研究21世紀病患傷口護理和疼痛管理

傷口換藥具有多方面的影響，不但對於醫療單位是項挑戰，而且也會影響病患的傷口治癒和生活品質。本研究利用Scopus資料庫，針對21世紀(2001年至2021年)現存文獻，透過精確設計的搜尋字串及文獻的篩選，結果獲得117篇科學文獻，並依此利用文獻計量法和VOSviewer軟體進行量化、質性及視覺化分析，以了解本領域的研究趨勢、研究發現及知識系統。結果顯示本領域研究尚處於萌芽階段，而美國是本領域的主流研究國家，具有最多的文獻發表量；Timsit et al. (2009)針對洗必泰浸漬海綿和減少敷料更換頻率在感染上的研究，平均每年有接近27次引用，是影響力最高的文獻。視覺化分析結果顯示”burns”、”pain”、”children”和”dressing change”是本領域主要的研究主體，而美國、中國和英國各自形成不同的合作研究網絡。傷口換藥除了造成高額的健保支出外，還可能引起不平衡和不良效應，對患者而言是一個值得關注的問題。換藥過程的時間長度因傷口特性而異，可能引發上皮細胞組織破壞、再凝血和傷口癒合遲緩，精神狀態和傷口產生明顯的創傷影響。本研究發現，換藥期間傷口疼痛的主要原因包括不良的粘合劑、乾燥的敷料、傷口沖洗以及患者的恐懼和焦慮，所以，選擇合適的敷料是減輕換藥期間疼痛的關鍵，護理人員和醫療人員應了解這些引起疼痛的原因並予以處理。其中。雖然人工皮一種新的生物醫學材料在傷口治療中的一些應用廣泛，但其存在如更換頻率、適用於特定的傷口類型和傷口限制等。換藥過程的疼痛尤其對壓力性疼痛或靜脈性潰瘍患者造成不便，但護理人員對此往往不願意正視。為了解決換藥過程中的疼痛問題，目前主要使用氯胺酮及其複合物，這些藥物具有較好的治療指數和較小的耐受性問題，是安全性較高的疼痛管理藥物。此外，非藥物管理如交談、放鬆技巧或音樂療法等在傷口治療過程中也有其重要性，這些方法可以有效減弱病患的焦慮和疼痛感。然而，本領域面臨一些挑戰，包括傷口功能的多樣性、研究的限制以及疼痛評估工具的標準化等。為了推進這一領域的研究，建議重視特定人群如兒童和老年人的需求，在換藥過程中提供心理支持。此外，鼓勵跨學科合作和跨國、跨機構的合作研究也是推動該領域發展的關鍵。傷口換藥和疼痛管理是一個重要而又複雜的領域，需要全體醫療人員的共同努力。通過多方面的研究和合作，可以改善傷口治療效果，提高病患生活質量，推動醫療護理領域的進步，造福更多的患者。關鍵字: 傷口換藥、燒燙傷、慢性傷口、敷料、疼痛管理

關鍵字

傷口換藥；燒燙傷；慢性傷口；敷料；疼痛管理

並列摘要

Wound dressing has multiple impacts. It is not only a challenge for medical institutions, but also affects wound healing and life quality of patients. This study used the Scopus database and focused on the existing literature in the 21st century (2001-2021), through precisely designed search strings and literature screening. Total 117 scientific literatures were obtained, then used bibliometric method and VOSviewer software to carry out quantitative, qualitative and visual analysis to understand research trends, research findings and knowledge systems in this field. The results showed that the United States is the mainstream research country in this field with the largest number of publications. Timsit et al. (2009) researched on chlorhexidine impregnated sponge and reducing the frequency of dressing changes on infection, which is the most influential literature based on nearly 27 citations per year. The visual analysis results show that "burns", "pain", "children" and "dressing change" are the main research subjects in this field, while the United States, China and the United Kingdom each form different collaborative research networks. Changing wound dressings not only incurs high healthcare costs but may also lead to imbalances and adverse effects, making it a matter of concern for patients. The duration of dressing changes varies depending on the wound's characteristics, which can result in tissue damage, delayed blood clotting, and slow wound healing, thereby significantly affecting patients' mental well-being and wound recovery. Particularly for patients with pressure ulcers or venous ulcers, the pain experienced during dressing changes can be inconvenient, yet this issue is often overlooked by caregivers. This study identifies the primary reasons for wound pain during dressing changes, including inadequate adhesives, dry dressings, wound irrigation, as well as patient fear and anxiety. Hence, healthcare professionals should be aware of these pain-inducing factors and address them accordingly. The key to mitigating pain during dressing changes lies in the careful selection of appropriate dressings. While artificial skin, a novel biomedical material, has been found extensive applications in wound healing, challenges persist concerning its replacement frequency, applicability to specific wound types, and wound restrictions. To address pain during dressing changes, ketamine and its derivatives are commonly used due to their favorable therapeutic index and reduced tolerance issues, making them safer pain management medications. Additionally, non-pharmacological approaches in wound healing, such as communication, relaxation techniques, and music therapy, are emphasized due to effectively reducing anxiety and pain perception in patients. However, this field faces challenges, including the diversity of wound functionality, research limitations, and the standardization of pain assessment tools. To advance research in this area, it should be focused on the needs of specific populations, such as children and the elderly, providing psychological support during dressing changes. Moreover, interdisciplinary and international collaborations are keys to driving progress in this field. Wound dressing and pain management are essential yet complex fields that require the collective efforts of healthcare professionals. Through multidimensional research and collaboration, it can improve wound treatment outcomes, enhance patients' quality of life, advance the field of medical and nursing care, and benefit a larger number of patients. Keywords: wound dressing, burns, chronic wounds, dressings, pain management