切口是被遗忘的伤口吗? 改变切口护理方式 改善患者结局 

Sara Carvalhal, Daniel Chaverri
20 November 2024
本报告汇总了多项研究成果,探讨了在一系列手术和术后护理中采用非干扰伤口愈合(UWH)原则的有效性和实施情况。其中特别关注了肿瘤外科手术和骨科手术期间及术后切口的护理。非干扰伤口愈合(UWH)原则旨在减少患者死亡率、缩短恢复时间、提高患者生活质量和降低治疗成本。

业界普遍认同,无论是急性还是慢性伤口,湿性愈合环境有利于伤口愈合。近年来,一个新的概念在手术切口护理领域悄然兴起,即:“非干扰伤口愈合(UWH)”。这一概念主张连续加速伤口愈合,除非绝对必要,尽可能减少对愈合过程的干扰(Brindle 等人,2019 年;Davies 等人,2019 年)。
实现非干扰伤口愈合(UWH)需要保持恒温,创造理想湿性愈合环境,并避免外界因素对伤口的干扰,从而促进伤口正常愈合。

开始伤口护理的最佳时机?

简单回答就是:从手术室开始,因为可以提供无菌环境,伤口新鲜且干净。

文献中一致认为,应至少于术后 48 小时再更换手术室中贴敷的无菌敷料。如果伤口无出血或无渗出物,强烈建议敷料贴敷四天,无需提前更换。术后前四天,手术伤口极易发生感染(尤其是术后前 48 小时内,Stryja 等人,2020 年)。结合这些证据,可以认为,如非必要,按照习惯或惯例频繁更换敷料是没有意义的。

纱布简单包扎是不够的

为了顺利实现非干扰伤口愈合(UWH),需要使用先进伤口敷料。这类敷料所用黏合剂性质温和,可预防水泡和伤口周围损伤,并有效管理渗出物,患者可以淋浴,并且自由活动时也无需担心敷料脱落(Stryja 等人,2020 年)。

非干扰伤口愈合(UWH)带来的成本优势

虽然先进切口敷料的成本高于传统敷料,但其减少换药频率的特性可以减少护理人员工作时间,降低并发症风险,从而显著节省了整体医疗成本。此外,相关研究中也明确建议最好使用先进敷料(Stryja 等人,2020 年;Clin Guidel,2020 年;Parvizi 和 Gehrke,2018 年)。

最后,少换药,甚至无需换药,有助于加快伤口愈合,降低换药成本,并大幅减少与换药相关的医疗废弃物。例如,根据最佳实践,与通常需要更换 5-7 次的传统敷料相比(包括更换无菌敷料或须在无菌环境下换药时所需的消耗品),较长时间内无需更换的敷料不会干扰伤口愈合,更具有性价比。

Disclaimer: This report is supported by an educational grant from Mölnlycke Healthcare.
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