下肢静脉溃疡的全程管理

The whole process of venous leg ulcer management

下肢静脉溃疡(VLU)是下肢慢性静脉疾病的终末期表现,常见的原因有大中静脉和微小静脉功能不全,非血栓性髂静脉压迫及下肢深静脉血栓后遗症,感染也是溃疡加重不愈合的原因。首先要对VLU进行评估,包括病人的一般情况,溃疡肢体的末梢血供情况,创面的大小,部位,渗液,感染,肉芽组织,创周皮肤情况。可以通过CEAP分级及临床严重程度评平(VCSS评分)进行溃疡客观评估,也可采用下肢静脉溃疡病人生活质量问卷(VLU-QOL)和Charing Cross下肢静脉溃疡问卷(CCVLUQ)量表评估溃疡对病人日常活动的影响。VLU的治疗包括药物、加压、病因治疗、创面清创和敷料选择四位一体的综合化,个体化治疗,结合病人科普宣教,往往可以取得较好的临床疗效。

Venous leg ulcer is the end-stage manifestation of chronic venous disease of the lower limbs.The usual reasons include insufficiency of large,medium,and small veins,iliac venous compression syndrome,and post-thrombic syndrome.Infection is also the reason for the progress of non-healing ulcers.First of all,to evaluate the venous leg ulcer,including the patient's general condition,the distal blood supply of the limb,the size and location of the ulcer,exudate,infection,granulation tissue,and the condition of the skin around the ulcer.Ulcers can be objectively assessed by the CEAP classification and VCSS score system,and the influence of ulcers on patients' daily activities using the VLU-QOL and CCVLUQ scales.The treatment option includes medication,compression therapy,etiological treatment,wound debridement,and dressing selection.A four-in-one comprehensive and individualized treatment,combined with popular science and education for patients,can often achieve better clinical results.