摘要
目的探讨既不增加应激反应又能使多发伤口愈合的方法。方法对暴发型流行性脑脊髓膜炎并发弥漫性血管内凝血继发全身41处全层伤口的3岁患儿,采取了分阶段干预:抢救期间保护伤口和皮肤,预防伤口感染。病情稳定出院后,对41处伤口分别采用自溶结合机械清创21处(A组)和自溶结合保守性锐器清创20处(B组),清创结束后使用水胶体敷料和泡沫敷料处理伤口,直至愈合。愈合后7d开始预防瘢痕治疗,连续6个月。每3个月随访1次,随访12个月。观察记录2组伤口清创期天数和愈合时间、瘢痕计分和活动能力计分。结果该患儿的41处伤口全部愈合,平均愈合时间(26.49±7.47)d。两组清创期分别为(9.90±5.82)d、(5.65±3.91)d,B组清创期短于A组,差异有统计学意义(P<0.05);两组愈合时间分别为(27.81±8.33)d、(25.10±6.35)d,差异无统计学意义(P>0.05)。随访6个月时患儿的瘢痕和活动能力计分明显优于3个月时(P<0.001)。结论分阶段干预促进了多发伤口的愈合,预防瘢痕治疗需持续6个月才能稳定效果。
Objective To explore the effective methods of wound care which can not only decrease stress reactions,but also enhance wounds healing. Methods Stages interventions were implemented in a 3-year old child with 41 full thickness wounds complicated to disseminated intravascular coagulation（DIC）. Early stage interventions focused on protecting wounds and skin from exudates,sweat and other body fluid in order to prevent wounds infection during critical care. During stable period after discharge,the 41 wounds were divided into two groups（21 wounds in group A and 20 wounds in group B）. The wounds in the two groups were debrided by autolysis combining with mechanical debridement and autolysis combining with conservation sharp debridement,respectively. After debridement,hydrocolloid dressing and foam dressing were used until wounds healed. During healed stage,prevention scars treatment used by occlusive silicon dressing was implemented for six months since seven days after healing. The patient was followed up once 3 months for a year. The debridement duration,healing time of each wound,scars rating scores and activity ability were recorded and compared between the two groups. Results All the 41 wounds were completely healed. The average healing time was （26.49±7.47）days. The average debridement duration in group B was significantly shorter than that of group A （5.65±3.91 vs. 9.90±5.82 days,P〈0.05）. There was no significant difference on the healing time between group A and group B（27.81±8.33 vs 25.10±6.35 days,P〉0.05）. The scars score and activity ability at 6 months after discharge were higher than that of 3 months （P〈0.001）. Conclusion Stages interventions can enhance wounds healing. Prevention scars treatment must be continuous for 6 months to get stabilizing effects.
出处
《中华护理杂志》
CSCD
北大核心
2010年第8期690-693,共4页
Chinese Journal of Nursing
基金
南京军区南京总医院科研基金资助课题(编号:2008001)
关键词
弥漫性血管内凝血
清创术
伤口愈合
Disseminated Intravascular Coagulation
Debridement
Wound Healing
