社区护士参与“互联网+伤口护理服务” 意愿及需求的质性研究

摘 要 目的了解城市医共体内社区护士开展“互联网+伤口护理服务”意愿及需求，为完善“互联网+伤口护理服务”模式提供参考。方法自拟访谈提纲对城市医共体内7个社区卫生服务中心的11名社区护士进行一对一的深入访谈，采用Colaizzi现象学研究法分析资料、提炼主题。结果提炼出4个主题：1）有较强的参与“互联网+伤口护理服务”意愿。（2）健全相关法律法规的需求。（3）控制护理服务风险和保障执业安全的需求。（4）完善相关配套制度和创新服务举措的需求。结论城市医共体内社区护士对“互联网+伤口护理服务”的参与意愿较强，健全法律法规、降低服务风险、完善配套制度及创新服务举措是当前主要需求。相关政府管理部门应尽快推进法律法规、制度流程、风险防范及服务新举措的建设和完善，以促进“互联网+伤口护理服务”良性发展。

关键词 社区护士 ；伤口护理；互联网+护理；质性研究

Bee Venom in Wound Healing

Abstract: Bee venom (BV), also known as api-toxin, is widely used in the treatment of different inflammatory diseases such as rheumatoid arthritis or multiple sclerosis. It is also known that BV can improve the wound healing process. BV plays a crucial role in the modulation of the different phases of wound repair. It possesses anti-inflammatory, antioxidant, antifungal, antiviral, antimicrobial and analgesic properties, all of which have a positive impact on the wound healing process. The mentioned process consists of four phases, i.e., hemostasis, inflammation, proliferation and remodeling. The impaired wound healing process constitutes a significant problem especially in diabetic patients, due to hypoxia state. It had been found that BV accelerated the wound healing in diabetic patients as well as in laboratory animals by impairing the caspase-3, caspase-8 and caspase-9 activity. Moreover, the activity of BV in wound healing is associated with regulating the expression of transforming growth factor (TGF-β1), vascular endothelial growth factor and increased collagen type I. BV stimulates the proliferation and migration of human epidermal keratinocytes and fibroblasts. In combination with polyvinyl alcohol and chitosan, BV significantly accelerates the wound healing process, increasing the hydroxyproline and glutathione and lowering the IL-6 level in wound tissues. The effect of BV on the wounds has been proved by numerous studies, which revealed that BV in the wound healing process brings about a curative effect and could be applied as a new potential treatment for wound repair. However, therapy with bee venom may induce allergic reactions, so it is necessary to assess the existence of the patient’s hypersensitivity to apitoxin before treatment.

Keywords: bee venom; wound healing; biological properties; molecular mechanism.

Skin Wound Healing: Normal Macrophage Function and Macrophage Dysfunction in Diabetic Wounds

Abstract: Macrophages play a prominent role in wound healing. In the early stages, they promote inflflammation and remove pathogens, wound debris, and cells that have apoptosed. Later in the repair process, they dampen inflflammation and secrete factors that regulate the proliferation, differentiation,and migration of keratinocytes, fifibroblasts, and endothelial cells, leading to neovascularisation and wound closure. The macrophages that coordinate this repair process are complex: they originate from different sources and have distinct phenotypes with diverse functions that act at various times in the repair process. Macrophages in individuals with diabetes are altered, displaying hyperresponsiveness to inflflammatory stimulants and increased secretion of pro-inflflammatory cytokines. They also have a reduced ability to phagocytose pathogens and efferocytose cells that have undergone apoptosis. This leads to a reduced capacity to remove pathogens and, as efferocytosis is a trigger for their phenotypic switch, it reduces the number of M2 reparative macrophages in the wound. This can lead to diabetic foot ulcers (DFUs) forming and contributes to their increased risk of not healing and becoming infected, and potentially, amputation. Understanding macrophage dysregulation in DFUs and how these cells might be altered, along with the associated inflflammation, will ultimately allow for better therapies that might complement current treatment and increase DFU’s healing rates.

Keywords: macrophage; inflflammation; diabetic foot ulcer; chronic wound; efferocytosis; phenotype; infection.

Study of hydrocellular functional material as microbicidal wound dressing for diabetic wound healing

Abstract

A hydrocellular functional material as a wound dressing is developed and it is found to be superior in its efficacy as  compared to some of the comparator controls in diabetic wound healing studies. A study on wound contraction and  Histopathological analysis is done in rats. The efficacy of the dressing is comparable to the established wound dressings  like Carboxymethyl cellulose alginate dressings and autolytic enzyme based hydrogel. It is found to be superior to  Polyhexamethylene biguanide dressing used as reference controls in this study.The reason for good wound healing performance of the dressing can be attributed to a combined property of effective  exudates management and broad spectrum antimicrobial effect. The concept of functional hydro cellular material has  shown good results due to the excellent balance of exudates pickup and drying it out. This ensures moist wound healing  conditions on the wound. Because of its porous nature it allows good air flow and gaseous exchange in the structure. The cationic sites created on the surface of the dressing ensure a good antimicrobial action on the exudates in the  dressing. It reduces the infection load on the wound. The nonleaching property of the dressing also helps in preventing  the generation of more resistant and mutant strains of the microbes.The developed dressing can be used as a relatively durable long lasting dressing for wound management in diabetic  wounds. The need of repetitive wound dressing changes can be brought down with this concept of dressing. It is not  only cost effective in terms of its material cost but also is a cost effective solution when entire wound management cost  is considered. Such novel wound dressing material can change the quality of life of diabetic wound patients especially in  developing world, where access to functional advanced wound care dressings is limited.

Keywords

Hydrocellular, wound dressing, microbicidal, diabetic wound, exudates.  Date received: 25 May 2021; revised: 3 October 2021; accepted: 5 October 2021.

护理干预对慢性伤口愈合的影响

【摘要】目的：通过护理干预更好的促进术后慢性伤口的恢复。方法：通过对患者实施整体局部的评估，并在伤口常规换药的基础上增加心理护理，伤口疼痛护理，营养支持等护理干预，以达到最佳的伤口愈合。结果：通过实施护理干预，减轻了患者的心理负担，伤口疼痛感，缩短了愈合时间，使慢性伤口更好的愈合。

【关键词】慢性伤口；愈合；护理。

下肢静脉溃疡伤口护理进展

摘要：慢性伤口因为护理难度非常大，持续时间比较长，患者的要求较高，欠缺统一护理标准，护理人员对于伤口的处理方式不被病人所理解，包含伤口清创、预后判断、选取敷料等具有比较大的护理风险以及无法避免的护理风险。文献资料显示，对于伤口评估以及操作流程加以规范，采取准确方式判断伤口预后效果和存在的问题，强化专科护理质量，减少安全隐患，充分体现零缺陷管理目标，属于临床对慢性伤口开展护理的基本原则。下肢静脉溃疡属于复杂性伤口，一直以来为临床外科治疗以及护理广泛关注的问题，该文对于下肢静脉溃疡伤口的护理进展情况做一综述。

关键词：下肢静脉溃疡；伤口；护理进展