伤口管理原则1

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最近读了这个伤口管理基本原则，发出来给大家看看。原文链接https://todaysveterinarynurse.com/wound-management/basic-principles-of-wound-care/

Basic Principles of Wound Care伤口管理基本原则

In veterinary medicine, wounds are common. Although they can be challenging, they can also be rewarding when managed properly by the veterinary team. The goal is to return the injured tissue to normal function; however, because not every wound is the same, treatment pathways and products used vary. Understanding the general principles of wound care and the techniques for managing them enables veterinary nurses to play an integral role in the care and treatment of wounds. This article covers wound classification, stages of healing, treatment, and pain management.

在兽医领域，伤口很常见。尽管有时伤口具有挑战性，但是当正确兽医管理它们时，会得到很好的结果让人很有成就感。伤口管理的目的是恢复受伤组织的正常功能；然而因为每一个伤口都是不一样的，用的治疗方法和产品也不一样。理解伤口管理的总体原则和技术帮助建立兽医护士在伤口治疗和护理中不可或缺的角色。这篇文章包括伤口分类、愈合阶段、治疗和疼痛管理。

Wound Classification伤口分类

Wounds can be classified according to their degree of contamination and the length of time between injury and treatment of the wound. Although time can be used as a guideline, it should not be the ultimate factor for determining the level of contamination.1

可以根据伤口的污染程度和从受伤到治疗之间的时长对伤口进行分类。虽然时间可以作为指导，但它不应该是决定污染水平的最终因素。

lClean wounds are made surgically, under aseptic conditions.

清洁伤口指在无菌操作下的手术切口。

lClean-contaminated wounds are created when a nonsterile organ (e.g., respiratory or genitourinary tract) is entered with little or no spillage of contents or when a minor breach in aseptic technique occurs when treating a clean wound. A wound less than 6 hours old is generally considered in this category.1

清洁污染伤口指进入非无菌器官(如呼吸道或泌尿生殖道)且只有很少或没有内容物泄漏时的切口，或在处理清洁伤口时轻微违法无菌操作原则。通常认为小于6小时的伤口属于这一类。

lContaminated wounds result from spillage of organ contents into the incision, a major breach in aseptic technique, or presence of foreign debris. A wound greater than 6 hours old is generally considered in this category.1

污染伤口指有器官内容物泄露到切口，或严重违反无菌操作原则，或存在异物碎片。通常认为超过6小时的伤口属于这一类。

lDirty wounds are those that are old or infected with >105 organisms per gram of tissue.1,2 A wound greater than 12 hours old is generally considered in this category.1

脏污伤口指存在时间长或者每克组织感染超过105个微生物的伤口。通常认为超过12小时的伤口属于这一类。

Stages of Wound Healing伤口愈合阶段

In addition to wound classification, the phase of wound healing should be determined. Wound healing occurs in 3 phases, each of which overlaps in terms of duration. Several phases may take place simultaneously within the wound.

除了对伤口分类，还应该判断伤口所处的愈合阶段。伤口愈合有3个阶段，每个阶段的时长有重叠，伤口可能处于多个阶段。

Phase 1: Inflammation and Debridement

1期：炎症和清创期

This phase begins at the time of injury and lasts 3 to 5 days. Blood vessels constrict, controlling hemorrhage. Thrombin forms, platelets aggregate, blood coagulates, and a clot is formed, providing hemostasis.3 Blood vessels then dilate, increasing blood flow and bringing transudates into the wound, causing the heat, redness, and swelling of inflammation. White blood cells in the exudate initiate debridement.4 Neutrophils help break down bacteria and debris while stimulating monocytes. Monocytes convert to macrophages, which continue to phagocytize debris and release growth factors that aid in tissue repair.3

这个阶段从损伤发生时开始，持续3-5天。血管收缩，控制出血。凝血酶形成，血小板聚集，血凝块形成，进行止血。然后血管扩张，血流增加，伤口内产生渗出液，炎症引起红、肿、热。渗出液中白细胞启动清创。中性粒细胞帮助分解细菌和碎片，同时刺激单核细胞。单核细胞转化成巨噬细胞，继续吞噬碎片，并释放生长因子帮助修复组织。

Phase 2: Proliferation/Repair

2期：增生/修复

This phase occurs 3 to 5 days after injury. Angiogenesis begins as capillaries grow into the wound from the surrounding healthy vasculature. Growth factors allow for migration of fibroblasts, which leads to creation of collagen (which provides wound strength) and myofibroblasts (which cause wound contraction).3 Granulation tissue begins to form, followed by epithelialization and wound contraction.

这个阶段出现在损伤发生后3-5天。当毛细血管从周围健康的血管系统生长到伤口中时，血管新生就开始了。生长因子刺激成纤维细胞迁移和产生胶原蛋白(提供伤口强度)，以及形成肌成纤维细胞(引起伤口收缩)。肉芽组织开始形成，接着是上皮化和伤口收缩。

Phase 3: Maturation/Remodeling

3期：成熟期/ 重构  

This phase occurs 7 to 14 days after injury, during which time wound strength increases at the fastest rate.4 Cells undergo apoptosis. Over subsequent months to years, collagen matures and forms a scar,3 the tensile strength of which will be only 70% to 80% that of uninjured healthy tissue.5

这个时期发生在损伤后7-14天，这个时期伤口强度以最快速度增加。细胞凋亡。经过随后数月到数年的时间，胶原蛋白成熟，形成疤痕，其抗拉强度仅为未受伤健康组织的70% - 80%。

Types of Wound Closure伤口闭合方式

Wounds can close in several ways, all of which depend on the wound classification and the stage of its healing.

伤口可以通过多种方式闭合，所有这些取决于伤口的分类和所处愈合阶段。

lPrimary Closure (healing by first intention): This is the immediate closure of a wound after injury. This process can be used to close clean or clean-contaminated wounds.

一期缝合（一期愈合）: 伤口出现后立刻缝合。这种闭合方式可用于清洁或清洁污染伤口。

lDelayed Primary Closure: This type of closure occurs 2 to 5 days after injury, before granulation tissue is formed. This process can be used to close clean-contaminated or contaminated wounds.

延迟一期缝合：这种闭合方式指在损伤发生后2-5天进行缝合，闭合时肉芽组织尚未形成。这种闭合方式可用于清洁污染或污染伤口。

lSecondary Closure: This type of closure occurs at least 5 days after injury and after healthy granulation tissue has formed. This process can be used to close contaminated or dirty wounds.

二期缝合：这种闭合发生在受伤后至少5天，此时已形成健康的肉芽组织。这种闭合方式可用于污染或脏污伤口。

lHealing by Second Intention: This type of closure occurs when a wound heals on its own by forming granulation tissue, epithelializing, and contracting. Second intention healing is not selected for areas such as a limb on which the wound involves two-thirds or more of the limb because of the risk that wound contraction will cause decreased mobility and/or a tourniquet effect.

二期愈合：指伤口通过形成肉芽组织、上皮化和收缩自行愈合。某些区域，例如肢体伤口涉及2/3或以上的范围，不选择二期愈合，因为伤口收缩可能会导致活动能力下降和/或止血带效应。

先发这么多，后面的明天再发，第一次使用网络版的宠医帮，还不太会弄。

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