The Clinical Application Research of Silver Dressing in the Management of Chronic Wounds
|School||Nanjing University of Traditional Chinese Medicine|
|Keywords||Silver-containing dressings Chronic wounds effectness safety|
[Objective] By observed dynamic changes of indexes in terms of the wound reduction rate, average wound healing time, Bacterial seroconversion rate,the bacterial species distribution, PUSH score, Inflammatory response and change of wounds exudate. the current study try to prove the effectness of the silver-containing dressings in the treatment of various of chronic wounds including the unhealed incision, pressure ulcer (III), the unhealed of full-thickness burns, diabetic foot ulcers (Wanger III), venous leg ulcers and traumatic chronic wounds in a long-term period as well as the mechanism concerned. Meanwhile our study try to verify the safety of the silver-containing dressings in the long time treatment of chronic wounds by observed the abnormal of the blood regular test, the function of liver and kidney as well as the allergic reactions.[Method]①Object of study:90cases of a chronic wound patients who come to the wound care center of Nanjing General Hospital of Nanjing Military Command and met the inclusion criteria were included in the study after they sign the informed consent form②method of operation Comprehensively assess the wounds by following the wound assessment process of "six step" and treat the wounds with the the wound treatment process of "four step" before the treatment of the silver-containing dressings. In the Observation period of63days, the dynamic changes of indexes in terms of the effectness evaluation and safety evaluation of the silver-containing dressings in the treatment of chronic wounds.effectness evaluation index incuding the wound reduction rate, average wound healing time, PUSH score, Inflammatory response and change of wounds exudate in day1,7,14,28,42,63and the bacterial seroconversion rate in day1,5,10,20as well as the bacterial species distribution; the safety evaluation index incling the Incidence rate of the abnormal results of blood regular test and liver and kidney function as well as the other adverse reactions③The statistical analysis of the data was conducted with SPSS18.0by professional people.[Results] The median wound reduction rate of chronic wounds in day7,14,28,42,63days were0%,9.29%,37.50%,66.70%,100.00%; The median wound reduction rate of day1and day7were not statistically different (P>0.005)but the rest of the median wound reduction rate in the different time were statistically significant (P<0.005); the Comparison of various types of wounds in terms of the median wound reduction rate were conducted in day28and day63, the results shows that in28days (4weeks), no statistically significant difference were observed between the wound reducton rate of different wounds (P>0.001), but in63days (9weeks), the different of wound reducton rate between the pressure ulcer and traumatic chronic wounds as well as the unhealed of full-thickness burns was statistically significant (P<0.001); the average wounds healing time of all types of wounds was46.22+15.98d and the different of the average wounds healing time between the diabetic foot ulcers and traumatic chronic wounds as well as the unhealed of full-thickness burns was statistically significant (p<0.05), the average wounds healing time Between the rest groups was not statistically significant(p>0.05). Bacterial seroconversion rate in day1,5,10,20were0%,30.6%、41.7%,58.3%, which difference was statistically significant (p<0.05). Of the bacterial infection of chronic wounds, Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa accounting for the top three bacteria in day1,5,10,20. Bacterial seroconversion rate of the Gram positive bacterial in day1,5,10,20were00%,23.8%,38.1%,57.1%, the bacterial seroconversion rate of Gram negative bacterial in day1,5,10,20were0%,40%,46.6%,60%, which difference between the different time was statistically significant (p<0.05), but the bacterial seroconversion rate these two types of bacterial was not statistically significant(p>0.05). Diference of the severity of inflammatory response and wounds exudate between day1,7,14,28,42,63was statistically significant(p<0.05),both the inflammatory response and the wounds exudate decrease with the prolonged treatment. The PUSH score in day1,7,14,28,42,63days were12.40±10.96,10.97±3.11,10.28±3.30,8.03±4.64、6.03±5.72、4.18±5.68; the Wound pain score in day1,7,14,28,42,63days were8.01±3.31、7.94±3.30、7.36±3.28、5.63±3.60、3.10±3.74、2.36±3.28, both of the scores in day1and day7were not statistically different.(P>0.05), but the rest of the median wound reduction rate in the different time were statistically different (P<0.05), the incidence of abnormal results of blood regular test and liver and kidney function as well as the other adverse reactions in all observing time point was0%.[Conclusion] The silver-containing dressings can be used for long-term treatment of chronic wounds, which could effectively promote the wound healing through the control of wound infection, reducing the wound inflammatory response and balancing the wound exudate. The silver-containing dressings is more applicable to the healing of full-thickness burns and trauma chronic wounds.its effects on the shortening of treatment time in diabetic foot ulcers as well as its effects on the wound reduction rate of long-term treatment in pressure ulcer are relatively poor. Of the bacterial infection of chronic wounds, Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa accounting for the top three bacteria and silver-containing dressings have favourable lethal effect on various types of bacteria. Silver containing dressings are fairly safe for long-term treatment of chronic wounds.