Silver dressings: their role in wound management.
Silver dressings: their role in wound management.
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DOI：
10.1111/j.1742-481x.2006.00265.x
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发表时间：
2006-12-01
影响因子：
3.1
通讯作者：
Leaper, David J
中科院分区：
文献类型：
--
作者：
Leaper, David J
敷料在伤口管理中发挥作用;无论是缝合伤口还是开放伤口，通常是多种病因的慢性伤口，通过继发性愈合。它们传统上提供湿润的伤口环境，但这种特性已通过简单到复杂的活性敷料得到扩展，这些敷料可以处理过多的渗出液，有助于清创，并促进无组织、停滞的愈合。控制感染仍然是一项重大挑战。不适当的抗生素使用会带来过敏、毒性和最重要的耐药性的风险，使用局部防腐剂（如聚维酮碘和氯己定）可以大大降低耐药性。什么是抗菌剂的定义和感染的识别已被证明是困难的。虽然银几个世纪以来一直被认为可以抑制感染，但其在伤口护理中的应用相对较新。根据科克伦协作组的标准判断，临床试验中越来越多的银敷料的有效性缺乏证据，但银敷料的使用有良好的适应症，可通过次要目的去除或减少烧伤和开放性伤口愈合中不断增加的生物负载，或作为抵抗耐药微生物（如MRSA）交叉污染的屏障。需要更多的实验室数据，特别是临床数据来证明目前可用的许多银敷料的价值。在毒性和抗菌活性的测量上仍然存在一些混淆，但所有敷料都具有抗菌作用，涉及几种输送方法。纳米晶体技术似乎可以向伤口提供最高的、持续的银释放，而没有明显的毒性风险。
Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity.