Wound cleansing, topical antiseptics and wound healing
Wound cleansing, topical antiseptics and wound healing
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DOI：
10.1111/j.1742-481x.2009.00639.x
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发表时间：
2009-12-01
影响因子：
3.1
通讯作者：
Hayek, Shady N.
中科院分区：
文献类型：
--
作者：
Atiyeh, Bishara S.;Dibo, Saad A.;Hayek, Shady N.
护理质量是伤口愈合的关键要求，“良好”的伤口护理一直是局部预防和控制微生物污染的代名词。外用抗菌剂是杀死、抑制或减少微生物数量的抗菌剂，被认为对于控制伤口感染至关重要。然而，长期以来，它们普遍用于伤口预防或治疗感染，但抗菌液冲洗的优点却很少受到科学研究。与选择性作用于特定靶点的抗生素不同，防腐剂具有多个靶点和更广泛的活性，包括细菌、真菌、病毒、原生动物甚至朊病毒。尽管某些皮肤和伤口清洁剂被设计为具有不同程度抗菌活性的局部溶液，但仍引起了人们的担忧。伤口清洁剂可能会影响正常人体细胞，并可能具有抗有丝分裂作用，对正常组织修复产生不利影响。在没有适当指征的情况下，重复和过度使用抗菌剂治疗伤口可能会产生负面结果，或促进类似于慢性伤口中发现的微环境。然而，当以适当的时间和浓度使用时，某些类别的抗菌剂可以为临床医生提供沿所需方向推动伤口床的工具。本综述总结了使用的各种抗菌剂及其对伤口愈合机制的负面影响。显然，需要重新考虑抗菌剂对伤口的作用及其在伤口护理管理中的作用。
Quality of care is a critical requirement for wound healing and 'good' care of wounds has been synonymous with topical prevention and management of microbial contamination. Topical antiseptics are antimicrobial agents that kill, inhibit or reduce the number of microorganisms and are thought to be essential for wounds infection control. However, they have long and commonly been used on wounds to prevent or treat infection, the merits of antiseptic fluid irrigation have received little scientific study. Unlike antibiotics that act selectively on a specific target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa and even prions. Although certain skin and wound cleansers are designed as topical solutions with varying degrees of antimicrobial activity, concerns have been raised. Wound cleansers may affect normal human cells and may be antimitotic adversely affecting normal tissue repair. Repeated and excessive treatment of wounds with antiseptics without proper indications may have negative outcomes or promote a microenvironment similar to those found in chronic wounds. However, when applied at the proper times and concentrations, some classes of antiseptics may provide a tool for the clinician to drive the wound bed in desired directions. The present review summarises the various antiseptics in use and their negative impact on the wound healing mechanisms. It is clear that the role of antiseptics on wounds and their role in wound care management need to be reconsidered.