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1、woundcleaning Techniques伤口清洁 技术 Componentswhichneedtoberemovedfromwoundbed需要从创面去除的部分Surplusexudate多余渗出物Necrotictissue坏死组织Deadcells死亡细胞Breadinggroundforbacteriaandcomponentswhichmightbesupportivetothedevelopmentofbiofilms 细菌滋养环境以及可能会促进生物被膜形成的成分 woundcleaning伤口清洁 Generalgoal总体目标Toremovedebriesandfroei
2、gnbodies 去除碎屑与异物Necrotictissue坏死组织Deadcells死亡细胞Fibrin纤维蛋白Toxins MMP毒素 MMPForeignbodies forinstanceremainsforpreviouslyuseddressings 异物 例如先前使用的敷料 Woundcleaning Techniques伤口清洁 技术 Requirementsonwoundrinsingsolutions对伤口冲洗液的要求Shouldbesterilie无菌Notcolored无色Genteltocells nontoxic细胞温和型 无毒Bodytemperature coo
3、lingdownwoundbedreducesorinactivatescellactivity 28 nofunction体温 冷却创面 减少细胞活性或使其灭活 28 无效 Woundcleaning伤口清洁 Ways方法Basiccleanningofwoundbed woundedgesandsurroundingarea对伤口创面 边缘以及周围进行基本清洗Antibacteiracleanning抗菌剂清洗Woundrinsing伤口冲洗WoundcleaningWettodry干燥清洗伤口Debridement清创术Negtivepressure负压 Woundcleaning伤口清
4、洁 技术 CleanigwithRinsingsolution采用冲洗溶液进行清洗Saline生理盐水Ringersolution林格氏液Indication Cleaningwound适应症 清洁伤口Nontouchtechnique非接触技术 Woundcleaning伤口清洁 技术 Cleanningwithantisepticsolution采用消毒溶液进行清洗Octenidin di hydrochlorid奥替尼啶盐酸化合物Polyhexanid聚已缩胍Iodine碘Indication Infectedandcontaminatedwound适应症 感染伤口和污染伤口Nontou
5、chtechnique Fromoutsidetocenterofwoundinordertoavoidfurtherspreadingofbacteriatothesurroundingarea 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 Woundcleaning Antisepticsolution伤口清洁 消毒溶液 Octenidin di hydrochlorid奥替尼啶盐酸化合物Polyhexanid聚已缩胍Advantages优点notcolored notinacticatedbybodyfluids无色 不会被体液灭活donotinitiateresistance
6、 skinirritationandallergies不会引起抗药性 皮肤刺激或过敏Disadvantages缺点notavailableandreimbursedinmanycountries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Bothshouldnotbeappliedoncartilageandincontactwithinternalorgans abdominalcavity 二者均不能在软骨上运用 且不能与内部器官接触 腹腔 Woundcleaning Antisepticsolution伤口清洁 消毒溶液 IodineAdvantages优点Eff
7、evtiveagainstGrampostiveandGramnegtivebacteria可有效对抗革兰阳氏和阴性菌Availableindifferentformsforapplication ointment lotions 可以采用不同形式加以运用 软膏 洗液 Disadvantages缺点Colored makeswoundassessmentdifficult 有色 难以对伤口进行评估 Inactivatedbybodyfluids会被体液灭活Sensitivitymightoccur可能会发生过敏Systemicsideeffectsduetoabsortion吸收会导致全身副作
8、用 Wounddebridement清创术 Incaseofachronic difficulttohealwoundcleaningcanbesupportedwithdifferentwaysofdebridement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 Asgentleaspossible尽可能温柔Asthoroughaspossible尽可能彻底Assoonaspossible尽早 Debridementopportunity清创时机 病情许可 越早越好Illnesspermission thesooner thebetter无明显感
9、染表现 均可清创Noapparentinfection debridementperformance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IftheWoundisinfected buthaveaforeignbodyormuchnecrotictissue wecanalsodebridement anddonotwoundclosureafterdebridement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Theidealtime 8hoursafterthewound andthehead handwithin12hoursafterthe
10、wound Debridementmethods伤口清创方法 机械清创 伤口清洗和伤口浴 水下低频超声波处理 聚氨酸脂类软性泡沫复合物产品等 Mechanicaldebridement外科清创 剪刀 手术刀 锋利勺 刮器 Surgicaldebridement酶清创 蛋白质 肽类 Enzymaticdebridement生物清创Biosurgicaldebridement自溶性清创 内活性伤口敷料 如水胶体 水凝胶 Autolyticdebridement Wounddebridemen清创术 Mechanical机械性清创Wipe mechancialyclean thewoundwiths
11、terilegauze无菌纱布擦拭伤口 机械型清洗 Gauzecanbemoistordry可以采用湿性或干性纱布Cave mightbepainfulforpatient孔洞 可能造成患者疼痛Aternative选择Soakedgauzeisappliedtowoundandshouldberemovedgently Everytimesomeofwounddebriswillremainingauze 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 Wounddebridemen清创术 Surgical手术清创Removalofdebriswithcure
12、tte abrasororscapel采用刮匙 刮除器或手术刀去除碎屑Usuallyperformedbysurgeonorspeciallytrainednursesundersupervisionofsurgeon 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Mightbepainfulforpatient可能会引起患者疼痛Chanceofbleeding可能会出血InseverecasesintmustbeconductedinOR严重时必须采用手术进行处理 Wounddebridemen清创术 Enzymatic酶解清创术Removalofdebriswit
13、hemzymes采用酶法Havetoberenewedfrequently必须经常更新Needamoistandbodywarmenvironmenttobeeffective需要保肢潮湿和体温环境才能产生作用Havetobeappliedattheareaofdebris必须在清创区域使用CollegesSanty1Z Ointment 胶原酶Santy1 Enzymaticdebridingagent 清创酶 Wounddebridemen清创术 Biosurgicalwithmaggots采用蛆进行生物手术Serratiamarcecens沙雷杆菌Advantage优点Veryselec
14、tivecleaning Antisepticeffect选择性清洁 防腐作用Stimulategranulation刺激肉芽生长Almostpainfree几乎无痛Disadvantage缺点Notalwayseasytoapplyandkeepinplace不容易使用而且不容易固定 Ethicalaspectsneedconsideration 需要对伦理学方面加以考虑 Wounddebridement清创术 Autolytic自熔性清创术Facilitatebodyownsofmechanismofdebridementmoistdressing采用适当的湿性敷料促进机体自身清创机制Ad
15、vantage优点Cellfriendly细胞亲和性Almostpainfree几乎无痛Easytodo容易操作Disadvantage缺点Tasksmoretimethanforinstancesurgicaldebridement比手术清创方法花费更多时间Needstobeadaptedtotheindividualrequirementsofwound需要适合伤口的个体要求Notalwayseffectiveforinstanceincaseofthicknecroticlayer在诸如坏死层较厚的情况下 Theevolutionandapplicationofdressings Gau
16、zeOilYam stickingHydrocolloiddressingsAntibacterialdressings 干纱布油砂 敷贴水胶体抗菌敷料 生物活性敷料 Wounddressings General伤口敷料 总体 Requirements要求Maintainmoistenvironment保持环境湿润Sterile无菌Removeexcessexudate去除多余渗出物Nontoxic无毒性Nonsenstizing无过敏性Protectthewoundfromfurthertrauma保护伤口防止进一步损伤Allownontraumaticremoval去除时不会产生损伤Protectfrommigrationofbacteria保护伤口防止细菌迁移Keepwoundatbodytemperature Isulation 保护伤口处于体温下 绝缘 Allowgaseousexchange允许空气交换Comfortable舒适Economical requireinfrequentchanges经济 不需要经常更换 Wounddressings Requirements伤