【正文】 wound cleaning Techniques傷口清潔(qīngji233。)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(zǔzhī) 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。,wound cleaning傷口(shāngkǒu)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，MMP Foreign bodies (for instance remains for previously used dressings) 異物（例如先前(xiānqi225。n)使用的敷料）,第二頁，共九十五頁。,Wound cleaningTechniques 傷口清潔(qīngji233。)技術(shù),Requirements 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(tǐwēn)（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。,Wound cleaning 傷口(shāngkǒu)清潔,Ways 方法 Basic cleanning of wound bed,wound edges and surrounding area 對傷口創(chuàng)面、邊緣(biānyu225。n)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。,Wound cleaning 傷口清潔(qīngji233。) 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 Indication:Cleaning wound 適應(yīng)癥：清潔(qīngji233。)傷口 Non touch technique非接觸技術(shù),第五頁，共九十五頁。,Wound cleaning 傷口(shāngkǒu)清潔 技術(shù),Cleanning with antiseptic solution 采用消毒溶液進(jìn)行清洗 Octenidindihydrochlorid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 center 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(zhōngjiān)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。,Wound cleaning Antiseptic solution 傷口清潔消毒(xiāo d)溶液,Octenidindihydrochlorid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、不會被體液滅活 do not initiate resistance ,skin irritation and allergies不會引起抗藥性、皮膚刺激或過敏(gu242。mǐn) 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，共九十五頁。,Wound cleaning Antiseptic solution 傷口(shāngkǒu)清潔消毒溶液,Iodine Advantages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(ruǎngāo)、洗液） Disadvantages 缺點(diǎn) Colored(makes wound assessment difficult )有色（難以對傷口進(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。,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(cǎiy242。ng)不同的清創(chuàng)術(shù)進(jìn)行支持治療 Requirements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。,Debridement opportunity清創(chuàng)時機(jī)(sh237。jī),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 infected,but have a foreign body or much necrotic tissue,we can also debridement,and do not wound closure after debridement 急性傷口理想時間：傷后8小時(xiǎosh237。)以內(nèi)，頭面、手部傷口12小時(xiǎosh237。)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。,Debridement methods傷口(shāngkǒu)清創(chuàng)方法,機(jī)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(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。,Wound debridemen清創(chuàng)術(shù),Mechanical 機(jī)械性清創(chuàng) Wipe(mechancialy clean)the wound with sterile gauze 無菌紗布擦拭傷口(shāngkǒu)（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)。,第十二頁，共九十五頁。,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(hu242。zhě)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 In severe cases int must be conducted in OR嚴(yán)重時必須采用手術(shù)進(jìn)行處理,第十三頁，共九十五頁。,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(tǐwēn)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)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。,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)(quēdiǎn) Not always 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。,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(cāozu242。) Disadvantage缺點(diǎn) Tasks more time than for instance surgical debridement比手術(shù)清創(chuàng)方法花費(fèi)更多時間 Needs to be adapted to the individual requirements of wound需要適合傷口的個體要求 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。,,The evolution and application of dressings,Gauze Oil Yam、sticking Hydrocolloid dressings Antibacterial dressings,干紗布 油砂、敷貼 水膠體 抗菌敷料(fūli224。o)、生物活性敷料(fūli224。o),第十七頁，共九十五頁。,Wound dressingsGeneral 傷口(shāngkǒu)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)傷口防止進(jìn)一步損傷 Allow non traumatic removal 去除時不會產(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）