慢性伤口处理PPT医学课件.ppt

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1wound cleaning伤口清洁 Gener

2、al goal 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，MMP Foreign bodies(for instance remains for previously used dressings)异物（例如先前使用的敷料）2Wound cleaning-Techniques伤口清洁-技术 Requirements on wound rinsing solutions 对伤口冲洗液的要求 Should be steril

3、ie 无菌 Not colored 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3Wound 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 clea

4、nning 抗菌剂清洗 Wound rinsing伤口冲洗 Wound cleaning Wet to dry 干燥清洗伤口 Debridement 清创术 Negtive pressure负压 4Wound 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5Wound cleaning 伤口清洁-技术 Cleanning with antisep

5、tic solution 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: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6Wound

6、cleaning-Antiseptic solution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

7、不能采用高压将奥替尼啶注入腔内加以应用Both should not be applied 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）7Wound 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 fo

8、r application(ointment,lotions)可以采用不同形式加以运用（软膏、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8Wound debridement清创术 In case of a chronic,difficult to heal wound cl

9、eaning can be supported with different ways of debridement 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9Debridement 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,d

10、ebridement 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 If 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

11、 after the wound10Debridement methods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）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 debridement11 Wound debridemen清创术 Mechanical 机械性清创 Wipe(me

12、chancialy clean)the wound with sterile gauze 无菌纱布擦拭伤口（机械型清洗）Gauze can be 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

13、些伤口碎屑留在纱布内。12Wound debridemen清创术 Surgical 手术清创 Removal of debris with curette,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

14、 severe cases int must be conducted in OR严重时必须采用手术进行处理13Wound debridemen清创术 Enzymatic 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 Sa

15、nty1Z*Ointment(胶原酶Santy1)Enzymatic debriding agent(清创酶)14Wound debridemen清创术 Bio surgical with 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

16、 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。15Wound debridement 清创术Autolytic 自熔性清创术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 s

17、urgical 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Not always effective for instance in case of thick necrotic layer在诸如坏死层较厚的情况下16The evolution and application of dressings Gauze Oil Yam、sticking Hydrocolloid dressings Antibacterial dressings干纱布 油砂、

18、敷贴 水胶体 抗菌敷料、生物活性敷料17Wound dressings-General伤口敷料总体Requirements要求Maintain moist environment保持环境湿润Sterile无菌Remove 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 woun

19、d 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 infrequent changes经济/不需要经常更换18Wound 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

20、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19Wound 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 res

21、iduals in wound伤口内不应留下残余物20Wound dressings-Different kinds Criteria for selection 选择标准 Wound site 伤口位置 Exudate 渗出物 Signs of infection感染迹象 Condition of wound surrounding skin伤口周围皮肤状况 Pain 疼痛21Wound 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 s

22、upportive 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 dangerous.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22Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Descripti

23、on 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。23Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（

24、德湿威Tender Wet Key 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 Release 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24Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威T

25、ender 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 mechanisms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25Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender W

26、et）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26Wound dressings-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

27、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27Wound dressings-Wet therapy(Tender Wet)伤口敷料湿润疗法（德湿威Tender Wet）Handing 操作 Protect wound surrounding 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

28、 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28Wound 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 woven adhesive 以非吸收性敷料、绷带或非编织型胶带进行固定。29Wound dressingsAlginates伤口敷料藻酸盐类敷料 Alginate from originate from between a

29、lgae 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 30Wound 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

30、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31Wound dressingsAlginates伤口敷料藻酸盐类敷料 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 Granulation 肉

31、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32Wound 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（深部和表浅）Wounds with stagnating healing 愈合停止的伤口 Wounds wiith tendency for bleeding 存

32、在出血倾向的伤口33Wound 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 Alginates 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

33、)Do not apply with pressure 不应加压使用 Avoid overlapping wound edges 避免与伤口边缘重叠34Wound 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:hydrocolloid or film dressing 非感染性伤口：细孔泡沫敷料、水胶敷料或薄膜敷料 Infecte

34、d wound Elastic 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35Wound 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 Turns into transparent get when in contact with wound e

35、xudate 垂直吸收创面渗出液36Wound 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 wound healing 主要应用于伤口愈合的以下阶段 Cleansing:Exuding

36、sloughed wounds清洁：排除伤口腐肉 Granulation:肉芽形成：很少37Wound 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 danger to develop maceration)surrou

37、nd 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）38Wound 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 39Wound dressingsHydrofiber dressings伤口敷料亲水性材料 Handling 操作 Dressing may develop the wound by

38、 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 40Wound 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 bandages o

39、r non woven fixation products 吸收垫、纱布绷带或非编织性产品41Wound 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 enables

40、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42Wound 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 adh

41、esive 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43Wound 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 comp

42、ression therapy 联合加压治疗 On slushy,fibrin coated wounds胶冻状纤维蛋白覆盖性伤口44Wound 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 ins

43、tance Hydrogel 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45Wound 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 Dressin

44、gs can sometimes be 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）46Wound 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 wit

45、h semi permeable films,silicone coated films or elastic bandages以半透膜、硅涂层薄膜或弹力绷带固定47Wound 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 Sometim

46、es with adhesive non woven boarders 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48Wound 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 E

47、nsuring a moist wound environment确保湿润的伤口环境 Protection against external effects保护伤口防止外部影响49Wound 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50Wound dressings Hydrocolloid dressings伤口

48、敷料水胶体敷料 Main indication 主要适应症 Low to medium amount of 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(e.g.alginates)作为其他伤口敷料的覆盖物51Wound dressings Hydrocolloid

49、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 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Di

50、abetic foot ulcers糖尿病性足部溃疡52Wound dressings Hydrocolloid dressings伤口敷料水胶体敷料 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