[摘要]目的：觀察银离子敷料联合水凝胶治疗压疮的临床疗效和抑制创面细菌生长的作用。方法：选取2019年3月-2020年3月于笔者医院接受治疗的压疮患者63例。患者均给予基础内科治疗，在此基础上采用银离子敷料联合水凝胶治疗。评价患者疗效，记录患者清创时间、肉芽组织形成时间、上皮组织形成时间以及压疮愈合评价量表（Pressure ulcer scale for healing，PUSH）评分。治疗前、治疗7d、14d、28d后对创面进行细菌培养，并分析细菌培养结果。结果：患者经治疗后，治愈15例（23.81%），显效33例（52.38%），有效10例（15.87%），无效5例（7.94%），总有效率92.06%（58/63）。患者平均清创时间（4.02±1.19）d，肉芽组织形成时间（9.47±2.31）d，上皮组织形成时间（10.15±3.27）d。治疗7d、14d、21d、28d PUSH评分均低于治疗前，治疗14d、21d、28d PUSH评分均低于治疗7d，治疗21d、28d PUSH评分均低于治疗14d，治疗28d PUSH评分低于治疗21d，差异均有统计学意义（P<0.05）。治疗7d、14d、28d创面细菌培养阳性率均低于治疗前，治疗14d、28d创面细菌培养阳性率均低于治疗7d，差异均有统计学意义（P<0.05）。结论：银离子敷料联合水凝胶治疗压疮疗效显著，能够有效促进患者肉芽组织、上皮组织生成和创面愈合进程，抑制创面细菌生长。

[关键词]压疮;银离子敷料;水凝胶;抑菌作用;压疮愈合评价量表

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0026-03

Curative Effect of Silver Ion Dressing Combined with Hydrogel in the Treatment of Pressure Ulcer

WANG Xiao-lei

（Wound Care Clinic，Langfang People's Hospital，Langfang 065000，Hebei，China）

Abstract： Objective  To observe the clinical efficacy of silver ion dressing combined with hydrogel in the treatment of pressure ulcer and the effect of inhibiting bacterial growth in wound. Methods  Selected 63 pressure ulcer patients who were treated in our hospital from March 2019 to March 2020. Patients were given basic medical treatment， and on this basis， silver ion dressing combined with hydrogel treatment was used. Evaluate the patient's efficacy， record the time of debridement， the time of granulation tissue formation， the time of epithelial tissue formation， and the Pressure ulcer scale for healing （PUSH） score during the treatment. Before treatment， 7d， 14d， and 28d after treatment， the wounds were cultured with bacteria， and the results of bacterial culture were analyzed. Results  After treatment， 15 patients were cured （23.81%）， 33 patients were markedly effective （52.38%）， 10 patients were effective （15.87%）， and 5 patients were ineffective （7.94%）， the total effective rate was 92.06% （58/63）. The average patient debridement time was （4.02±1.19）d， granulation tissue formation time was （9.47±2.31）d， epithelial tissue formation time was （10.15±3.27）d. The PUSH scores of pressure ulcers were lower than before treatment for 7d， 14d， 21d and 28d. The PUSH scores of pressure ulcers were lower than 7d after treatment for 14d， 21d and 28d. The PUSH scores of pressure ulcers were lower than 14d of treatment for 21d and 28d. The PUSH scores of pressure ulcers were lower than 21d of treatment for 28d. The differences were statistically significant （P<0.05）. The positive rates of bacterial culture on the wounds of patients on the 7d， 14d and 28d of treatment were lower than before treatment， and the positive rates of bacterial culture on the wounds on the 14d， 28d of treatment were lower than those of 7d of treatment （P<0.05）. Conclusion  Silver ion dressing combined with hydrogel has a significant effect on the treatment of patients with pressure ulcers. It can effectively promote the formation of granulation tissue and epithelial tissue and the process of wound healing， inhibit the growth of wound bacteria.

Key words： pressure ulcer; silver ion dressing; hydrogel; bacteriostasis effect; pressure ulcer scale for healing（PUSH）

压疮是局部持续受压，导致受压部位出现血液循环障碍，最终引起溃烂或坏死的病变，常见于长期卧床、截瘫、糖尿病足等患者[1]。压疮创面局部组织炎症反复、血供差，并且患者多同时存在营养不良、免疫力功能低下等问题，多种因素导致压疮创面不能及时愈合，尤其是Ⅱ、Ⅲ期压疮，更是极大增加了创面愈合的难度[2]。研究发现，湿潤条件以及创面微环境的改善都是促进压疮组织修复的有利条件[3]。银离子敷料主要由羧甲基纤维素钠及银组成，兼具有吸收创面渗液和强效杀菌的作用，控制感染的同时改善创面微环境，利于创面愈合恢复[4]。……