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傷口床準備概念-TIME
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Jessie 謝佳芩
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傷口癒合緩慢可能是因為清創不夠、細菌負荷量太多、換藥方式不當,或是本身體質不良。 了解原因,處理原因,才能有效加快傷口癒合速度。
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傷口床準備概念-TIME
1.
傷口照護 傷口床準備概念 謝佳 傷口護理師芩
2.
如果傷口無法按時期復原 ... ?
3.
傷口護理演進 • 18 世紀前,人類使用茶葉、羽毛、樹葉、泥土 等作為傷口敷料,目的在減輕傷口疼痛。 •
18 世紀末,巴斯德 (Pasteur) 發展出無菌和細菌 控制的觀念。 • 19 世紀中,開始有 潤環境促進傷口癒合溼 的研 究報告出現,傷口照護的觀念開始有了重大的轉 變。
4.
Wound Bed Preparation •
2003 年,一個傷口護理的新觀念「傷口床準備」 WBP (wound bed preparation) – 找出影響或停滯傷口癒合的原因,給予適當的治療。 • 評估傷口 - 使用 TIME 的評估準則 (2004 年 ) – Tissue :組織顏色 - 粉紅、紅、黃、黑 – Infection :是否有感染 - 紅、腫、熱、 痛?滲液顏色?惡臭? – Moisture :適當濕潤度。周圍皮膚是否有浸潤 情形 ? 滲液量 ? – Edge :傷口邊緣是否平整?潛行傷口 ? 隧道傷 口 ? 有上皮化 ?
5.
5/27 Leaper DJ et
al (2012) Int Wound J 9(Suppl 2): 1–19 Schultz GS et al (2004) Int Wound J 1(1): 19–32
6.
7.
8.
T: Debridement
9.
T: Debridement
10.
11.
I: Antimicrobials
12.
I: Removed Biofilm
13.
14.
15.
M: Moisture balance
16.
17.
E: Promote Wound
Close
18.
E: NPWT /
Ultrasound
19.
E: HBO /
LLLT
20.
這樣傷口就會好了 ?嗎
21.
從微觀到宏觀,從傷口到全人 既存、潛在內科疾病 藥物的使用 精神、意識狀態 年齡 有無不良生活習慣 ( 抽 、喝酒菸
) 營養狀態 神經系統功能 周邊血循狀況 免疫系統功能 是否放射線治療
22.
傷口癒合 需要 面面俱到