慢性傷口處理課件

1、wound cleaning -Techniques傷口清潔(qngji)-技術(shù)Components which need to be removed from wound bed 需要從創(chuàng)面去除的部分Surplus exudate多余滲出物Necrotic tissue壞死組織(zzh)Dead cells 死亡細(xì)胞Breading ground for bacteria and components which might be supportive to the development of biofilms.細(xì)菌滋養(yǎng)環(huán)境以及可能會促進(jìn)生物被膜形成的成分第一頁，共九十五頁。慢性傷口處理w

2、ound cleaning傷口(shngku)清潔General goal總體目標(biāo)To remove debries and froeign bodies.去除碎屑與異物Necrotic tissue壞死組織Dead cells死亡細(xì)胞Fibrin纖維蛋白Toxins，MMP毒素，MMPForeign bodies (for instance remains for previously used dressings)異物（例如先前(xinqin)使用的敷料） 第二頁，共九十五頁。慢性傷口處理Wound cleaning-Techniques傷口清潔(qngji)-技術(shù)Requirements

3、 on wound rinsing solutions 對傷口沖洗液的要求Should be sterilie 無菌Not colored 無色Gentel to cells/non toxic 細(xì)胞溫和型/無毒Body temperature(cooling down wound bed reduces or inactivates cell activity) 28 no function 體溫(twn)（冷卻創(chuàng)面、減少細(xì)胞活性或使其滅活）28 無效第三頁，共九十五頁。慢性傷口處理Wound cleaning 傷口(shngku)清潔Ways 方法Basic cleanning of wo

4、und bed,wound edges and surrounding area對傷口創(chuàng)面、邊緣(binyun)以及周圍進(jìn)行基本清洗Antibacteira cleanning 抗菌劑清洗Wound rinsing傷口沖洗Wound cleaning Wet to dry 干燥清洗傷口Debridement 清創(chuàng)術(shù)Negtive pressure負(fù)壓 第四頁，共九十五頁。慢性傷口處理Wound cleaning 傷口清潔(qngji)-技術(shù)Cleanig with Rinsing solution采用沖洗溶液進(jìn)行清洗Saline 生理鹽水Ringer solution林格氏液Indicatio

5、n:Cleaning wound 適應(yīng)癥：清潔(qngji)傷口Non touch technique非接觸技術(shù)第五頁，共九十五頁。慢性傷口處理Wound cleaning 傷口(shngku)清潔-技術(shù)Cleanning with antiseptic solution 采用消毒溶液進(jìn)行清洗Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid 聚已縮胍Iodine 碘Indication:Infected and contaminated wound 適應(yīng)癥：感染傷口和污染傷口Non touch technique:From outside to cen

6、ter of wound in order to avoid further spreading of bacteria to the surrounding area.非接觸技術(shù)：從外圍向中間(zhngjin)清洗以避免細(xì)菌向周圍進(jìn)一步播散第六頁，共九十五頁。慢性傷口處理Wound cleaning -Antiseptic solution傷口清潔-消毒(xio d)溶液Octenidin-di-hydrochlorid奧替尼啶鹽酸化合物Polyhexanid 聚已縮胍Advantages優(yōu)點(diǎn)not colored,not inacticated by body fluids無色、不會被體液

7、滅活do not initiate resistance ,skin irritation and allergies不會引起抗藥性、皮膚刺激或過敏(gumn)Disadvantages缺點(diǎn)not available and reimbursed in many countries在許多地區(qū)不能使用而且不能報(bào)銷不能采用高壓將奧替尼啶注入腔內(nèi)加以應(yīng)用Both should not be applied on cartilage and in contact with internal organs(abdominal cavity)二者均不能在軟骨上運(yùn)用，且不能與內(nèi)部器官接觸（腹腔）第七頁，共九

8、十五頁。慢性傷口處理Wound cleaning -Antiseptic solution傷口(shngku)清潔-消毒溶液IodineAdvantages優(yōu)點(diǎn)Effevtive against Gram postive and Gram negtive bacteria可有效對抗革蘭陽氏和陰性菌Available in different forms for application(ointment,lotions)可以采用不同形式加以運(yùn)用（軟膏(rungo)、洗液）Disadvantages 缺點(diǎn)Colored(makes wound assessment difficult )有色（難以

9、對傷口進(jìn)行評估）Inactivated by body fluids會被體液滅活Sensitivity might occur 可能會發(fā)生過敏Systemic side effects due to absortion吸收會導(dǎo)致全身副作用第八頁，共九十五頁。慢性傷口處理Wound debridement清創(chuàng)術(shù)In case of a chronic,difficult to heal wound cleaning can be supported with different ways of debridement在慢性、難愈合性傷口的清潔中可才采用(ciyng)不同的清創(chuàng)術(shù)進(jìn)行支持治療Req

10、uirements要求：As gentle as possible 盡可能溫柔As thorough as possible 盡可能徹底As soon as possible盡早第九頁，共九十五頁。慢性傷口處理Debridement opportunity清創(chuàng)時(shí)機(jī)(shj)病情許可，越早越好Illness permission,the sooner ,the better 無明顯感染表現(xiàn)，均可清創(chuàng)No apparent infection,debridement performance 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If the Wound is infec

11、ted,but have a foreign body or much necrotic tissue,we can also debridement,and do not wound closure after debridement急性傷口理想時(shí)間：傷后8小時(shí)(xiosh)以內(nèi)，頭面、手部傷口12小時(shí)(xiosh)以內(nèi)The ideal time:8 hours after the wound,and the head ,hand within 12 hours after the wound第十頁，共九十五頁。慢性傷口處理Debridement methods傷口(shngku)清創(chuàng)方法

12、機(jī)械清創(chuàng)（傷口(shngku)清洗和傷口(shngku)浴，水下低頻超聲波處理、聚氨酸脂類軟性泡沫復(fù)合物產(chǎn)品等）Mechanical debridement外科清創(chuàng)（剪刀、手術(shù)刀、鋒利勺、刮器）Surgical debridement酶清創(chuàng)（蛋白質(zhì)、肽類）Enzymatic debridement生物清創(chuàng)Bio surgical debridement自溶性清創(chuàng)（內(nèi)活性傷口敷料、如水膠體、水凝膠）Autolytic debridement第十一頁，共九十五頁。慢性傷口處理 Wound debridemen清創(chuàng)術(shù)Mechanical 機(jī)械性清創(chuàng)Wipe(mechancialy clean)the

13、 wound with sterile gauze無菌紗布擦拭傷口(shngku)（機(jī)械型清洗）Gauze can be moist or dry可以采用濕性或干性紗布Cave:might be painful for patient孔洞：可能造成患者疼痛Aternative選擇 Soaked gauze is applied to wound and should be removed gently.Every time some of wound debris will remain in gauze. 對傷口使用浸濕紗布，而且去除紗布時(shí)動作應(yīng)當(dāng)輕柔。每次都會有一些傷口碎屑留在紗布內(nèi)。第十

14、二頁，共九十五頁。慢性傷口處理Wound debridemen清創(chuàng)術(shù)Surgical 手術(shù)清創(chuàng)Removal of debris with curette,abrasor or scapel采用刮匙、刮除器或手術(shù)刀去除碎屑Usually performed by surgeon or specially trained nurses under supervision of surgeon.通常由外科醫(yī)生執(zhí)行清創(chuàng)或者(huzh)在外科醫(yī)生的監(jiān)督下由護(hù)士進(jìn)行清創(chuàng)。Cave 空洞Might be painful for patient可能會引起患者疼痛Chance of bleeding可能會出血

15、In severe cases int must be conducted in OR嚴(yán)重時(shí)必須采用手術(shù)進(jìn)行處理第十三頁，共九十五頁。慢性傷口處理Wound debridemen清創(chuàng)術(shù)Enzymatic 酶解清創(chuàng)術(shù)Removal of debris with emzymes 采用酶法Have to be renewed frequently 必須經(jīng)常更新Need a moist and body warm environment to be effective需要保肢潮濕和體溫(twn)環(huán)境才能產(chǎn)生作用Have to be applied at the area of debris必須在清創(chuàng)區(qū)

16、域使用Colleges Santy1Z*Ointment(膠原酶Santy1)Enzymatic debriding agent(清創(chuàng)酶)第十四頁，共九十五頁。慢性傷口處理Wound debridemen清創(chuàng)術(shù)Bio surgical with maggots采用蛆進(jìn)行生物手術(shù)Serratia marcecens沙雷桿菌Advantage優(yōu)點(diǎn)Very selective cleaning/Antiseptic effect選擇性清潔/防腐作用Stimulate granulation刺激肉芽生長Almost pain free 幾乎無痛Disadvantage缺點(diǎn)(qudin)Not alwa

17、ys easy to apply and keep in place不容易使用而且不容易固定。Ethical aspects need consideration.需要對倫理學(xué)方面加以考慮。第十五頁，共九十五頁。慢性傷口處理Wound debridement 清創(chuàng)術(shù)Autolytic 自熔性清創(chuàng)術(shù)Facilitate body owns of mechanism of debridement moist dressing采用適當(dāng)?shù)臐裥苑罅洗龠M(jìn)機(jī)體自身清創(chuàng)機(jī)制Advantage優(yōu)點(diǎn)Cell friendly細(xì)胞親和性Almost pain free幾乎無痛Easy to do容易操作(cozu)

18、Disadvantage缺點(diǎn)Tasks more time than for instance surgical debridement比手術(shù)清創(chuàng)方法花費(fèi)更多時(shí)間Needs to be adapted to the individual requirements of wound需要適合傷口的個(gè)體要求Not always effective for instance in case of thick necrotic layer在諸如壞死層較厚的情況下第十六頁，共九十五頁。慢性傷口處理The evolution and application of dressingsGauze Oil Yam

19、、sticking Hydrocolloid dressings Antibacterial dressings干紗布 油砂、敷貼 水膠體 抗菌敷料(flio)、生物活性敷料(flio)第十七頁，共九十五頁。慢性傷口處理Wound dressings-General傷口(shngku)敷料總體Requirements要求Maintain moist environment保持環(huán)境濕潤Sterile無菌Remove excess exudate去除多余滲出物Non toxic無毒性Non senstizing無過敏性Protect the wound from further trauma保護(hù)傷

20、口防止進(jìn)一步損傷Allow non traumatic removal 去除時(shí)不會產(chǎn)生損傷Protect from migration of bacteria保護(hù)傷口防止細(xì)菌遷移Keep wound at body temperature (Isulation)保護(hù)傷口處于體溫下（絕緣）Allow gaseous exchange 允許(ynx)空氣交換Comfortable 舒適Economical /require infrequent changes經(jīng)濟(jì)/不需要經(jīng)常更換第十八頁，共九十五頁。慢性傷口處理Wound dressings-Requirements傷口(shngku)敷料要求K

21、ey functions主要作用Keep wound bed moist保持(boch)創(chuàng)面濕潤Keep wound surrounding skin dry保持傷口周圍皮膚干燥Avoid cooling down of wound temperature避免傷口溫度降低Protect from infection預(yù)防感染Should not leave residuals in wound傷口內(nèi)不應(yīng)留下殘余物第十九頁，共九十五頁。慢性傷口處理Wound dressings-Requirements傷口(shngku)敷料要求Key functions主要作用Keep wound bed mo

22、ist保持創(chuàng)面濕潤Keep wound surrounding skin dry保持傷口(shngku)周圍皮膚干燥Avoid cooling down of wound temperature避免傷口溫度降低Protect from infection預(yù)防感染Should not leave residuals in wound傷口內(nèi)不應(yīng)留下殘余物第二十頁，共九十五頁。慢性傷口處理Wound dressings-Different kindsCriteria for selection選擇(xunz)標(biāo)準(zhǔn)Wound site 傷口位置Exudate 滲出物Signs of infection

23、感染跡象Condition of wound surrounding skin傷口周圍皮膚狀況Pain 疼痛第二十一頁，共九十五頁。慢性傷口處理Wound dressings-Requirements傷口(shngku)敷料要求Occlusive or non occlusive dressings封閉型或非封閉型敷料Occlusive environment is supportive for wound healing封閉環(huán)境有助于傷口愈合Attention注意In case of infection ,severe contamination exposed tendon,bone,fi

24、stuals an occlusion can be dangerous.在肌腱(jjin)、骨骼暴露以及瘺管存在感染或嚴(yán)重感染時(shí)，封閉可能具有危險(xiǎn)Keep wound surrounding skin dry保持傷口周圍皮膚干燥第二十二頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口(shngku)敷料濕潤療法（德濕威Tender Wet ）Description 說明(shumng)Hydroactive dressing pad for wet therapy采用水活化性敷料墊用于濕潤療法Made of highly abso

25、rbing polyacrylate采用高吸水性聚丙烯酸酯制造Active absorbing and rinsing effect具有有效吸收和沖洗作用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。第二十三頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口敷料(flio)濕潤療法（德濕威Tender WetKey objectives for application使用的主要目的Hydration of wo

26、und bed for 24 hours使創(chuàng)面保濕24小時(shí)Initiation and support of autolytic debridement引發(fā)或有助于自溶性清創(chuàng)Release of Ringer solution into wound bed將林格氏液釋放至創(chuàng)面Absorption of wound exudate吸收(xshu)傷口滲出液第二十四頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口敷料(flio)濕潤療法（德濕威Tender Wet）Predominate use in following phases

27、of wound healing 主要應(yīng)用(yngyng)于傷口愈合的以下階段Cleaning 清潔(qngji)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機(jī)制Reduce MMP減少M(fèi)MPProtects and maintains clean保持并維持清潔第二十五頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口敷料(flio)濕潤療法（德濕威Tender Wet）Main

28、indication主要適應(yīng)癥Infected wounds (deep and superficial )感染傷口（深部和表淺）Necrotic wounds (deep and superficial )壞死傷口（深部和表淺）Wounds with stagnating healing愈合(yh)停止的傷口第二十六頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口(shngku)敷料濕潤療法（德濕威Tender Wet）Contra indication禁忌癥Eschar due to untreated arterial ulc

29、eration 由未經(jīng)治療的動脈性潰瘍所導(dǎo)致的焦痂Exercise caution注意(zh y)Contact of dressing with wound bed must be secured 敷料和創(chuàng)面必須牢固接觸第二十七頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口敷料(flio)濕潤療法（德濕威Tender Wet）Handing 操作Protect wound surrounding area 保護(hù)傷口周圍(zhuwi)區(qū)域Must be changed after 24hours24小時(shí)后必須更換Green str

30、ipes of Tender Wet 24 are facing away from wound bed在創(chuàng)面使用德濕威24時(shí)，應(yīng)將綠色條紋面朝外。Dressing must not be cut 不要對敷料進(jìn)行裁減第二十八頁，共九十五頁。慢性傷口處理Wound dressings-Wet therapy(Tender Wet)傷口敷料濕潤(shrn)療法（德濕威Tender Wet）Fixation固定Fixation with nonabsorbent dressing, bandage or non woven adhesive以非吸收性敷料、繃帶或非編織型膠帶(jiodi)進(jìn)行固定。第

31、二十九頁，共九十五頁。慢性傷口處理Wound dressingsAlginates傷口(shngku)敷料藻酸鹽類敷料Alginate from originate from between algae海藻纖維源于褐藻Alginate turn into get when in contact with wound exudate藻酸鹽類敷料與傷口接觸(jich)時(shí)可變成凝膠Alginates can absorb a significant amount more than their weight of wound fluids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，

32、共九十五頁。慢性傷口處理Wound dressingsAlginates傷口(shngku)敷料藻酸鹽類敷料Key objectives for application使用的主要目的Wound filling 填充傷口Support of autolytic debridement due to get information 凝膠形成有助于自溶性清創(chuàng)Absorption of wound exudate吸收傷口滲出液Embed bacteria and toxin in structure將細(xì)菌和毒物包裹在凝膠中Haemostatic effect具有止血(zh xu)作用第三十一頁，共九十

33、五頁。慢性傷口處理Wound dressingsAlginates傷口(shngku)敷料藻酸鹽類敷料Predominate use in following phases of wound healing主要(zhyo)應(yīng)用于傷口愈合的以下階段Cleaning 清潔Granulation 肉芽形成Especially for deep small cavity wounds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。慢性傷口處理Wound dressingsAlginates傷口(shngku)敷料藻酸鹽類敷料Main indication 主要適應(yīng)癥Infec

34、ted wounds (deep and superficial )感染(gnrn)傷口（深部和表淺）Necrotic wounds (deep and superficial )壞死傷口（深部和表淺）Wounds with stagnating healing 愈合停止的傷口Wounds wiith tendency for bleeding 存在出血傾向的傷口第三十三頁，共九十五頁。慢性傷口處理Wound dressingsAlginates傷口(shngku)敷料藻酸鹽類敷料Contra indication 禁忌癥Dry or crusted wounds 干燥或結(jié)痂傷口Dry nec

35、rosis 干性壞死Third-degree burns or higher 3度或3度以上燒傷Exercise caution 注意Pressure releases wound exudate again壓力解除傷口會再次滲出Remove Alginates residual-free 去除藻酸鹽類敷料(flio)時(shí)不應(yīng)留有殘余（danger of infection） (具有危害性或感染性)Do not apply with pressure 不應(yīng)加壓使用Avoid overlapping wound edges 避免與傷口邊緣重疊第三十四頁，共九十五頁。慢性傷口處理Wound dres

36、singsAlginates傷口(shngku)敷料藻酸鹽類敷料Fixation固定Alginates need to be covered by a secondary dressing藻酸鹽類敷料需要采用次級敷料加以覆蓋Non-infected wound Fine pored foam dressing :hydrocolloid or film dressing 非感染性傷口(shngku)：細(xì)孔泡沫敷料、水膠敷料或薄膜敷料Infected woundElastic gauze bandages: tubular bandages or non woven fixation produ

37、cts感染性傷口：彈力繃帶、筒形繃帶或非編織性固定產(chǎn)品第三十五頁，共九十五頁。慢性傷口處理Wound dressingsHydrofiber dressings傷口(shngku)敷料親水性材料Description 說明Made of “Natrium carboxymethycellulose”由羧甲基纖維素制成High absorption capacity 吸收性能(xngnng)較高Turns into transparent get when in contact with wound exudate 垂直吸收創(chuàng)面滲出液第三十六頁，共九十五頁。慢性傷口處理Wound dressin

38、gsHydrofiber dressings傷口(shngku)敷料親水性材料Key objectives 使用主要目的Absorption of wound exudate吸收傷口滲出液Inclusion of wound exudate even under pressure (compression therapy) 即使可以(ky)在壓力作用下（加壓治療）也可以(ky)吸入傷口滲液Predominate use in following phases of wound healing 主要應(yīng)用于傷口愈合的以下階段Cleansing:Exuding sloughed wounds清潔：排

39、除傷口腐肉Granulation:肉芽形成：很少第三十七頁，共九十五頁。慢性傷口處理Wound dressingsHydrofiber dressings傷口敷料(flio)親水性材料Main indication 主要適應(yīng)癥Highly secreting wounds 高分泌型傷口Acute and chronic wounds急性和慢性傷口Postoperative wounds 術(shù)后傷口First and second-degree burns1度或2度燒傷In case of problematic (in danger to develop maceration )surround

40、 skin用于傷口周圍皮膚存在問題的情況下（具有發(fā)展成浸漬(jnz)傷口的危險(xiǎn)）第三十八頁，共九十五頁。慢性傷口處理Wound dressingsHydrofiber dressings傷口敷料(flio)親水性材料Contra indication禁忌癥Dry wounds 干燥傷口(shngku)Dry necrosis wounds 干性壞死Third-or forth-degree burns3度或4度燒傷Exercise caution 注意None 第三十九頁，共九十五頁。慢性傷口處理Wound dressingsHydrofiber dressings傷口(shngku)敷料親水

41、性材料Handling操作(cozu)Dressing may develop the wound by about 1 inch敷料可以在傷口上重疊約1英寸厚Hydrofiber tamponades should be poke out of the wound by approximately an inch水性纖維敷料填塞應(yīng)高于傷口約1英寸 第四十頁，共九十五頁。慢性傷口處理Wound dressingsHydrofiber dressings傷口(shngku)敷料親水性材料Fixation固定(gdng)Hydrofiber dressings need to be covered

42、 by as secondary dressing富含纖維敷料需要采用次級敷料加以覆蓋Absorbing pads、gauze bandages or non woven fixation products吸收墊、紗布繃帶或非編織性產(chǎn)品第四十一頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressings傷口敷料(flio)聚氨酯/泡沫敷料Description 說明Made of a fine (Polyurethane)foam covered with a semi occlusive Polyurethane film 由覆蓋一層封閉型

43、聚氨基甲酯薄膜的精制泡沫構(gòu)成Foam dressings have high absorption泡沫敷料具有高度吸水性Air permeable membrane enables gas exchange空氣可以滲入薄膜使氣體得以交換Available with and without adhesive可以和膠帶一起應(yīng)用(yngyng)，也可以單獨(dú)使用第四十二頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressings傷口敷料(flio)聚氨酯/泡沫敷料Predominate use in following phases of wound

44、 healing 主要應(yīng)用于傷口愈合的以下階段Cleaning 清潔 even in case of sloughy/necrotic wounds，sometimes on infected wounds (withoout adhesive border) 甚至可以用于壞死性傷口,有時(shí)可以用于感染性傷口（無粘性(zhn xn)邊緣）Granulation 肉芽形成 Epithellialisation 上皮形成 thin foam dressing only只采用薄層泡沫敷料第四十三頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressin

45、gs傷口(shngku)敷料聚氨酯/泡沫敷料Main indication 主要適應(yīng)癥Exudating wounds滲出性傷口As cavity in deep, undermined exudating wounds孔腔較深的潛行性滲出傷口In combination with compression therapy 聯(lián)合加壓治療(zhlio)On slushy ,fibrin coated wounds膠凍狀纖維蛋白覆蓋性傷口第四十四頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressings傷口敷料(flio)聚氨酯/泡沫敷料Cont

46、ra indication禁忌癥Infected wounds (bordered versions)感染傷口（邊界模糊）Dry wound 干燥傷口Third-or forth-degree and higher 3度或3度以上燒傷Necrotic wounds.Only as a cover in combination with for instance Hydrogel wound壞死傷口，只能與其他敷料合用坐覆蓋，如水凝膠敷料。Exercise caution 注意(zh y)Possibility of maceration when dressing capacity is ex

47、hausted當(dāng)敷料吸收能力達(dá)極限時(shí)具有浸漬的可能第四十五頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressings傷口敷料(flio)聚氨酯/泡沫敷料Handing 操作Cavity products for deep wounds孔腔產(chǎn)品用于深部傷口Dressing should be overlapping 敷料應(yīng)當(dāng)重疊(chngdi)使用Dressings can sometimes be cut to fitting size 有時(shí)可將敷料裁剪成適當(dāng)大小Can stay on wound up to 7days(depending

48、 on amount of wound exudate)可以在傷口保留長達(dá)7天（依據(jù)傷口滲出液的量）第四十六頁，共九十五頁。慢性傷口處理Wound dressingsPolyurethane/Foam dressings傷口敷料(flio)聚氨酯/泡沫敷料Fixation固定Often not needed due to adhesive borders of dressing pads由于敷料墊具有粘性邊緣通常(tngchng)不需要固定Fixation with semi permeable films, silicone coated films or elastic bandages以

49、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。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Description 說明(shumng)Semi oclusive,made of water-repelling polymer matrix (thin polyurethane film)半封閉型采用防水性聚合物基質(zhì)形成（聚氨酯薄膜）Matrix contains hydrocolloid substance基質(zhì)包含親水物質(zhì)Sometimes with adhesive non woven boarders or

50、 flatter boarders for easy application有時(shí)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。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Key objectives for application使用的主要目的Support granulation有助于肉芽組織(zzh)形成Absorption of cell debris吸收細(xì)胞碎屑Limited absorption of wound exudate傷口滲出液吸收有限Ensuring a moist wo

51、und environment確保濕潤的傷口環(huán)境Protection against external effects保護(hù)傷口防止外部影響第四十九頁，共九十五頁。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Predominate use in following phases of wound healing 主要應(yīng)用于傷口愈合的以下階段Cleansing 清潔(qngji)Granulation 肉芽形成Epithelialisation 上皮形成第五十頁，共九十五頁。慢性傷口處理Wound dressings Hyd

52、rocolloid dressings傷口(shngku)敷料水膠體敷料Main indication主要適應(yīng)癥Low to medium amount of wound exudate少量到中等量的傷口(shngku)滲出液Abrasions,first-and ssecond degree burns,decubitus,leg ulcers擦傷、1度或2度燒傷、褥瘡、腿部潰瘍Wounds in Epithelialisation phase處于上皮形成時(shí)期的傷口As a cover for other wound dressings (e.g.alginates)作為其他傷口敷料的覆蓋物

53、第五十一頁，共九十五頁。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Contra indication禁忌癥Deep mycosis深部真菌病Highly exuding or bleeding wounds高度滲血或出血傷口Third or forth-degree burns3度或4度燒傷Osteomyelitis 骨髓炎Deep wounds with bare bones,muscles,tendons深部傷口伴谷歌、肌肉、肌腱裸露Exercise caution 注意Maceration of surround

54、ing skin possible傷口具有浸漬(jnz)可能Hyper granulation 肉芽組織過度形成Diabetic foot ulcers糖尿病性足部潰瘍第五十二頁，共九十五頁。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Handing 操作(cozu)Some of hydrocolloid dressing should have body temperature when applied在使用時(shí)應(yīng)將某些水膠體敷料加熱至體溫Surrounding of wound needs to be free of

55、 hair 傷口周圍備皮Dressing need to be approximately an inch bigger than wound 敷料應(yīng)當(dāng)大于傷口約1英寸Can stay on wound up to 7days可以在傷口上保留長達(dá)7天Dressing change required when get close to border of dressing當(dāng)凝膠接近敷料邊緣時(shí)則需要更換敷料第五十三頁，共九十五頁。慢性傷口處理Wound dressings Hydrocolloid dressings傷口敷料(flio)水膠體敷料Fixation固定No secondary dre

56、ssing or fixation needed不需要次級敷料或固定 Hydrocolloid dressings are often used as fixation for other wound dressings水膠體敷料通常最為其他敷料的固定物If needed further fixation with adhesive products like films ect,possible如果需要，可以采取注入(zh r)膠帶之類的產(chǎn)品進(jìn)行固定第五十四頁，共九十五頁。慢性傷口處理Wound dressings Hydrogel amorphous gels傷口(shngku)敷料無定形

57、水凝膠敷料Contra indication禁忌癥Wound pain 傷口疼痛Maceration of surrounding skin 周圍皮膚(p f)浸漬Exercise caution 注意Sensitivity against components possible可能會有成分過敏第五十五頁，共九十五頁。慢性傷口處理Wound dressings Hydrogel amorphous gels傷口(shngku)敷料無定形水凝膠敷料Handing 操作Application of 0.3 to 0.5 cm of gel on wound在傷口上使用0.3到0.5 cm的凝膠Pr

58、otection of surrounding skin necessary to avoid maceration有必要對周圍皮膚進(jìn)行保護(hù)以免發(fā)生(fshng)浸漬Rinsing of wound with Ringer solution or saline to remove residues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。慢性傷口處理Wound dressings Hydrogel amorphous gels傷口(shngku)敷料無定形水凝膠敷料Fixation 固定Secondary dressing absolutely necessary絕對有必要

59、使用次級敷料固定Hydropolymer or hydrocolloid dressings in case of non-infected ,moist wounds對于(duy)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Semi permeable films for dry wounds對于干性傷口，可以采用半透膜固定Sterile pads or non woven adhesives for infected wounds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。慢性傷口處理Wound dressings Hydrogel sheets傷口

60、(shngku)敷料水凝膠片Description 說明Semi olcusive ,transparent dressings半封閉性、透明敷料Application directly on wound 直接用于傷口Keep wound moist保持傷口濕潤Allow inspection of wound through dressing 可以通過敷料檢查傷口Can stay several days on wound 可以在傷口保留數(shù)日Reduce pain減輕疼痛(tngtng)Small amount of exudate can be absorbed 可以吸收少量滲出液Cont