以實證醫學方法探討使用不同敷料對住院糖尿病足部潰瘍傷口之影響

實證醫學的相關訓練中培養發現重要問題，找尋合適資料及作出最佳決策的能力。本研究依搜尋策略評讀相關實證文獻，探討使用不同敷料於住院糖尿病足部潰瘍之傷口癒合，以病歷回溯方式收集從2006年7月到2008年12月止，於某醫學中心因嚴重糖尿病足部潰瘍住院患者之資料及評估表，共分析50位患者資料。平均年齡為65.8±11.2歲，平均使用高壓氧治療次數為12.4±11.3次。研究觀察傷口嚴重程度為Wanger stage 3以上，且入院皆有發炎指數偏高情形，依傷口評估結果選用5大類敷料與合併全身性抗生素的使用，則分析其他功能型敷料類包括(Antimicrobial dressings)則佔了37.1％。水凝膠類（Hydrogel）可用於軟化黃腐肉組織，以及泡棉類（Foam）可吸收肉芽增生期所帶來的大量滲液，使用量佔20.4％及28.1％。水膠體敷料（hydrocolloid）保濕性較好但較不容易吸收滲液，故在傷口初期運用較少，亦可與海藻酸鹽類（Alginate）共用，分別佔7.1％和7.3％。結果顯示五大類藥物在住院期間對傷口的影響力，對於出院前WBC與CRP皆有明顯下降46.6％及40.5％，且無主要截肢的情形。故建議患者初期於基層醫療院所求診時，醫護人員應更積極評估患者傷口狀態，給予適當的傷口敷料，以提升醫療成效。

關鍵字

糖尿病足；敷料；高壓氧；實證醫學

並列摘要

How to pose adequate clinical questions, search for appropriate information and make the best decisions of this information can be achieved through the related training programs in Evidence based medicine (EBM). The aim of this study was to effect on the use of different dressings fot hospitalized diabetic foot ulcers based on evidence-based medicine. This was a retrospective study of 50 diabetic foot ulcer patients who were admitted to a medical center between July 2006 and December 2008. The average age of 65.8 ± 11.2 years old, the average use of HBO number of 12.4 ± 11.3. Research observations show that the influence of the five drugs during hospitalization for wound, wound severity Wanger stage3, and admission to all high inflammatory index situation, combined use of systemic antibiotics, local antibiotic the case of drugs or dressings accounted for 37.1% (other functional dressing). As for the 1-2 weeks into the wound debridement and granulation of the hydrogel can be used to soften the yellow slough tissue, and the foam type can absorb exudate, granulation of accounts for 20.4% (hydrogel) and 28.1% (Foam). Hydrocolloid dressings moisture is good but also less easy to absorb exudate, and therefore use less in the wound early stage, or will be shared with other dressings, such as Alginate products, accounting for 7.1% and 7.3% respectively. Since the patients included in this research setting might have received medical treatment in a primary care setting for a certain period of time, we recommend aggressive assessment the wound status with diabetic foot ulcer with more active and positive professional team of referral to enhance the outcome of the treatment.

並列關鍵字

Diabetic Foot ； Bandages ； Hyperbaric Oxygenation ； Evidence-based Medicine

參考文獻

Armstrong, D. G., Lavery, L. A., Nixon, B. P., & Boulton, A. J. (2004). It's not what you put on, but what you take off: Techniques for debriding and off-loading the diabetic foot wound. Clinical Infectious Diseases, 39(Suppl 2), S92-9.

Boulton, A. J. (2004). Pressure and the diabetic foot: Clinical science and offloading techniques. American Journal of Surgery, 187(5A), 17S-24S.

Boulton, A. J., Armstrong, D. G., Albert, S. F., Frykberg, R. G., Hellman, R., Kirkman, M. S., et al. (2008). Comprehensive foot examination and risk assessment. Endocrine Practice, 14(5), 576-583.

Boyko, E. J., Ahroni, J. H., Stensel, V., Forsberg, R. C., Davignon, D. R., & Smith, D. G. (1999). A prospective study of risk factors for diabetic foot ulcer. the seattle diabetic foot study. Diabetes Care, 22(7), 1036-1042.

Broussard, C. L. (2004). Hyperbaric oxygenation and wound healing. Journal of Vascular Nursing, 22(2), 42-48.

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以實證醫學方法探討使用不同敷料對住院糖尿病足部潰瘍傷口之影響

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