中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
5期
303-306
,共4页
湿性疗法%肝疾病%外科伤口感染%伤口愈合%封闭敷料%敷料,水胶体
濕性療法%肝疾病%外科傷口感染%傷口愈閤%封閉敷料%敷料,水膠體
습성요법%간질병%외과상구감염%상구유합%봉폐부료%부료,수효체
Moist therapy%Liver diseases%Surgical wound infection%Wound healing%Occlusive dressings%Bandages,hydrocolloid
目的探讨湿性疗法在肝病患者术后切口愈合不良中的应用价值。方法回顾性分析2011年1月至2014年1月在中山大学附属第三医院行手术治疗的54例术后切口愈合不良患者临床资料。其中男45例，女9例；年龄24～70岁，中位年龄47岁；均合并肝病。所有患者均签署知情同意书，符合医学伦理学规定。对愈合不良的切口按照湿性疗法换药，对患者进行局部及整体评估，根据评估结果选择合适的清洗液，根据切口基底组织的活性、位置及患者的凝血功能选择机械性清创、保守锐性清创、自溶性清创，通过渗液管理、密闭伤口来营造有利于伤口愈合的微环境，选择适宜的磺胺嘧啶银脂质水胶体敷料、高渗盐敷料、藻酸钙敷料、亲水性纤维敷料、亲水性纤维银离子敷料等包扎固定伤口。了解导致患者切口愈合不良的原因，观察湿性疗法处理后切口愈合情况。结果导致切口愈合不良的原因包括皮下脂肪液化30例、切口感染16例、皮下血肿8例。54例患者切口经湿性疗法处理5～21 d后肉芽生长良好，其中42例行二期手术缝合，12例行3M 免缝胶带加压拉合，切口均完全愈合，治愈率达100%。结论对术后切口愈合不良肝病患者采用湿性疗法换药，能有效促进切口肉芽组织生长，为二期愈合提供有利条件。
目的探討濕性療法在肝病患者術後切口愈閤不良中的應用價值。方法迴顧性分析2011年1月至2014年1月在中山大學附屬第三醫院行手術治療的54例術後切口愈閤不良患者臨床資料。其中男45例，女9例；年齡24～70歲，中位年齡47歲；均閤併肝病。所有患者均籤署知情同意書，符閤醫學倫理學規定。對愈閤不良的切口按照濕性療法換藥，對患者進行跼部及整體評估，根據評估結果選擇閤適的清洗液，根據切口基底組織的活性、位置及患者的凝血功能選擇機械性清創、保守銳性清創、自溶性清創，通過滲液管理、密閉傷口來營造有利于傷口愈閤的微環境，選擇適宜的磺胺嘧啶銀脂質水膠體敷料、高滲鹽敷料、藻痠鈣敷料、親水性纖維敷料、親水性纖維銀離子敷料等包扎固定傷口。瞭解導緻患者切口愈閤不良的原因，觀察濕性療法處理後切口愈閤情況。結果導緻切口愈閤不良的原因包括皮下脂肪液化30例、切口感染16例、皮下血腫8例。54例患者切口經濕性療法處理5～21 d後肉芽生長良好，其中42例行二期手術縫閤，12例行3M 免縫膠帶加壓拉閤，切口均完全愈閤，治愈率達100%。結論對術後切口愈閤不良肝病患者採用濕性療法換藥，能有效促進切口肉芽組織生長，為二期愈閤提供有利條件。
목적탐토습성요법재간병환자술후절구유합불량중적응용개치。방법회고성분석2011년1월지2014년1월재중산대학부속제삼의원행수술치료적54례술후절구유합불량환자림상자료。기중남45례，녀9례；년령24～70세，중위년령47세；균합병간병。소유환자균첨서지정동의서，부합의학윤리학규정。대유합불량적절구안조습성요법환약，대환자진행국부급정체평고，근거평고결과선택합괄적청세액，근거절구기저조직적활성、위치급환자적응혈공능선택궤계성청창、보수예성청창、자용성청창，통과삼액관리、밀폐상구래영조유리우상구유합적미배경，선택괄의적광알밀정은지질수효체부료、고삼염부료、조산개부료、친수성섬유부료、친수성섬유은리자부료등포찰고정상구。료해도치환자절구유합불량적원인，관찰습성요법처리후절구유합정황。결과도치절구유합불량적원인포괄피하지방액화30례、절구감염16례、피하혈종8례。54례환자절구경습성요법처리5～21 d후육아생장량호，기중42례행이기수술봉합，12례행3M 면봉효대가압랍합，절구균완전유합，치유솔체100%。결론대술후절구유합불량간병환자채용습성요법환약，능유효촉진절구육아조직생장，위이기유합제공유리조건。
Objective To explore the value of moist therapy for delayed wound healing in patients with liver diseases after surgery. Methods Clinical data of 54 patients undergoing surgical treatments with delayed wound healing in the Third Affiliated Hospital of Sun Yat-sen University from January 2011 to January 2014 were analyzed retrospectively. There were 45 males and 9 females with the age ranging from 24 to 70 years old and a median of 47 years old. All the patients were complicated with liver diseases. The informed consents of all patients were obtained and the ethical committee approval was received. Moist therapy was used in the dressing changing of the delayed healing wounds. After regional and overall assessment, appropriate cleaning solutions were chosen. According to the activity of wound basal lamina, location and patients' coagulation function, mechanical debridement, conservative sharp debridement or autolytic debridement were chosen. Microenvironment which benefited the wound healing was created through exudates management and wound sealing. Different wound dressings such as silver sulphadiazine impregnated hydrocolloid dressing (Urgotul SSD), sodium chloride impregnated dressing <br> (Mesalt), calcium alginate dressing (Sorbalgon), hydrofiber dressing (Aquacel), silver-containing hydrofiber dressing (AquacellAg) were chosen and the wounds were dressed and fixed. The causes of delayed wound healing were explored and the wound healing were observed after giving moist therapy. Results The causes of delayed wound healing included subcutaneous fat liquefaction (n=30), incision infection (n=16), subcutaneous hemotoma (n=8). After giving moist therapy for 5 to 21 d, the granulation proliferation of the wounds was observed well in 54 patients. Forty-two cases received second suture and the wounds in 12 cases were compressed and pulled up using 3M steri-strip. All the wounds healed completely with a cure rate of 100%. Conclusions Moist therapy can promote the proliferation of granulation tissues of patients with liver diseases and delayed wound healing after surgery, and provides favorable condition for the secondary healing.
