下肢深静脉血栓形成后综合征的溃疡管理

Ulcer management of post-deep venous thrombosis syndrome of lower extremity

下肢静脉性溃疡(VLU)是深静脉血栓形成(DVT)逐渐发展而成的慢性严重并发症之一,是血管外科常见的静脉类疾病,主要与各种慢性静脉疾病导致的下肢静脉高压有关,属于临床表现-病因学-解剖学-病理生理学(CEAP)分级中的C5级或C6级,治疗方法包括手术治疗和非手术治疗,具有发病率低、病因复杂、溃疡愈合速度慢、复发率高、残疾率高的特点,不但严重影响患者的睡眠、情绪及生活质量,而且给患者及其家庭、社会带来严重的经济负担。从溃疡管理的角度出发,及时、准确评估溃疡局部情况及患者全身情况,对伤口情况进行评估时根据创面床准备,彻底清创,选择合适的伤口敷料,必要时进行细菌培养,合理使用抗菌药物以控制感染,同时保持创面清洁、湿润,定期伤口换药。以患者为中心、压力治疗为基础,平衡溃疡进展与经济因素,普及下肢DVT及下肢深静脉血栓形成后综合征(PTS)的相关知识,提高对VLU的认识度,引导患者及家属对压力治疗的健康教育,促使患者长期、规律地坚持压力治疗,重视体育锻炼、清淡饮食、戒烟限酒、作息规律等生活方式,提高对溃疡治疗的依从性,提供个体化溃疡管理,加速创面愈合,预防溃疡复发,提高患者的生活质量。

Venous leg ulcer(VLU)is one of the chronic and serious complications of deep venous thrombosis(DVT),as well as a common venous disease in vascular surgery,which is associated with lower extremity venous hypertension caused by various chronic venous diseases,the clinical symptoms refer to grade C5 or C6 on the clinical etiology anatomy pathophysiology(CEAP)scale.Treatment includes surgical and nonsurgical treatment.The disease is characterized by slow morbidity,complex etiology,slow healing of ulcers,high recurrence and possibility of disability,which seriously affects the sleep,mood and quality of life of patients,and brings serious economic burden to patients,their families and the society.From the perspective of ulcer management,prompt and accurate evaluation of local and systemic conditions of ulcer is needed,the wound assessment need to be prepared based on the wound bed for thorough debridement and appropriate selection of dressing.Bacterial culture is needed when necessary to use antibiotics to control infection,while keeping the wound clean,moist,and change wound dressing regularly.Patient-centered,stress-based treatment by balancing ulcer progression with economic factors,popularizing the relevant knowledge of DVT and post-thrombotic syndrome(PTS)of the lower extremity,improving the awareness of the venous leg ulcer,guiding patients and their families to provide health education on stress treatment to promote patients to maintain long-term and regular compliance to stress treatment,paying attention to physical exercise,light diet,smoking cessation and alcohol restriction,regular work and rest and other lifestyles,improving the medical compliance of ulcer treatment,and providing individualized ulcer management can accelerate wound healing,prevent ulcer recurrence,and improve the quality of life of patients.