傷口癒合機轉 傷口種類與處裡 - sgecm.org.tw

1 1 .. Clveland WOCN/ET TEL: (06) 2812811 53053E-mail: 3 Whelan, & Schwartz, 2005 4 Injury Hours DaysWeeks Haemostasis Inflammation Proliferation Remodeling Platelets Platelets Macrophages Neutrophils Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells Fibroblasts(Kane & Krasner, 1997)5 Injury Hours DaysWeeksCell types involved Haemostasis Inflammation Proliferation Remodeling Platelets Macrophages Neutrophils Platelets Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells FibroblastsCoagulationInflammationProlif eration MigrationRemodelingChronic WoundAcute Wound Coagulation Inflammation Proliferation Migration Remodeling7 (McGuckin, Goldman, Bolton, & Salcido, 2003) 8 9 Erythema Induration Warmth around the wound Pain or tenderness Poor granulation tissue : dull, friable.

2 Purulent or increased wound exudate Maceration Edema 10 MMPs MMPs Matrix metalloproteinases (MMPs) 11 ( ) 12 , 14 15 Inflammatory response3-4 ( ) 17 18 (PMN Neutrophil) 19 lysozyme 20 Proliferative phase5-20 21 Proliferation Angiogenesis Contraction Epithelialisation22 Characteristics of granulation tissue 23 Wound Contraction 24 Cell contraction theory Myofibroblasts actin-rich cells 25 Epithelialisation Migration of new cells begins from wound margin contact inhibitiob 26 (capillary bud) (fibroblast) (collagen)

3 27 Epithelia-lization Contraction (myofibroblast) 28 Maturation29 Maturation 80%(Harvey, 2005)30 (Collagen remolding) (Capillary regression) ( ) (Maturation phase)31 (Type III collagen) (collagenase) (Type II collagen) 32 33 time from injurywounding ECM ECM Moore 2004 35 15-20% (Mulder 2001) 36 Wound Assessment37 38 39 Patient Assessment 40 {(Hess,& Kirsner,2003) 41 (Anderson,2004)42 wound assessment - 1 A= Anatomic location and age of wound S= Size, shape, and stage S= Sinus tracts and undermining E= Exudate S= Sepsis (septic wound)}

4 S= Surrounding skin , Volume 35, Number 343 M= Maceration E= Edges and epithelialization N= Necrotic tissue T= Tissue bed S= Status , Volume 35, Number 3 wound assessment - 244 Assessment of Wounds Healing by Secondary Intention 45 Assessment of Wounds Healing by Secondary Intention 4647T I M E 01 2 3T 0% 30%<60%<90%I M E 0 30% 60% 90%48H 01 01 Alb TSF 12mm Alb /dl TSF 12mm <70 >70 49 TIME-H 0-6 6-12 12-18 50T 01 2 3 1-2 3-4 u-burn Jelly u-burn NS wet 5.

5 Jelly u-burn NS wet 5. NS wet oint NS wet 1:20 /NS wet u-burn NS wet 1:20 /NS wet Jelly u-burn NS wet NS wet 5. 1:20 /NS wet Jelly u-burn NS wet NS wet 5. 51T 0123 1-2 3-4 Paste Paste Paste Paste Paste 52I 0123 1-2 3-4 oint oint oint NS wet oint NS wet 1:20 /NS wet u-burn oint 1:20 /NS wet u-burn oint 1:20 /NS wet u-burn oint 53I 0123 1-2 3-4 54M 012 3 1-2 3-4 oint NS wet oint NS wet oint 55M 01 2 3 1-2 3-4 Paste Paste 56E 0123 1-2 3-4 NS wet NS wet 57E 01 2 3 1-2 3-4

6 Paste Paste Paste Paste 5859 2002 6 TIME 60 T Tissue : I Infection or Inflammation : M Moisture Imbalbnce : E Edge of Wound : Lynne Watret 2005 Teaching wound management: a collaborative model for future education wound bed preparation ,WBP 61T tissue WBP -1 WBP 62 WBP T tissue WBP -263I infection inflammation WBP WBP 64 WBP 105microgram/ml I infection inflammation WBP 65 contamination colonization critical colonization infection 105 66 67.

7 Aquacel-Ag Biatain-Ag 68M moisture WBP moisture imbalance WBP 69 WBP M moisture WBP 70 1 : -1712 : gauze dressing hydrocolloid hydrogel alginate foam -2723 :(Negative Pressure Wound Therapy;VAC) -373 50-150mmHg 2-3 74 75 76E edge of wound WBP non-ad-vancing undermining keratinocytes WBP 77 WBP E edge of wound WBP 78 Dry wound scab epithelialiazation.

8 , (Exudate) , (maceration) , , , 79 (senescence) 80 81 60 TIME-H T I M E H 82 ( Department of Health and Human Services, 2007) --- --- --- --- 14 83 Hydrogel film composite film composite Hydrocollid foam Hydrogel Hydrocollid foam Aquacel hydrofiber ( Department of Health and Human Services, 2007)84 Hydrogel film composite film composite Hydrocollid foam foam foam Aquacel hydrofiber ( Department of Health and Human Services, 2007)

9 8586 87 88 89 30 30 ,, ,, ,, .. ((NPUAP, 1998) NPUAP, 1998) 90 91 92 93 4 3-2-1 healing process what is 3 , 2 and 1 4 , , 3-2-1 94 NPUAP 95969798 N/S 99 101 102 103 104 ( ) 105 ( )

10 ABI 106 ABI Ankle-Brachial Index - ABI 107 ABI ABI (Ankle-Brachial Index) ABI= ABI 108 ABI PAOD PAOD PAOD JAMA 2006,295:536-546109110111112113114115116 117118119 CONFIDENTIAL For Internal Use Only Flexi-Seal Fecal Management System 120 121122 8 Nasal air way foley bag foley bag foley bag Nasal air way 125 Nasal air way foley bag 127 Nasal air way 128foleybag ElienM. Lynn M.,1999 131 132 N/S U-burn 1 Flagyl 25ccD/W 5 1 Flagyl 24 gm Jelly 133 Flagyl Jelly U-burn 134 Flagy