臨牀透析 Vol.27 No.2(9)


特集名 透析医療と他科連携 -- 見逃しやすい疾患を中心に
題名 形成外科【透析患者における創傷と消毒の知見】
発刊年月 2011年 02月
著者 安田 順子 産業医科大学病院形成外科
著者 安田 浩 産業医科大学病院形成外科
著者 三宅 伸完 産業医科大学病院形成外科
著者 木村 勇亮 産業医科大学病院形成外科
【 要旨 】 透析患者の創傷の多くは慢性創傷で,創傷治癒は遅延する.白癬などの感染により急激に悪化する.下肢潰瘍は,虚血による潰瘍を疑い血流の評価が必要である.非侵襲的な血流の評価には,動脈硬化の影響を受けない皮膚還流圧の測定が有用である.30 mmHg以下の場合は,まず血管内治療を行う必要がある.局所治療には,外用薬のほか増殖因子の投与や陰圧閉鎖療法が有効である.出口部潰瘍は,二次的治癒の得られた脆弱な部位で感染や機械的外力に弱い.正常皮膚に対する消毒は有用であるが,感染していない潰瘍に対しては再生修復に必要な因子も傷害する.創洗浄を行うことは,細菌数を減少させ細菌のbiofilm形成を防止するうえで有用である.
Theme Working in Cooperation with Other Departments for Dialysis Treatment -- Centered Mainly on Easily Overlooked Conditions
Title Wound management of dialyzed patient
Author Junko Yasuda Department of Plastic and Reconstructive Surgery, University of Occupational and Environmental Health Hospital
Author Hiroshi Yasuda Department of Plastic and Reconstructive Surgery, University of Occupational and Environmental Health Hospital
Author Tadahiro Miyake Department of Plastic and Reconstructive Surgery, University of Occupational and Environmental Health Hospital
Author Yusuke Kimura Department of Plastic and Reconstructive Surgery, University of Occupational and Environmental Health Hospital
[ Summary ] Dialysis patients experience delayed healing of chronic ulcers. Tinea infections due to ulcers may cause rapid deterioration of patients' conditions. It is necessary we evaluate blood flow in lower extremities to detect peripheral arterial disease (PAD). Measurement of skin perfusion pressure (SPP) is a useful and non-traumatic method to evaluate blood flow. SPP is not affected by arterial calcification. When SPP is below 30 mmHg, patients require vascular intervention to predict the likelihood of limb salvage. Topical ointments, negative-pressure wound therapy (NPWT) and growth factors are effective wound care treatments. Because wounds around catheters sites require regeneration of the epithelium, mechanical stimulation and infections positively affects healing. Disinfection of unaffected skin is an effective way to prevent infection. However, disinfection of wound damage regions is a factor in wound repair and regeneration. Therefore, physiological saline or tap water should be used to irrigate ulcers.
戻る