切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2018, Vol. 13 ›› Issue (05) : 378 -382. doi: 10.3877/cma.j.issn.1673-9450.2018.05.012

所属专题: 文献

综述

精准清创技术研究进展
徐杨1, 刘彤2, 郑兴锋2, 夏照帆2,()   
  1. 1. 200433 上海,海军军医大学基础医学院
    2. 200433 上海,海军军医大学附属长海医院烧创伤中心
  • 收稿日期:2018-07-22 出版日期:2018-10-01
  • 通信作者: 夏照帆
  • 基金资助:
    全军后勤科研计划重大专项(AWS14C001); 海军军医大学校级军事课题(2017JS14)

Progress in clinical application of precise debridement

Yang Xu1, Tong Liu2, Xingfeng Zheng2, Zhaofan Xia2,()   

  1. 1. College of Basic Medicine, Naval Medical University, Shanghai 200433, China
    2. Burns and Trauma Center, First Affiliated Hospital, Naval Medical University, Shanghai 200433, China
  • Received:2018-07-22 Published:2018-10-01
  • Corresponding author: Zhaofan Xia
  • About author:
    Corresponding author: Xia Zhaofan, Email:
引用本文:

徐杨, 刘彤, 郑兴锋, 夏照帆. 精准清创技术研究进展[J]. 中华损伤与修复杂志(电子版), 2018, 13(05): 378-382.

Yang Xu, Tong Liu, Xingfeng Zheng, Zhaofan Xia. Progress in clinical application of precise debridement[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2018, 13(05): 378-382.

清创是伤口治疗的基础和关键,其基本要点是彻底清除坏死组织及污染异物,促进创面愈合。根据处理方式的不同,清创可分为手术清创、机械清创、自溶清创、酶解清创和生物清创等,但这几类清创方式在临床应用中都各有其优点及不足之处。近年来,一些新型的清创技术不断出现,如水动力清创和低温等离子射频消融清创等,它们能弥补传统清创方式的不足,更为精准地清除污染或坏死的组织,且尽可能减少对周围正常组织的破坏。精准清创的概念由此产生,其目的是靶向性地清除坏死及不健康组织,最大限度地保留正常组织,并减轻清创时的疼痛。本文就目前常用的清创方法及精准清创新技术作一综述。

Debridement is the basic and key step of wound treatment. The basic point is to removes necrotic tissues and contaminated foreign matter completely, and promotes wound healing. According to different treatment methods, debridement can be divided into surgical debridement, mechanical debridement, autolysis debridement, enzymatic debridement, biological debridement etc. All of these debridement methods have advantages and shortcomings in clinical application. Recent years, a number of new debridement techniques have emerged, such as hydrodynamic debridement and low-temperature plasma radiofrequency ablation debridement, which make up for the deficiency of traditional debridement methods. These new methods can remove contaminated or necrotic tissue accurately, and minimize damage to the surrounding normal tissues. The concept of precise debridement has been developed to target the removal of necrotic and unhealthy tissues, to maximize the retention of normal tissue, and to alleviate pain during debridement. This article reviews the current clinical debridement methods and the new techniques which can achieve accurate debridement.

[1]
蒋琪霞,李晓华. 清创方法及其关键技术的研究进展[J]. 中华护理杂志,2009, 44(11): 1045-1047.
[2]
Ramundo J, Gray M. Enzymatic wound debridement[J]. J Wound Ostomy Continence Nurs, 2008, 35(3): 273-280.
[3]
Kahl M, Gökcen A, Fischer S, et al. Maggot excretion products from the blowfly Lucilia sericata contain contact phase/intrinsic pathway-like proteases with procoagulant functions[J]. Thromb Haemost, 2015, 114(2): 277-288.
[4]
田冰洁,王璐,王红红. 慢性伤口清创术的研究进展[J]. 护理学杂志,2016, 31(16): 101-104.
[5]
弓辰,吕开阳,王光毅,等. 水动力清创系统在烧伤创面中的应用[J]. 中华烧伤杂志,2015, 31(6): 470-472.
[6]
Cubison TC, Pape SA, Jeffery SL. Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns[J]. Burns, 2006, 32(6): 714-720.
[7]
Duteille F, Perrot P. Management of 2nd-degree facial burns using the Versajet (®) hydrosurgery system and xenograft: a prospective evaluation of 20 cases[J]. Burns, 2012, 38(5): 724-729.
[8]
Tenenhaus M, Bhavsar D, Rennekampff HO. Treatment of deep partial thickness and indeterminate depth facial burn wounds with water-jet debridement and a biosynthetic dressing[J]. Injury, 2007, 38 Suppl 5: S39-S45.
[9]
Klein MB, Hunter S, Heimbach DM, et al. The Versajet water dissector: a new tool for tangential excision[J]. J Burn Care Rehabil, 2005, 26(6): 483-487.
[10]
Yang JY, Hwuang JY, Chuang SS. Clinical experience in using the water jet in burn wound debridement[J]. Ann Burns Fire Disasters, 2007, 20(2): 72-77.
[11]
Caputo WJ, Beggs DJ, DeFede JL, et al. A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers[J]. Int Wound J, 2008, 5(2): 288-294.
[12]
Madhok BM, Vowden K, Vowden P. New techniques for wound debridement[J]. Int Wound J, 2013, 10(3): 247-251.
[13]
Ennis WJ, Foremann P, Mozen N, et al. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study[J]. Ostomy Wound Manage, 2005, 51(8): 24-39.
[14]
Kavros SJ, Liedl DA, Boon AJ, et al. Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis[J]. Adv Skin Wound Care, 2008, 21(9): 416-423.
[15]
曹瑛,薛耀明,赖西南,等. 超声清创术对糖尿病足溃疡创面细菌清除及微循环作用的临床研究[J]. 中国糖尿病杂志,2010, 18(8): 597-600.
[16]
Mukai S, Ito H, Nakagawa Y, et al. Transforming growth factor-beta1 mediates the effects of low-intensity pulsed ultrasound in chondrocytes[J]. Ultrasound Med Biol, 2005, 31(12): 1713-1721.
[17]
Nishikori T, Ochi M, Uchio Y, et al. Effects of low-intensity pulsed ultrasound on proliferation and chondroitin sulfate synthesis of cultured chondrocytes embedded in Atelocollagen gel[J]. J Biomed Mater Res, 2002, 59(2): 201-206.
[18]
林联铎. 超声清创在烧伤创面的应用[J]. 中国药物经济学,2014(4): 114-115.
[19]
Sönnergren HH, Strömbeck L, Faergemann J. Antimicrobial effects of plasma-mediated bipolar radiofrequency ablation on bacteria and fungi relevant for wound infection[J]. Acta Derm Venereol, 2012, 92(1): 29-33.
[20]
Bahr S, Mustafi N, Hättig P, et al. Clinical efficacy of a new monofilament fibre-containing wound debridement product[J]. J Wound Care, 2011, 20(5): 242-248.
[21]
Haemmerle G, Duelli H, Abel M, et al. The wound debrider: a new monofilament fibre technology[J]. Br J Nurs, 2011, 20(6): S35-S36, S38, S40-S42.
[22]
Gray D, Cooper P, Russell F, et al. Assessing the clinical performance of a new selective mechanical wound debridement product[J]. Wounds UK, 2011, 7(3): 42-46.
[23]
König M, Vanscheidt W, Augustin M, et al. Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial[J]. J Wound Care, 2005, 14(7): 320-323.
[24]
Paustian C, Stegman MR. Preparing the wound for healing: the effect of activated polyacrylate dressing on debridement[J]. Ostomy Wound Manage, 2003, 49(9): 34-42.
[25]
Fleck CA, Chakravarthy D. Newer debridement methods for wound bed preparation[J]. Adv Skin Wound Care, 2010, 23(7): 313-315.
[26]
Bruggisser R. Bacterial and fungal absorption properties of a hydrogel dressing with a superabsorbent polymer core[J]. J Wound Care, 2005, 14(9): 438-442.
[27]
Koupil J, Brychta P, Horky D, et al. The influence of moisture wound healing on the incidence of bacterial infection and histological changes in healthy human skin after treatment of interactive dressings[J]. Acta Chir Plast, 2003, 45(3): 89-94.
[28]
Fleck CA. Why "wet to dry" ?[J]. J Am Col Certif Wound Spec, 2009, 1(4): 109-113.
[29]
Cutting KF. Honey and contemporary wound care: an overview[J]. Ostomy Wound Manage, 2007, 53(11): 49-54.
[30]
Molan PC. Re-introducing honey in the management of wounds and ulcers - theory and practice[J]. Ostomy Wound Manage, 2002, 48(11): 28-40.
[31]
Van der Weyden EA. The use of honey for the treatment of two patients with pressure ulcers[J]. Br J Community Nurs, 2003, 8(12): 14-20.
[32]
Mavric E, Wittmann S, Barth G, et al. Identification and quantification of methylglyoxal as the dominant antibacterial constituent of Manuka (Leptospermum scoparium) honeys from New Zealand[J]. Mol Nutr Food Res, 2008, 52(4): 483-489.
[33]
Adams CJ, Boult CH, Deadman BJ, et al. Isolation by HPLC and characterisation of the bioactive fraction of New Zealand manuka (Leptospermum scoparium) honey[J]. Carbohydr Res, 2008, 343(4): 651-659.
[34]
Moghazy AM, Shams ME, Adly OA, et al. The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers[J]. Diabetes Res Clin Pract, 2010, 89(3): 276-281.
[35]
Stephen-Haynes J. Evaluation of a honey-impregnated tulle dressing in primary care[J]. Br J Community Nurs, 2004, Suppl: S21-S27.
[36]
陈淼,谭惠仪,何汶霞,等. 蜂蜜敷料与磺胺嘧啶银敷料对烧伤伤口作用效果的Meta分析[J]. 中国实用护理杂志,2014, 30(19): 16-20.
[37]
Yapucu Güneş U, Eşer I. Effectiveness of a honey dressing for healing pressure ulcers[J]. J Wound Ostomy Continence Nurs, 2007, 34(2): 184-190.
[38]
王霞,马平兰,张文娟,等. 蜂蜜治疗褥疮创面的护理研究[J]. 西南国防医药,2015, 25(3): 322-324.
[39]
郭春兰,田玉凤,陈军,等. 自制蜂蜜敷料治疗慢性感染伤口的疗效观察[J]. 中华医院感染学杂志,2010, 20(23): 3717-3718.
[40]
王双群,刘培会,周卫东. 蜂蜜用于感染性伤口辅助治疗的效果观察[J]. 实用医院临床杂志,2011, 8(5): 137-138.
[41]
耿爱香,韩恩崑,唐万斌,等. 蜂蜜敷料促进浅表脓肿切口愈合的研究[J]. 天津医药,2012, 40(8): 835-836.
[1] 贺敬龙, 尚宏喜, 郝敏, 谢伟, 高明宏, 孙炜, 刘安庆. 重度类风湿关节炎患者行多关节置换术的临床手术疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 860-864.
[2] 陈宏兴, 张立军, 张勇, 李虎, 周驰, 凡一诺. 膝骨关节炎关节镜清理术后中药外用疗效的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(05): 663-672.
[3] 周子慧, 李恭驰, 李炳辉, 王知, 刘慧真, 王卉, 邹利军. 细胞自噬在创面愈合中作用的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 542-546.
[4] 闫甲, 刘双池, 王政宇. 胆囊癌肿瘤标志物的研究和应用进展[J]. 中华普通外科学文献(电子版), 2023, 17(05): 391-394.
[5] 姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[6] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[7] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[8] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[9] 汪毅, 许思哲, 任章霞. 胸乳入路腔镜单侧甲状腺叶切除术与开放手术对分化型甲状腺癌患者术后恢复的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 542-545.
[10] 蓝冰, 王怀明, 王辉, 马波. 局部晚期结肠癌膀胱浸润的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 505-511.
[11] 胡建生, 周佐霖, 孙林梅, 马腾辉. 不同诊断分型的慢性放射性直肠损伤临床治疗转归:85例回顾性分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 466-472.
[12] 丁晨梦, 胡雪慧, 闫沛, 程乔. 髋部骨折术后患者居家康复体验质性研究的Meta整合[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 365-372.
[13] 李岩松, 李涛, 张元鸣飞, 李志鹏, 周谋望. 头戴式虚拟现实设备辅助全膝关节置换术后康复的初步研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 676-681.
[14] 李莹倩, 李华山. 基于真实世界的完全性直肠脱垂治疗方式评价[J]. 中华临床医师杂志(电子版), 2023, 17(06): 700-705.
[15] 吴一菡, 雷章, 卢宏达. MUC16/CA125在良恶性肿瘤诊治中的作用及其研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(05): 591-595.
阅读次数
全文


摘要