慢性傷口處理

woundcleaning--Techniques傷口清潔(qīngjié)---技術Componentswhichneedtoberemovedfromwoundbed需要從創(chuàng)面去除的部分Surplusexudate多余滲出物Necrotictissue壞死組織(zǔzhī)Deadcells死亡細胞Breadinggroundforbacteriaandcomponentswhichmightbesupportivetothedevelopmentofbiofilms.細菌滋養(yǎng)環(huán)境以及可能會促進生物被膜形成的成分第一頁，共九十五頁。整理課件woundcleaning傷口(shāngkǒu)清潔Generalgoal總體目標Toremovedebriesandfroeignbodies.去除碎屑與異物Necrotictissue壞死組織Deadcells死亡細胞Fibrin纖維蛋白Toxins，MMP毒素，MMPForeignbodies(forinstanceremainsforpreviouslyuseddressings)異物（例如先前(xiānqián)使用的敷料）第二頁，共九十五頁。整理課件Woundcleaning--Techniques

傷口清潔(qīngjié)-----技術Requirementsonwoundrinsingsolutions對傷口沖洗液的要求Shouldbesterilie無菌Notcolored無色Genteltocells/nontoxic細胞溫和型/無毒Bodytemperature(coolingdownwoundbedreducesorinactivatescellactivity)>28℃nofunction體溫(tǐwēn)（冷卻創(chuàng)面、減少細胞活性或使其滅活）>28℃無效第三頁，共九十五頁。整理課件Woundcleaning傷口(shāngkǒu)清潔

Ways方法Basiccleanningofwoundbed,woundedgesandsurroundingarea對傷口創(chuàng)面、邊緣(biānyuán)以及周圍進行基本清洗Antibacteiracleanning抗菌劑清洗Woundrinsing傷口沖洗WoundcleaningWettodry干燥清洗傷口Debridement清創(chuàng)術Negtivepressure負壓

第四頁，共九十五頁。整理課件Woundcleaning傷口清潔(qīngjié)

----技術CleanigwithRinsingsolution采用沖洗溶液進行清洗Saline生理鹽水Ringersolution林格氏液Indication:Cleaningwound適應癥：清潔(qīngjié)傷口Nontouchtechnique非接觸技術第五頁，共九十五頁。整理課件Woundcleaning傷口(shāngkǒu)清潔

----技術Cleanningwithantisepticsolution采用消毒溶液進行清洗Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid聚已縮胍Iodine碘Indication:Infectedandcontaminatedwound適應癥：感染傷口和污染傷口Nontouchtechnique:Fromoutsidetocenterofwoundinordertoavoidfurtherspreadingofbacteriatothesurroundingarea.非接觸技術：從外圍向中間(zhōngjiān)清洗以避免細菌向周圍進一步播散第六頁，共九十五頁。整理課件Woundcleaning--Antisepticsolution

傷口清潔--消毒(xiāodú)溶液Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid聚已縮胍Advantages優(yōu)點notcolored,notinacticatedbybodyfluids無色、不會被體液滅活donotinitiateresistance,skinirritationandallergies不會引起抗藥性、皮膚刺激或過敏(guòmǐn)Disadvantages缺點notavailableandreimbursedinmanycountries在許多地區(qū)不能使用而且不能報銷不能采用高壓將奧替尼啶注入腔內加以應用Bothshouldnotbeappliedoncartilageandincontactwithinternalorgans(abdominalcavity)二者均不能在軟骨上運用，且不能與內部器官接觸（腹腔）第七頁，共九十五頁。整理課件Woundcleaning--Antisepticsolution

傷口(shāngkǒu)清潔--消毒溶液IodineAdvantages優(yōu)點EffevtiveagainstGrampostiveandGramnegtivebacteria可有效對抗革蘭陽氏和陰性菌Availableindifferentformsforapplication(ointment,lotions)可以采用不同形式加以運用（軟膏(ruǎngāo)、洗液）Disadvantages缺點Colored(makeswoundassessmentdifficult)有色（難以對傷口進行評估）Inactivatedbybodyfluids會被體液滅活Sensitivitymightoccur可能會發(fā)生過敏Systemicsideeffectsduetoabsortion吸收會導致全身副作用第八頁，共九十五頁。整理課件Wounddebridement清創(chuàng)術Incaseofachronic,difficulttohealwoundcleaningcanbesupportedwithdifferentwaysofdebridement在慢性、難愈合性傷口的清潔中可才采用(cǎiyòng)不同的清創(chuàng)術進行支持治療Requirements要求：Asgentleaspossible盡可能溫柔Asthoroughaspossible盡可能徹底Assoonaspossible盡早第九頁，共九十五頁。整理課件Debridementopportunity清創(chuàng)時機(shíjī)病情許可，越早越好Illnesspermission,thesooner,thebetter無明顯感染表現(xiàn)，均可清創(chuàng)Noapparentinfection,debridementperformance已有感染，但傷口有異物或較多壞死組織，也可清創(chuàng)，清創(chuàng)后傷口暫不縫合IftheWoundisinfected,buthaveaforeignbodyormuchnecrotictissue,wecanalsodebridement,anddonotwoundclosureafterdebridement急性傷口理想時間：傷后8小時(xiǎoshí)以內，頭面、手部傷口12小時(xiǎoshí)以內Theidealtime:8hoursafterthewound,andthehead,handwithin12hoursafterthewound第十頁，共九十五頁。整理課件Debridementmethods傷口(shāngkǒu)清創(chuàng)方法機械清創(chuàng)（傷口(shāngkǒu)清洗和傷口(shāngkǒu)浴，水下低頻超聲波處理、聚氨酸脂類軟性泡沫復合物產品等）Mechanicaldebridement外科清創(chuàng)（剪刀、手術刀、鋒利勺、刮器）Surgicaldebridement酶清創(chuàng)（蛋白質、肽類）Enzymaticdebridement生物清創(chuàng)Biosurgicaldebridement自溶性清創(chuàng)（內活性傷口敷料、如水膠體、水凝膠）Autolyticdebridement第十一頁，共九十五頁。整理課件Wounddebridemen清創(chuàng)術Mechanical機械性清創(chuàng)Wipe(mechancialyclean)thewoundwithsterilegauze無菌紗布擦拭傷口(shāngkǒu)（機械型清洗）Gauzecanbemoistordry可以采用濕性或干性紗布Cave:mightbepainfulforpatient孔洞：可能造成患者疼痛Aternative選擇Soakedgauzeisappliedtowoundandshouldberemovedgently.Everytimesomeofwounddebriswillremainingauze.對傷口使用浸濕紗布，而且去除紗布時動作應當輕柔。每次都會有一些傷口碎屑留在紗布內。第十二頁，共九十五頁。整理課件Wounddebridemen清創(chuàng)術Surgical手術清創(chuàng)Removalofdebriswithcurette,abrasororscapel采用刮匙、刮除器或手術刀去除碎屑Usuallyperformedbysurgeonorspeciallytrainednursesundersupervisionofsurgeon.通常由外科醫(yī)生執(zhí)行清創(chuàng)或者(huòzhě)在外科醫(yī)生的監(jiān)督下由護士進行清創(chuàng)。Cave空洞Mightbepainfulforpatient可能會引起患者疼痛Chanceofbleeding可能會出血InseverecasesintmustbeconductedinOR嚴重時必須采用手術進行處理第十三頁，共九十五頁。整理課件Wounddebridemen清創(chuàng)術Enzymatic酶解清創(chuàng)術Removalofdebriswithemzymes采用酶法Havetoberenewedfrequently必須經常更新Needamoistandbodywarmenvironmenttobeeffective需要保肢潮濕和體溫(tǐwēn)環(huán)境才能產生作用Havetobeappliedattheareaofdebris必須在清創(chuàng)區(qū)域使用CollegesSanty1Z**Ointment(膠原酶Santy1)Enzymaticdebridingagent(清創(chuàng)酶)第十四頁，共九十五頁。整理課件Wounddebridemen清創(chuàng)術Biosurgicalwithmaggots采用蛆進行生物手術Serratiamarcecens沙雷桿菌Advantage優(yōu)點Veryselectivecleaning/Antisepticeffect選擇性清潔/防腐作用Stimulategranulation刺激肉芽生長Almostpainfree幾乎無痛Disadvantage缺點(quēdiǎn)Notalwayseasytoapplyandkeepinplace不容易使用而且不容易固定。Ethicalaspectsneedconsideration.需要對倫理學方面加以考慮。第十五頁，共九十五頁。整理課件Wounddebridement清創(chuàng)術Autolytic自熔性清創(chuàng)術Facilitatebodyownsofmechanismofdebridementmoistdressing采用適當?shù)臐裥苑罅洗龠M機體自身清創(chuàng)機制Advantage優(yōu)點Cellfriendly細胞親和性Almostpainfree幾乎無痛Easytodo容易操作(cāozuò)Disadvantage缺點Tasksmoretimethanforinstancesurgicaldebridement比手術清創(chuàng)方法花費更多時間Needstobeadaptedtotheindividualrequirementsofwound需要適合傷口的個體要求Notalwayseffectiveforinstanceincaseofthicknecroticlayer在諸如壞死層較厚的情況下第十六頁，共九十五頁。整理課件TheevolutionandapplicationofdressingsGauze

OilYam、stickingHydrocolloiddressingsAntibacterialdressings干紗布油砂、敷貼水膠體抗菌敷料(fūliào)、生物活性敷料(fūliào)第十七頁，共九十五頁。整理課件Wounddressings-General

傷口(shāngkǒu)敷料—總體Requirements要求Maintainmoistenvironment保持環(huán)境濕潤Sterile無菌Removeexcessexudate去除多余滲出物Nontoxic無毒性Nonsenstizing無過敏性Protectthewoundfromfurthertrauma保護傷口防止進一步損傷Allownontraumaticremoval去除時不會產生損傷Protectfrommigrationofbacteria保護傷口防止細菌遷移Keepwoundatbodytemperature(Isulation)保護傷口處于體溫下（絕緣）Allowgaseousexchange允許(yǔnxǔ)空氣交換Comfortable舒適Economical/requireinfrequentchanges經濟/不需要經常更換第十八頁，共九十五頁。整理課件Wounddressings-Requirements

傷口(shāngkǒu)敷料—要求Keyfunctions主要作用Keepwoundbedmoist保持(bǎochí)創(chuàng)面濕潤Keepwoundsurroundingskindry保持傷口周圍皮膚干燥Avoidcoolingdownofwoundtemperature避免傷口溫度降低Protectfrominfection預防感染Shouldnotleaveresidualsinwound傷口內不應留下殘余物第十九頁，共九十五頁。整理課件Wounddressings-Requirements

傷口(shāngkǒu)敷料—要求Keyfunctions主要作用Keepwoundbedmoist保持創(chuàng)面濕潤Keepwoundsurroundingskindry保持傷口(shāngkǒu)周圍皮膚干燥Avoidcoolingdownofwoundtemperature避免傷口溫度降低Protectfrominfection預防感染Shouldnotleaveresidualsinwound傷口內不應留下殘余物第二十頁，共九十五頁。整理課件Wounddressings-DifferentkindsCriteriaforselection選擇(xuǎnzé)標準Woundsite傷口位置Exudate滲出物Signsofinfection感染跡象Conditionofwoundsurroundingskin傷口周圍皮膚狀況Pain疼痛第二十一頁，共九十五頁。整理課件Wounddressings-Requirements

傷口(shāngkǒu)敷料—要求Occlusiveornonocclusivedressings封閉型或非封閉型敷料Occlusiveenvironmentissupportiveforwoundhealing封閉環(huán)境有助于傷口愈合Attention注意Incaseofinfection,severecontaminationexposedtendon,bone,fistualsanocclusioncanbedangerous.在肌腱(jījiàn)、骨骼暴露以及瘺管存在感染或嚴重感染時，封閉可能具有危險Keepwoundsurroundingskindry保持傷口周圍皮膚干燥第二十二頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口(shāngkǒu)敷料—濕潤療法（德濕威TenderWet）Description說明(shuōmíng)Hydroactivedressingpadforwettherapy采用水活化性敷料墊用于濕潤療法Madeofhighlyabsorbingpolyacrylate采用高吸水性聚丙烯酸酯制造Activeabsorbingandrinsingeffect具有有效吸收和沖洗作用AlreadyactivatedversionplusseparateRingersolutionavailable可以采用已活化型或者未活化型外加林格氏液。第二十三頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口敷料(fūliào)—濕潤療法（德濕威TenderWetKeyobjectivesforapplication使用的主要目的Hydrationofwoundbedfor24hours使創(chuàng)面保濕24小時Initiationandsupportofautolyticdebridement引發(fā)或有助于自溶性清創(chuàng)ReleaseofRingersolutionintowoundbed將林格氏液釋放至創(chuàng)面Absorptionofwoundexudate吸收(xīshōu)傷口滲出液第二十四頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口敷料(fūliào)—濕潤療法（德濕威TenderWet）Predominateuseinfollowingphasesofwoundhealing主要應用(yìngyòng)于傷口愈合的以下階段Cleaning清潔(qīngjié)Cleaning+Granulation清洗+肉芽形成Granulation肉芽形成Rehydratesescharsupportautolyticmechanisms再次水化焦痂有助于自溶機制ReduceMMP減少MMPProtectsandmaintainsclean保持并維持清潔第二十五頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口敷料(fūliào)—濕潤療法（德濕威TenderWet）Mainindication主要適應癥Infectedwounds(deepandsuperficial)感染傷口（深部和表淺）Necroticwounds(deepandsuperficial)壞死傷口（深部和表淺）Woundswithstagnatinghealing愈合(yùhé)停止的傷口第二十六頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口(shāngkǒu)敷料—濕潤療法（德濕威TenderWet）Contraindication禁忌癥Escharduetountreatedarterialulceration由未經治療的動脈性潰瘍所導致的焦痂Exercisecaution注意(zhùyì)Contactofdressingwithwoundbedmustbesecured敷料和創(chuàng)面必須牢固接觸第二十七頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口敷料(fūliào)—濕潤療法（德濕威TenderWet）Handing操作Protectwoundsurroundingarea保護傷口周圍(zhōuwéi)區(qū)域Mustbechangedafter24hours24小時后必須更換GreenstripesofTenderWet24arefacingawayfromwoundbed在創(chuàng)面使用德濕威24時，應將綠色條紋面朝外。Dressingmustnotbecut不要對敷料進行裁減第二十八頁，共九十五頁。整理課件Wounddressings-Wettherapy(TenderWet)

傷口敷料—濕潤(shīrùn)療法（德濕威TenderWet）Fixation固定Fixationwithnonabsorbentdressing,bandageornonwovenadhesive以非吸收性敷料、繃帶或非編織型膠帶(jiāodài)進行固定。第二十九頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Alginatefromoriginatefrombetweenalgae海藻纖維源于褐藻Alginateturnintogetwhenincontactwithwoundexudate藻酸鹽類敷料與傷口接觸(jiēchù)時可變成凝膠Alginatescanabsorbasignificantamountmorethantheirweightofwoundfluids藻酸鹽類敷料可以吸收顯著高于其自身重量的傷口滲出液第三十頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Keyobjectivesforapplication使用的主要目的Woundfilling填充傷口Supportofautolyticdebridementduetogetinformation凝膠形成有助于自溶性清創(chuàng)Absorptionofwoundexudate吸收傷口滲出液Embedbacteriaandtoxininstructure將細菌和毒物包裹在凝膠中Haemostaticeffect具有止血(zhǐxuè)作用第三十一頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Predominateuseinfollowingphasesofwoundhealing主要(zhǔyào)應用于傷口愈合的以下階段Cleaning清潔Granulation肉芽形成Especiallyfordeepsmallcavitywounds尤其用于較深而且較小的孔腔性潰瘍Rarely很少第三十二頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Mainindication主要適應癥Infectedwounds(deepandsuperficial)感染(gǎnrǎn)傷口（深部和表淺）Necroticwounds(deepandsuperficial)壞死傷口（深部和表淺）Woundswithstagnatinghealing愈合停止的傷口Woundswiithtendencyforbleeding存在出血傾向的傷口第三十三頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Contraindication禁忌癥Dryorcrustedwounds干燥或結痂傷口Drynecrosis干性壞死Third-degreeburnsorhigher3度或3度以上燒傷Exercisecaution注意Pressurereleaseswoundexudateagain壓力解除傷口會再次滲出RemoveAlginatesresidual-free去除藻酸鹽類敷料(fūliào)時不應留有殘余（dangerofinfection）(具有危害性或感染性)Donotapplywithpressure不應加壓使用Avoidoverlappingwoundedges避免與傷口邊緣重疊第三十四頁，共九十五頁。整理課件Wounddressings—Alginates

傷口(shāngkǒu)敷料—藻酸鹽類敷料Fixation固定Alginatesneedtobecoveredbyasecondarydressing藻酸鹽類敷料需要采用次級敷料加以覆蓋Non-infectedwoundFineporedfoamdressing:hydrocolloidorfilmdressing非感染性傷口(shāngkǒu)：細孔泡沫敷料、水膠敷料或薄膜敷料InfectedwoundElasticgauzebandages:tubularbandagesornonwovenfixationproducts感染性傷口：彈力繃帶、筒形繃帶或非編織性固定產品第三十五頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口(shāngkǒu)敷料—親水性材料Description說明Madeof“Natriumcarboxymethycellulose”由羧甲基纖維素制成Highabsorptioncapacity吸收性能(xìngnéng)較高Turnsintotransparentgetwhenincontactwithwoundexudate垂直吸收創(chuàng)面滲出液第三十六頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口(shāngkǒu)敷料—親水性材料Keyobjectives使用主要目的Absorptionofwoundexudate吸收傷口滲出液Inclusionofwoundexudateevenunderpressure(compressiontherapy)即使可以(kěyǐ)在壓力作用下（加壓治療）也可以(kěyǐ)吸入傷口滲液Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing:Exudingsloughedwounds清潔：排除傷口腐肉Granulation:肉芽形成：很少第三十七頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口敷料(fūliào)—親水性材料Mainindication主要適應癥Highlysecretingwounds高分泌型傷口Acuteandchronicwounds急性和慢性傷口Postoperativewounds術后傷口First–andsecond-degreeburns1度或2度燒傷Incaseofproblematic(indangertodevelopmaceration)surroundskin用于傷口周圍皮膚存在問題的情況下（具有發(fā)展成浸漬(jìnzì)傷口的危險）第三十八頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口敷料(fūliào)—親水性材料Contraindication禁忌癥Drywounds干燥傷口(shāngkǒu)Drynecrosiswounds干性壞死Third-orforth-degreeburns3度或4度燒傷Exercisecaution注意None第三十九頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口(shāngkǒu)敷料—親水性材料Handling操作(cāozuò)Dressingmaydevelopthewoundbyabout1inch敷料可以在傷口上重疊約1英寸厚Hydrofibertamponadesshouldbepokeoutofthewoundbyapproximatelyaninch水性纖維敷料填塞應高于傷口約1英寸第四十頁，共九十五頁。整理課件Wounddressings—Hydrofiberdressings

傷口(shāngkǒu)敷料—親水性材料Fixation固定(gùdìng)Hydrofiberdressingsneedtobecoveredbyassecondarydressing富含纖維敷料需要采用次級敷料加以覆蓋Absorbingpads、gauzebandagesornonwovenfixationproducts吸收墊、紗布繃帶或非編織性產品第四十一頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口敷料(fūliào)—聚氨酯/泡沫敷料Description說明Madeofafine(Polyurethane)foamcoveredwithasemiocclusivePolyurethanefilm由覆蓋一層封閉型聚氨基甲酯薄膜的精制泡沫構成Foamdressingshavehighabsorption泡沫敷料具有高度吸水性Airpermeablemembraneenablesgasexchange空氣可以滲入薄膜使氣體得以交換Availablewithandwithoutadhesive可以和膠帶一起應用(yìngyòng)，也可以單獨使用第四十二頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口敷料(fūliào)—聚氨酯/泡沫敷料Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleaning清潔evenincaseofsloughy/necroticwounds，sometimesoninfectedwounds(withooutadhesiveborder)甚至可以用于壞死性傷口,有時可以用于感染性傷口（無粘性(zhānxìnɡ)邊緣）Granulation肉芽形成Epithellialisation上皮形成thinfoamdressingonly只采用薄層泡沫敷料第四十三頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口(shāngkǒu)敷料—聚氨酯/泡沫敷料Mainindication主要適應癥Exudatingwounds滲出性傷口Ascavityindeep,underminedexudatingwounds孔腔較深的潛行性滲出傷口Incombinationwithcompressiontherapy聯(lián)合加壓治療(zhìliáo)Onslushy,fibrincoatedwounds膠凍狀纖維蛋白覆蓋性傷口第四十四頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口敷料(fūliào)—聚氨酯/泡沫敷料Contraindication禁忌癥Infectedwounds(borderedversions)感染傷口（邊界模糊）Drywound干燥傷口Third-orforth-degreeandhigher3度或3度以上燒傷Necroticwounds.OnlyasacoverincombinationwithforinstanceHydrogelwound壞死傷口，只能與其他敷料合用坐覆蓋，如水凝膠敷料。Exercisecaution注意(zhùyì)Possibilityofmacerationwhendressingcapacityisexhausted當敷料吸收能力達極限時具有浸漬的可能第四十五頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口敷料(fūliào)—聚氨酯/泡沫敷料Handing操作Cavityproductsfordeepwounds孔腔產品用于深部傷口Dressingshouldbeoverlapping敷料應當重疊(chóngdié)使用Dressingscansometimesbecuttofittingsize有時可將敷料裁剪成適當大小Canstayonwoundupto7days(dependingonamountofwoundexudate)可以在傷口保留長達7天（依據(jù)傷口滲出液的量）第四十六頁，共九十五頁。整理課件Wounddressings—Polyurethane/Foamdressings

傷口敷料(fūliào)—聚氨酯/泡沫敷料Fixation固定Oftennotneededduetoadhesivebordersofdressingpads由于敷料墊具有粘性邊緣通常(tōngcháng)不需要固定Fixationwithsemipermeablefilms,siliconecoatedfilmsorelasticbandages以半透膜、硅涂層薄膜或彈力繃帶固定第四十七頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Description說明(shuōmíng)Semioclusive,madeofwater-repellingpolymermatrix(thinpolyurethanefilm)半封閉型采用防水性聚合物基質形成（聚氨酯薄膜）Matrixcontainshydrocolloidsubstance基質包含親水物質Sometimeswithadhesivenonwovenboardersorflatterboardersforeasyapplication有時存在便于使用的粘性非編織性邊緣或更為平整的粘性邊緣第四十八頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Keyobjectivesforapplication使用的主要目的Supportgranulation有助于肉芽組織(zǔzhī)形成Absorptionofcelldebris吸收細胞碎屑Limitedabsorptionofwoundexudate傷口滲出液吸收有限Ensuringamoistwoundenvironment確保濕潤的傷口環(huán)境Protectionagainstexternaleffects保護傷口防止外部影響第四十九頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing清潔(qīngjié)Granulation肉芽形成Epithelialisation上皮形成第五十頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口(shāngkǒu)敷料—水膠體敷料Mainindication主要適應癥Lowtomediumamountofwoundexudate少量到中等量的傷口(shāngkǒu)滲出液Abrasions,first-andsseconddegreeburns,decubitus,legulcers擦傷、1度或2度燒傷、褥瘡、腿部潰瘍WoundsinEpithelialisationphase處于上皮形成時期的傷口Asacoverforotherwounddressings(e.g.alginates)作為其他傷口敷料的覆蓋物第五十一頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Contraindication禁忌癥Deepmycosis深部真菌病Highlyexudingorbleedingwounds高度滲血或出血傷口Third–orforth-degreeburns3度或4度燒傷Osteomyelitis骨髓炎Deepwoundswithbarebones,muscles,tendons深部傷口伴谷歌、肌肉、肌腱裸露Exercisecaution注意Macerationofsurroundingskinpossible傷口具有浸漬(jìnzì)可能Hypergranulation肉芽組織過度形成Diabeticfootulcers糖尿病性足部潰瘍第五十二頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Handing操作(cāozuò)Someofhydrocolloiddressingshouldhavebodytemperaturewhenapplied在使用時應將某些水膠體敷料加熱至體溫Surroundingofwoundneedstobefreeofhair傷口周圍備皮Dressingneedtobeapproximatelyaninchbiggerthanwound敷料應當大于傷口約1英寸Canstayonwoundupto7days可以在傷口上保留長達7天Dressingchangerequiredwhengetclosetoborderofdressing當凝膠接近敷料邊緣時則需要更換敷料第五十三頁，共九十五頁。整理課件Wounddressings—Hydrocolloiddressings

傷口敷料(fūliào)—水膠體敷料Fixation固定Nosecondarydressingorfixationneeded不需要次級敷料或固定

Hydrocolloiddressingsareoftenusedasfixationforotherwounddressings水膠體敷料通常最為其他敷料的固定物Ifneededfurtherfixationwithadhesiveproductslikefilmsect,possible如果需要，可以采取注入(zhùrù)膠帶之類的產品進行固定第五十四頁，共九十五頁。整理課件Wounddressings—Hydrogelamorphousgels

傷口(shāngkǒu)敷料—無定形水凝膠敷料Contraindication禁忌癥Woundpain傷口疼痛Macerationofsurroundingskin周圍皮膚(pífū)浸漬Exercisecaution注意Sensitivityagainstcomponentspossible可能會有成分過敏第五十五頁，共九十五頁。整理課件Wounddressings—Hydrogelamorphousgels

傷口(shāngkǒu)敷料—無定形水凝膠敷料Handing操作Applicationof0.3to0.5cmofgelonwound在傷口上使用0.3到0.5cm的凝膠Protectionofsurroundingskinnecessarytoavoidmaceration有必要對周圍皮膚進行保護以免發(fā)生(fāshēng)浸漬RinsingofwoundwithRingersolutionorsalinetoremoveresidues采用林格氏液或生理鹽水沖洗去除殘余凝膠第五十六頁，共九十五頁。整理課件Wounddressings—Hydrogelamorphousgels

傷口(shāngkǒu)敷料—無定形水凝膠敷料Fixation固定Secondarydressingabsolutelynecessary絕對有必要使用次級敷料固定Hydropolymerorhydrocolloiddressingsincaseofnon-infected,moistwounds對于(duìyú)非感染傷口,可以采用水聚合型敷料或水膠體型敷料加以固定Semipermeablefilmsfordrywounds對于干性傷口，可以采用半透膜固定Sterilepadsornonwovenadhesivesforinfectedwounds對于感染性傷口，可以采用無菌敷料或非編織型膠帶固定第五十七頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Description說明Semiolcusive,transparentdressings半封閉性、透明敷料Applicationdirectlyonwound直接用于傷口Keepwoundmoist保持傷口濕潤Allowinspectionofwoundthroughdressing可以通過敷料檢查傷口Canstayseveraldaysonwound可以在傷口保留數(shù)日Reducepain減輕疼痛(téngtòng)Smallamountofexudatecanbeabsorbed可以吸收少量滲出液Contain15-95%waterbutarenotabsolutelyinwater含15-95%水分但不溶于水Cushioningeffect緩沖作用第五十八頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Keyobjectivesforapplication使用的主要目的Superficial,drywoundsarekeptmoist保持淺表、干燥傷口的濕潤Accelerationofcellgrowth促進細胞(xìbāo)生長Supportofautolyticdebridement有助于自溶性清創(chuàng)Coolingeffectonburns對于燒傷具有冷卻作用Painreduction減輕疼痛第五十九頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段CleaningRehydrateseschar，supportautolyticmechanisms清潔再次水化焦痂、有助于自溶機制Granulationprotects肉芽(ròuyá)形成保護

Epithelialisationpreventsdessication上皮形成防止干燥第六十頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Mainindication主要適應癥Useonpaper/cortisone/olderskin聯(lián)合可的松涂在紙面上用于老年人的皮膚(pífū)Superficial,cleanabrasion淺表的清潔擦傷Burnsuptosecond-degree直至2度的燒傷Woundsproducinglittleexudate傷口幾乎沒有滲出物Skindonorsites皮膚供體位置第六十一頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Contraindication禁忌癥Escharduetoarterialulceration因動脈性可以(kěyǐ)所導致的焦痂Strongexudatiionorbleeding大量滲出液或出血Deepwounds,mycosis傷口較深或真菌病Sheetsshouldnotbeusedoninfectedwounds水凝膠片不用于感染性傷口

Exercisecaution注意Sensitivitytocomponentspossible可能對成分過敏第六十二頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片Handing操作(cāozuò)Dressingshouldbeapproximatelyaninchbiggerthanwound敷料應當大于傷口約1英寸Dressingscanbecuttoidealsize可以將敷料剪至適當大小Canstayupto7daysonwound(whendressingturnsuncleardressingchangerequired)可以在傷口保留7天以上（當敷料變得不透明時，則需要更換敷料）第六十三頁，共九十五頁。整理課件Wounddressings—Hydrogelsheets

傷口(shāngkǒu)敷料—水凝膠片F(xiàn)ixation固定Productswithadhesivebordersdon’trequireadditionalfixation帶有粘性邊緣的產品不需要額外固定Otherwisefixationwithgauzebandageornonwovenadhesives否則(fǒuzé)采用紗布或非編織型膠帶固定第六十四頁，共九十五頁。整理課件Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料Description說明Wounddressingcoatedwithsilver（e.g.woundcontactllayer,foam.alginate,hydrofiber）傷口敷料涂銀（例如,傷口接觸層、泡沫敷料、藻酸鹽敷料、水性纖維敷料）Useofbactericidalimpactofsilver利用銀離子殺菌Releaseofsilverionswhenincontactwithwoundexudate與傷口滲出液接觸時可以釋放銀離子Silveriseffectiveagainstawiderangeofbacteria銀可以有效(yǒuxiào)對抗多種細菌第六十五頁，共九十五頁。整理課件Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料Keyobjectivesforapplication使用的主要目的Killingofbacteria殺滅細菌Wideeffectivenessagainstmicroorganisms(Saphylococcusaureus,Pseudomonas,MRSA,etc.)廣譜(ɡuǎnɡpǔ)對抗微生物（金黃色葡萄球菌、假單胞菌、MRSA等）第六十六頁，共九十五頁。整理課件Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料Predominateuseinthefollowingphaseofwoundhealing主要應用于傷口愈合(yùhé)的以下階段Cleaningoninfectedwounds清潔用于感染性傷口第六十七頁，共九十五頁。整理課件Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料Mainindication主要適應癥Secondaryhealingwoundslikepressureorlegulcer中等愈合傷口如壓迫性潰瘍或腿部潰瘍Tumorwounds,abscess,etc.腫瘤傷口、膿腫等Cleaningwoundswhichareinfected,indangerofinfectionorbadlysmelling對感染傷口或有感染危險或嚴重(yánzhòng)異味性傷口進行傷口清潔第六十八頁，共九十五頁。整理課件Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料Contraindication禁忌癥Barefibers,bonesormuscles纖維、谷歌、或肌肉裸露(luǒlù)Exercisecaution注意Sensitivityagainstcomponents對成分過敏Silvershouldonlybeusedaslongasindicated只要有過敏表現(xiàn)不能直接使用Releaseofsilverionsnotsufficientondrywounds在干性傷口上銀離子不能充分釋放第六十九頁，共九十五頁。整理課件Handing(Dependingontypeofdressing)操作（根據(jù)敷料類型(lèixíng)）Dressingshouldbeaboutaninchbiggerthanwound敷料應當高于傷口約1英寸Padsshouldbeeasilyplacedinwound,directedcontactwithwoundbed墊料應當容易放入傷口，直接與創(chuàng)面接觸IncaseofdryandsuperficialwoundsdressingshouldbementionedwithRingersolutionorSalineofcombinedwithhydogel在干燥且表淺的傷口情況下，應當采用林格氏液或生理鹽水結合水凝膠對其進行濕潤Dressingcanbecuttooptimalsize可將敷料剪裁至最佳尺寸Dailydressingchangeoninfectedwounds每日更換感染性傷口的敷料Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷料第七十頁，共九十五頁。整理課件Fixation固定Dependsoninformationofproductioncompanies按照產品公司所提供的信息(xìnxī)進行固定Wounddressings—silvercontainingwounddressings

傷口(shāngkǒu)敷料—含銀傷口敷第七十一頁，共九十五頁。整理課件注意：Note需控制銀離子的釋放速度(sùdù)，保證安全性Toensuresafety,andweshouldcontrolthereleasespeedofsilverions某些銀離子使用不當會著色Someimproperuseofsilveriondressingcanshading價格相對較高Thepriceisrelativelyhigh

第七十二頁，共九十五頁。整理課件Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口(shāngkǒu)敷料—具有強力吸收劑的無紡布（吸收墊料）Description說明Nonwovenpadcontaining/surroundingsuperabsorber無紡布墊料，含有強力吸收劑Canabsorbhighamountofliquids可以吸收大量液體Bacteriaandcelldebriscanbeabsorbed可以吸收細菌(xìjūn)和壞死物Moistwoundclimateiskept保持濕潤的傷口環(huán)境Smellisbound限制傷口異味第七十三頁，共九十五頁。整理課件Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口(shāngkǒu)敷料—具有強力吸收劑的無紡布（吸收墊料）Keyobjectivesforapplication使用的主要目的Keepingthewoundmoist保持傷口濕潤Absorptionofwoundexudate吸收傷口滲液Enclosureofbacteria,celldebris,etc.包裹細菌細胞碎片等Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段(jiēduàn)Cleansing清潔

whenwoundproduceshighamountofexudate傷口產生大量滲出物時第七十四頁，共九十五頁。整理課件Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口(shāngkǒu)敷料—具有強力吸收劑的無紡布（吸收墊料）Mainindication主要適應癥Onwoundsthatproducehighamountofexudate(pressure,legulcer,etc.)傷口(shāngkǒu)產生大量滲出液（壓迫性潰瘍、腿部潰瘍等）Contraindication禁忌癥Ondrywoundsriskthatpadstickstothewound(canharmnewganulatedtissue)干性傷口具有墊料粘附傷口的風險（可損害新生肉芽組織）第七十五頁，共九十五頁。整理課件Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料—具有強力(qiánɡlì)吸收劑的無紡布（吸收墊料）Handing操作Productsmustnotbecut不能對產品進行裁剪Productsshouldnotbefoldedtogether產品不應疊放在一起Canstayonwoundforseveraldays(dependsonamountofexudate)可以在傷口上保留數(shù)日Fixation固定Fixationdependsonwoundlocationandskincondition依據(jù)傷口位置(wèizhi)和皮膚狀況進行固定第七十六頁，共九十五頁。整理課件Wounddressings—Nonwoven(aborbent)padswithsuperabsorber

傷口敷料(fūliào)

—具有強力吸收劑的無紡布（吸收墊料）Description說明Widelyvarietyavailable應用廣泛Madeofseverallayers由數(shù)層構成Cancontainadditionalmaterialslikeanabsorptionpad可以包含附加材料，如吸收墊料Bindssmell限制異味Whenindirectedcontactwithwounditbindsproteinmoleculesandbacteria在直接接觸傷口時可以與蛋白質分子以及細菌相結合Predominateuseinfollowingphasesofwoundhealing主要應用于傷口愈合的以下階段Cleansing:oninfected,badlysmellingwounds清潔：用于感染傷口、具有(jùyǒu)嚴重異味的傷口第七十七頁，共九十五頁。整理課件Wounddressings—Activecoaldressings

傷口(shāngkǒu)敷料—活性碳敷料Handing操作(cāozuò)Dressingshouldbeaboutaninchbiggerthanwound敷料應當大于傷口1英寸Padsshouldbeeasilyplacedinwound墊料應當容易放入傷口內Dressingsmustnotbecut不能對敷料進行剪裁第七十八頁，共九十五頁。整理課件Wounddressings—Activecoaldressings

傷口(shāngkǒu)敷料—活性碳敷料Description說明Semipermeable,polyurethanefilm半透明、聚氨酯甲酸酯薄膜Woundprotection,fixationmaterial傷口(shāngkǒu)保護型固定材料Barriertobacteria阻擋細菌Enablesmonitoringofwound能都進行傷口監(jiān)護Naabsorptioncapacity無吸收能力Atraumaticdressingchang