目的:探讨纯中药制剂化腐生肌散治疗中重度压疮的治疗效果。方法:对2005年2月至2009年1月北戴河医院和内蒙古民族大学附属医院经治的住院和门诊压疮患者106例,经中药方剂化腐生肌散外敷治疗的临床资料进行回顾性分析。结果:中重度压疮患者106例,经外敷治疗,愈合90例(84％),显效16例(16％),总有效率为100％。结论:化腐生肌散有明显的活血化瘀、去腐生肌、抗感染、迅速长皮之功能。治疗效果明显,治愈率高,缩短治疗时间,无毒副作用,减少了患者的痛苦值得推广。
ObjectiveTo investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse.MethodsThe subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups (n=15). The wounds were injected with 100 μL of hADSCs (1×106 cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day.ResultsThe cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group (t=5.781, P=0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group (P<0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group (P<0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days (P<0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection.ConclusionLocal transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.
目的 为老年股骨颈骨折的患者制定合理的循证护理方案。 方法 在充分了解老年股骨颈患者病情的基础上，根据PICO原则，提出临床问题并转化为易于检索的形式，于2012年5月检索了Cochrane系统评价数据库（CDSR）、Cochrane对照试验注册中心（CCTR）、效果评论摘要数据库（DARE）、Medline、国家指南网（NGC）、PubMed 网站、中国生物医学文献数据库（CBM）以及复旦大学JBI循证护理中心，获取并评价相关的系统评价、随机对照试验以及临床指南。 结果 共检索到3篇系统评价、2篇临床随机对照试验和1篇临床实践指南。根据检索的结果，与患者及家属沟通后，选用Braden量表对患者进行压疮评估；指导患者每2小时翻身；进行腰背肌的锻炼，2～4 h/次，第1天5遍/次，之后逐渐递增为10～20遍/次；指导摄入高能量、高蛋白食物。1周后，患者机体状况良好，顺利接受手术治疗。 结论 采取循证护理的方法可以为患者提供科学、个性化的护理。
ObjectiveTo understand the application of the Braden pressure ulcer risk-factor assessment scale in the nursing staff, in order to provide reference for clinical nurses to standardize the use of Braden assessment scale and facilitate the hospital to develop training programs on pressure ulcer related knowledge. MethodsStratified cluster sampling method was applied in February 2015. Using the self-designed questionnaire of “Application of Braden pressure ulcer risk-factor assessment scale in the nursing staff ”, we conducted a survey on 198 clinical nurses, and the survey results were scrutinized. The difficulty level of using Braden assessment scale in the nurses was analyzed based on their different demographic characteristics. We also analyzed the items which were most difficult to judge for the nurses and nurses’ learning needs for knowledge on Braden assessment scale. ResultsA total of 168 (84.85%) nurses found it difficult in using Braden scale for the evaluation of pressure ulcer. The most difficult items to judge for the nurses were friction force, shear force and feeling. Nurses in departments with pressure ulcer as a common symptom of the patients could better use the Braden pressure ulcer risk-factor scale, compared with those in departments where pressure ulcer was uncommon (P＜ 0.05) . A total of 189 (95.46%) nurses thought it necessary to carry out a unified quantitative standard analysis of six risk factors in the Braden scale. Conclusions The poor mastery of the assessment standards for Braden scale in the nurses causes various degrees of difficulty in applying the scale, which can influence the accuracy of assessment. It is important to train the nurses on pressure ulcer risk factor assessment in order to raise the clinical assessment accuracy.
Objective To investigate the effectiveness of pedicled superior gluteal artery perforator bilateral quadrilobed flaps for repairing large sacrococcygeal pressure sores. Methods Between June 2003 and August 2011, 6 paraplegia patients with large sacrococcygeal pressure sores were repaired with the pedicled superior gluteal artery perforator bilateral quadrilobed flaps. There were 2 males and 4 females with an average age of 45.6 years (range, 37-62 years). The mean disease duration was 8.4 months (range, 3-26 months). According to National Pressure Ulcer Advisory Panel (NPUAP) standard, 6 cases rated as degree IV. The size of pressure sores ranged from 15 cm × 13 cm to 18 cm × 16 cm. The size of flaps ranged from 18 cm × 14 cm to 21 cm × 15 cm. Results After operation, all flaps survived successfully. The wounds healed by first intention in 5 cases; partial dehiscence of incision occurred in 1 case, which was cured after dressing change for 26 days. Six patients were followed up 6-24 months (mean, 12.5 months). The appearance and texture of the flaps were smooth and soft with good elasticity and no ulceration. Conclusion Pedicled superior gluteal artery perforator bilateral quadrilobed flaps can repair large sacrococcygeal pressure sores. The appearance of flaps is smooth and has good compression-resistance effect.
ObjectiveTo explore the application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement. MethodsAccording to the standard, 68 stage-Ⅲ pressure ulcer cases were selected from January 2011 to December 2014. All the patients had yellow surface and positive bacterium cultivation suggesting wound infection. They were randomly divided into control group and trial group. The control group used traditional treatment for debridement, while the trial group used 10% sodium chloride, until the end of debridement where the granulation became fresh and bacterium cultivation negative. Then we compared these two groups in terms of debridement time, wound drainage, wound smell, granulation growth, pain score and cost. ResultsThe control group debridement time was 18-32 days, averaging (22.4±10.8) days, and the trial group debridement time was 5-13 days, averaging (11.6±4.0) days (P<0.05). The control group wound drainage ratings score was 6.70±2.87, while the trial group wound drainage ratings score was 3.65±1.23 (P<0.05). In terms of the wound smell, the control group had a score of 2.74±1.62, and the score for the experimental group was 1.26±0.51 (P<0.05). The average cost of the control group was (975.00±10.29) yuan, while the experimental group was (626.00±8.18) yuan (P<0.05). ConclusionThe application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement can shorten debridement time, promote the growth of granulation and reduce the economic burden, which is worth clinical promotion.