2013年3月16日 星期六

使用美皮蕾防水型自黏性矽膠泡棉敷料來做一種簡單的負壓傷口治療換藥方法

游朝慶
   這篇是第二篇海報,以個案報告的方是來寫出另一種NPWT的創新換藥方法。這裡當然也曾試過其他家的防水敷料,但最後還是Mölnlycke家的最好用,至於若傷口比較深的話,還是需要以泡棉或紗布來填塞。

此張照片已一次拍下三張海報。
負壓傷口治療(NPWT)已被認為可有效治療急慢性問題傷口,但其換藥方式有點複雜,需先將泡棉剪裁後塞入傷口,這會花一點時間,然後用一塊大於傷口邊緣3-5公分的防水薄膜覆蓋,然而,在一些不平整的區域,或會被重壓的部位,如腳底或薦部壓瘡,要用防水薄膜來確保密封,是一件很困難的事,常會遇到漏氣或薄膜破裂。作者介紹使用美皮蕾防水型自黏性矽膠泡棉敷料(Mepilex® Border, Mölnlycke Health Care)來取代泡棉及防水薄膜,並使這種換藥方法變得更簡單。
個案報告:
Mepilex® Border是一種多合一的島型敷料,1.傷口接觸面含有抗沾黏的silicone,可有效密封傷口及不傷害傷口周圍皮膚,2.可吸收滲液的泡棉,3.最外層是可透氣的防水層,有優越的抗張力能力,可用來取代防水薄膜。

一個87歲的臥床男性,過去病史有巴金森氏病,其兩側髖關節及薦骨處均有壓瘡,已超過一年,我在Mepilex® Border上切開一個3公分的切口,將抽痰管置入其切口中,再以Tegaderm防水薄膜密封其切口。再將此組合裝置於患者的右邊髖股壓瘡上,再接上牆壁上的抽吸系統,整個過程花不到5分鐘。
討論:
NPWT適當地使用可促進傷口床的肉芽增生,但由於NPWT安裝複雜,使得許多醫師不願去使用,我們介紹這一種簡單的NPWT安裝方式,可適用於各式傷口。不易漏氣,不怕破掉,可重複黏貼數次。最後,但非最不重要的是,Mepilex® Border 健保有給付。

患者的右臗部壓瘡,6.5*6cm

使用的材料

將mepilex border切開一小洞

將抽痰管至入小洞

以Tegaderm密封

將mepilex-border背面薄膜撕開

直接貼在傷口上

接上wall suction

It works
最後附上原文Abstract如下:
a easy dressing change method of negative pressure wound therapy by use of Mepilex Border
Chao-Chin Yu
Department of Surgery, Tainan Municipal Hospital
Purpose:
Negative Pressure Wound Therapy (NPWT) has become an established method of treatment for problematic acute and chronic wounds. Traditionally, when we apply the VAC system on the wound, we first place the foam into the wound cavity and then cover the foam and 3-5cm of surrounding intact skin with the drapes. However, it takes lots of time to cut and shape the foam to fit the wound. And in some hard-to-access wound site, to ensure an occlusive seal becomes difficult with the transparent drape. The introduction of Mepilex® Border (Mölnlycke Health Care) use instead of drape and foam may facilitate access to this therapy.
Materials and Methods:
Mepilex® Border is an all-in-one island dressing that consists of: 1. A silicone adhesive wound contact layer which helps establish an effective seal and is gentle on the periwound area. 2. an absorbent pad which can replace the foam, and 3. an outer vapour-permeable waterproof film which has excellent tensile strength and elongation and can replace the transparent film.
The 87 year bed-ridden old male with past history of Parkinsonism is a victim of pressure ulcers over bil hip and sacrum for 1 year. I cut 3 cm sized hole in film of mepilex border. Place the sputum suction tube into the hole of mepilex border and sealed with Tegaderm. The Mepilex Border was placed on the rt hip ulcer. And then apply a wall suction system. It works and takes less than 5minutes.
Discussion:
Appropriate use of NPWT may be an effective alternative therapy to achieve faster granulation of the wound bed. However, the difficulty of NPWT installation deters many physicians from using the technique. We introduce a simple and easy method of NPWT for all kind of ulcer. Last, but not least, the Mepilex® Border is paid by National Health Insurance.

6 則留言:

  1. 請問這樣的敷料需要多少費用???

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    1. 『防水自黏性矽膠泡棉敷料』一片健保價
      MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 7.5X7.5CM :68元
      10X10CM 119元 15X15CM 250元 15CMX20CM 326元
      其餘都是醫院常用的耗材

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  2. 請問這樣的換藥方式也是一週只換兩次嗎?肉芽組織生長情形與放海綿比較,何種方式較優呢

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    1. 一週兩次
      以長肉芽組織而言,單然還是配合傳統的海綿較優
      此種Mepilex-border只是用來取代防水薄膜
      整個設計,和smith & nephew的PICO類似
      可參考『最小的NPWT機器~~PICO開箱文(圖多)』http://woundmaster.blogspot.tw/2012/08/npwtpico.html

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  3. 不知該如何才能買到這產品呢?

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    1. 問問杏一或維康吧
      這已不是新產品了
      很多醫院都有進此產品

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