞应高于伤口约1英寸 Wound dressingsHydrofiber dressings伤口敷料亲水性材料Fixation固定Hydrofiber dressings need to be covered by as secondary dressing富含纤维敷料需要采用次级敷料加以覆盖Absorbing pads、gauze

38、 bandages or non woven fixation products吸收垫、纱布绷带或非编织性产品Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Description 说明Made of a fine(Polyurethane)foam covered with a semi occlusive Polyurethane film 由覆盖一层封闭型聚氨基甲酯薄膜的精制泡沫构成Foam dressings have high absorption泡沫敷料具有高度吸水性Air permeable membrane enabl

39、es gas exchange空气可以渗入薄膜使气体得以交换Available with and without adhesive可以和胶带一起应用，也可以单独使用Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Predominate use in following phases of wound healing 主要应用于伤口愈合的以下阶段Cleaning 清洁 even in case of sloughy/necrotic wounds，sometimes on infected wounds(withoout adhesiv

40、e border)甚至可以用于坏死性伤口,有时可以用于感染性伤口（无粘性边缘）Granulation 肉芽形成 Epithellialisation 上皮形成 thin foam dressing only只采用薄层泡沫敷料Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Main indication 主要适应症Exudating wounds渗出性伤口As cavity in deep,undermined exudating wounds孔腔较深的潜行性渗出伤口In combination with compression the

41、rapy 联合加压治疗On slushy,fibrin coated wounds胶冻状纤维蛋白覆盖性伤口Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Contra indication禁忌症Infected wounds(bordered versions)感染伤口（边界模糊）Dry wound 干燥伤口Third-or forth-degree and higher 3度或3度以上烧伤Necrotic wounds.Only as a cover in combination with for instance Hydrogel

42、 wound坏死伤口，只能与其他敷料合用坐覆盖，如水凝胶敷料。Exercise caution 注意Possibility of maceration when dressing capacity is exhausted当敷料吸收能力达极限时具有浸渍的可能Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Handing 操作Cavity products for deep wounds孔腔产品用于深部伤口Dressing should be overlapping 敷料应当重叠使用Dressings can sometimes be

43、cut to fitting size 有时可将敷料裁剪成适当大小Can stay on wound up to 7days(depending on amount of wound exudate)可以在伤口保留长达7天（依据伤口渗出液的量）Wound dressingsPolyurethane/Foam dressings伤口敷料聚氨酯/泡沫敷料Fixation固定Often not needed due to adhesive borders of dressing pads由于敷料垫具有粘性边缘通常不需要固定Fixation with semi permeable films,sili

44、cone coated films or elastic bandages以半透膜、硅涂层薄膜或弹力绷带固定Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Description 说明Semi oclusive,made of water-repelling polymer matrix(thin polyurethane film)半封闭型采用防水性聚合物基质形成（聚氨酯薄膜）Matrix contains hydrocolloid substance基质包含亲水物质Sometimes with adhesive non woven boarde

45、rs or flatter boarders for easy application有时存在便于使用的粘性非编织性边缘或更为平整的粘性边缘Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Key objectives for application使用的主要目的Support granulation有助于肉芽组织形成Absorption of cell debris吸收细胞碎屑Limited absorption of wound exudate伤口渗出液吸收有限Ensuring a moist wound environment确保湿润的伤口环境

46、Protection against external effects保护伤口防止外部影响Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Predominate use in following phases of wound healing 主要应用于伤口愈合的以下阶段Cleansing 清洁Granulation 肉芽形成Epithelialisation 上皮形成Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Main indication主要适应症Low to medium amount of

47、wound exudate少量到中等量的伤口渗出液Abrasions,first-and ssecond degree burns,decubitus,leg ulcers擦伤、1度或2度烧伤、褥疮、腿部溃疡Wounds in Epithelialisation phase处于上皮形成时期的伤口As a cover for other wound dressings()作为其他伤口敷料的覆盖物Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Contra indication禁忌症Deep mycosis深部真菌病Highly exuding or

48、bleeding wounds高度渗血或出血伤口Third or forth-degree burns3度或4度烧伤Osteomyelitis 骨髓炎Deep wounds with bare bones,muscles,tendons深部伤口伴谷歌、肌肉、肌腱裸露Exercise caution 注意Maceration of surrounding skin possible伤口具有浸渍可能Hyper granulation 肉芽组织过度形成Diabetic foot ulcers糖尿病性足部溃疡Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料

49、Handing 操作Some of hydrocolloid dressing should have body temperature when applied在使用时应将某些水胶体敷料加热至体温Surrounding of wound needs to be free of hair 伤口周围备皮Dressing need to be approximately an inch bigger than wound 敷料应当大于伤口约1英寸Can stay on wound up to 7days可以在伤口上保留长达7天Dressing change required when get cl

50、ose to border of dressing当凝胶接近敷料边缘时则需要更换敷料Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料Fixation固定No secondary dressing or fixation needed不需要次级敷料或固定 Hydrocolloid dressings are often used as fixation for other wound dressings水胶体敷料通常最为其他敷料的固定物If needed further fixation with adhesive products like fil