探討活性碳銀離子敷料對感染性壓傷治療之成效

The Effectiveness of Activated Carbon Silver Ion Dressings for Treatment of Infected Pressure Injury

李叡筠(Ruei-Yun Li)；朱舜天(Yu-Tian Zhu)；江采宜(Tsay-I Chiang)

活性碳銀離子敷料 ； 感染性壓傷 ； 銀離子敷料 ； Activated carbon silver dressing ； Infected pressure injury ； Silver dressing

醫學與健康期刊

8卷1期（2019 / 03 / 01）

53 - 66

繁體中文

目的：壓傷是最應被重視的疾病，其合併傷口感染時將會延長照護，臨床發現活性碳銀離子敷料可使微生物菌種感染下降與降低換藥時疼痛，但無研究證明，因此進一步探討活性碳銀離子敷料對於感染性壓傷之成效。方法：本研究為類實驗性研究，採立意取樣，收案期間自2015年5月22日至2016年5月21日，共收案68個傷口，由專科護理師評估活性碳銀離子敷料與銀離子藻膠敷料在傷口疼痛指數、傷口面積、微生物菌種感染與傷口床之差異。結果：運用SPSS套裝軟體分析下，活性碳銀離子敷料能降低傷口疼痛及傷口床總分（p＜0.001），但在微生物菌種感染數與傷口面積皆無顯著差異（p＞0.05）。然而，活性碳銀離子敷料與銀離子藻膠敷料無比較上的差異（p＞0.05）。結論：利用活性碳銀離子敷料，能降低傷口疼痛指數與傷口床分數，但是本研究受限於時間及人力，可能會有引介偏差（referral bias）存在。除此之外，本研究僅為前驅性研究（pilot study），期盼未來能有較大規模之研究探討其差異性。

Objectives. Pressure injuries are frequently encountered in healthcare and increase the number of hospitalization days. Thus, modern dressings, especially those that decrease the drug-resistant infection rates, antibiotics dosage, and pain during dressing changes, are becoming more popular. In this study, we explored the effectiveness of two activated carbon silver dressings on infected wound healing using a conceptual model of wound bed preparation. Methods. In this quasi-experimental study, we sampled 68 wounds in 60 persons from May 22, 2015 to May 21, 2016. Surgical dressings were changed every three days after admission by a single researcher. Wounds were evaluated on the 1st, 4th, 7th, and 14th day after surgical procedures. All statistical operations were performed using SPSS 20.0. Results. Use of activated carbon silver dressing reduced the wound pain and wound bed scores (p＜0.001), but we found no significant difference in decreases in infection rate and wound healing area (cm^2)(p＜0.05). Conclusion. We found no significant difference in changes in wound area and dressing (p＞0.05 ). Both wound dressings were sliver dressings and we did not compare them with other dressings without silver. Further studies with larger sample sizes and different designs to further explore the differences in dressings.

1. Dowsett, C,Newton, H(2005).Wound bed preparation: TIME in practice.WOUNDS UK,1,58-70.
2. Drew, P,Posnett, J,Rusling, L(2007).The cost of wound care for a local population in England.Int Wound J,4,149-155.
3. Falanga, Vincent(2000).Classifications for wound bed preparation and stimulation of chronic wounds.Wound repair and regeneration,6,347-352.
4. Garibaldi, RA,Brodine, S,Matsumiya, S(1981).Infections among patients in nursing homes: policies, prevalence, and problems.NEJM,305,731-735.
5. Kordestani, S,Shahrezaee, M,Tahmasebi, M(2008).Randomised controlled trial on the effectiveness of an advanced wound dressing used in iran.Journal of Wound Care,17,323-327.
6. Lindgren, M,Unosson, M,Fredrikson, M,Ek, AC(2004).Immobility-a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study.Scandinavian journal of caring sciences,18,57-64.
7. Meffre, R,Gehin, C,Schmitt, PM,De Oliveira, F,Dittmar, A(2006).New methodology for preventing pressure ulcers using actimetry and autonomous nervous system recording.Conf Proc IEEE Eng Med Biol Soc,1,5563-5566.
8. Muangman, P,Pundee, C,Opasanon, S,Muangman, S(2010).A prospective, randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns.International wound journal,7,271-276.
9. National Pressure Ulcer Advisory Panel.: NPUAP Pressure Injury Stages. Avialable at: http://www.npuap.org/resources/ educational-and-clinical-resources/npuap-pressure-injury-stages. Accessed Aug 01, 2018.
10. Schultz, GS,Sibbald, RG,Falanga, V(2003).Wound bed preparation: a systematic approach to wound management.Wound Repair Regen,11,S1-S28.
11. Sibbald, RG,Williamson, D,Orsted, HL(2000).Preparing the wound bed--debridement, bacterial balance, and moisture balance.Ostomy Wound Manage,46,14-22+24-28+30-37.
12. Terekeci, H,Kucukardali, Y,Top, C,Onem, Y,Celik, S,Öktenli, Ç(2009).Risk assessment study of the pressure ulcers in intensive care unit patients.Eur J Intern Med,20,394-397.
13. Thomas, S,McCubbin, P(2003).An in vitro analysis of the antimicrobial properties of 10 silver-containing dressings.Journal of wound care,12,305-308.
14. Trial, C,Darbas, H,Lavigne, JP(2010).Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: A RCT.J of Wound Care,19,20-26.
15. 李叡筠, RY,朱彥紅, YH,江采宜, TI,顧家恬, CT(2015)。銀離子敷料於傷口照護之文獻回顧。澄清醫護管理雜誌，11，43-50。
16. 徐翊庭, YT,翁清松, CS(2011)。醫療用傷口照護材之全球產業規模及競爭力分析。先進工程學刊，6，193-199。
17. 曹文昱, WY,羅淑芬, SF,哈鐵木爾, T,李茹萍, RP(2013)。比較傷口敷料處置於壓瘡預防之成效。護理雜誌，60，65-75。
18. 許世祥, SX,楊榮森, RS(2010).臨床傷口醫學.臺北市=Taipei City:力大圖書有限公司=Lida Books Co., Ltd..
19. 游朝慶, CC(2009)。國立雲林科技大學商管專業學院碩士班=Master Class, School of Business Administration, National Yunlin University of Science and Technology。
20. 靳燕芬, YF(2006)。敷料與傷口換藥疼痛。護理雜誌，53，73-77。
21. 靳燕芬, YF,吳蕙菱, WL,林淑眞, SC,邱月璧, YP(2006)。某醫學中心住院病人壓瘡盛行率及發生壓瘡相關因素探討。長庚護理，17，11-21。
22. 羅淑芬, SF,胡文郁, WY(2007)。慢性傷口之評估與測量原則。護理雜誌，54，62-67。
23. 羅淑芬, SF(2010)。國立台灣大學護理研究所博士班=Doctoral Program, National Taiwan University School of Nursing。

1. (2024)。照顧一位硬皮症病人創傷之門診護理經驗。新臺北護理期刊，26(2)，155-163。