造口治疗师主导富血小板血浆联合湿性敷料治疗术后不愈合慢性伤口的效果观察  

The observation of the effect led by the enterostomal therapist of platelet-rich plasma combined with wet dressings in the treatment of postoperative chronic wounds

作　　者：夏振兰[1] 杨晓君 周永林 杨逸禧 陈月玲 陈丽萍[4] 刘泽炫 Xia Zhenlan;Yang Xiaojun;Zhou Yonglin;Yang Yixi;Chen Yueling;Chen Liping;Liu Zexuan(Department of Traumatic Orthopedics,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Research Center for Regenerative Medicine and 3D Printing Technology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Surgical Outpatient Clinics,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Nursing,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院创伤外科,广州510150 [2]广州医科大学附属第三医院3D打印再生医学转化研究中心,广州510150 [3]广州医科大学附属第三医院外科门诊,广州510150 [4]广州医科大学附属第三医院护理部,广州510150

出　　处：《中国实用护理杂志》2024年第23期1761-1767,共7页Chinese Journal of Practical Nursing

基　　金：广东省医学科研基金项目(A2024134);广东省教育厅广东省临床教学基地教学改革研究项目(2021JD103)。

摘　　要：目的:探讨由造口治疗师(ET)主导的多学科协作模式下,综合运用富血小板血浆(PRP)联合湿性敷料治疗术后不愈合慢性伤口的应用效果,为提高慢性伤口患者的临床实践与管理水平提供参考和借鉴。方法:采用随机对照试验,便利抽样法选取2018年10月至2023年2月广州医科大学附属第三医院慢性伤口护理门诊就诊的术后不愈合慢性伤口患者88例,采用抛硬币法随机分组,对照组(41例)采用标准的湿性敷料治疗,试验组(47例)采用以PRP联合湿性敷料为核心的综合治疗方案,由ET采用三通头同步推注PRP和助凝混合液并覆盖超薄型泡沫敷料的创新护理技术。观察2组患者伤口压疮愈合计分量表(PUSH)评分、伤口面积愈合指数(WSHI)、换药过程中的疼痛程度、伤口愈合时间和治疗满意率。结果:88例患者中,对照组女25例,男16例,年龄为58.00(37.00,79.00)岁,试验组女31例,男16例,年龄为57.00(35.00,72.00)岁。试验组患者在伤口治疗后第7、14、21天的PUSH评分中位数分别是11.00、9.00、7.00分,优于对照组的13.00、11.00、9.00分,WSHI中位数分别是0.35、0.58、0.84,优于对照组的0.09、0.30、0.50,2组比较差异均有统计学意义(Z值为4.08~8.20,均P<0.01);试验组换药治疗第7天、第14天、第21天疼痛评分分别为3.00(2.00,3.00)、2.00(1.00,2.00)、0.00(0.00,1.00)分,低于对照组的3.00(3.00,3.00)、2.00(2.00,3.00)、2.00(1.00,2.00)分,差异有统计学意义(Z=2.16、3.38、6.14,均P<0.05);试验组伤口愈合时间为(37.04±25.33)d,短于对照组的(52.88±36.58)d,差异有统计学意义(t=5.53,P<0.05);试验组满意率为97.90%(46/47),高于对照组的87.80%(36/41),差异有统计学意义(χ^(2)=3.13,P<0.05)。结论:由ET主导的多学科协作模式下,以PRP联合湿性敷料为核心的综合治疗对术后不愈合慢性伤口具有明显的治疗效果,包括缩短伤口愈合时间、加快愈合速度、降低伤口疼痛程度以及提高患者满意度,Objective To explore the application effect of a multidisciplinary collaborative model led by stomatognathic therapists,utilizing a combination of platelet-rich plasma(PRP)and moist wound dressings in the comprehensive treatment of postoperative chronic wounds,and to provide references and guidance for improving the clinical practice and management level of patients with chronic wounds.MethodsThis was a prospective randomized controlled trial.Eighty-eight patients with postoperative non-healing chronic wounds who visited the Chronic Wound Care Clinic of the Third Affiliated Hospital of Guangzhou Medical University from October 2018 to February 2023 were conveniently sampled.They were randomly divided into two groups using a coin toss method:the control group(n=41)received standard moist wound dressing therapy,while the experimental group(n=47)received comprehensive treatment based on PRP combined with moist wound dressings.This treatment,led by enterostoml therpist,involved the innovative nursing technique of simultaneous injection of PRP and coagulant mixture via a three-way connector and covering with ultra-thin foam dressing.The Pressure Ulcer Scale for Healing(PUSH)score,wound area healing index(WSHI),pain level during dressing change,wound healing time,and treatment satisfaction rate were observed in both groups.ResultsAmong 88 cases,there were 25 females and 16 males in the control group,aged 58.00(37.00±79.00)years old.There were 31 females and 16 males in the experimental group,aged 57.00(35.00±72.00)years old.The median PUSH scores of the experimental group on the 7th,14th,and 21th day after wound treatment were 11.00,9.00,and 7.00,respectively,which were better than those of the control group,which were 13.00,11.00,and 9.00.The median WSHI scores were 0.35,0.58,and 0.84 for the experimental group,respectively,which were better than those of the control group,which were 0.09,0.30,and 0.50.The differences between the two groups were statistically significant(Z values ranged from 4.08 to 8.20,all P<0.01)

关 键 词：富血小板血浆 伤口愈合 外科伤口 治疗结果 

分 类 号：R473.6[医药卫生—护理学]