Expert consensus on systematic assessment and treatment of refractory wounds in the elderly (2025 edition)
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摘要: 老年难愈性创面的早期预防与规范化管理对于改善预后、降低致残率及提高患者生命质量至关重要。针对老年难愈性创面的诊断和治疗,需全面考虑患者的原发疾病或共病,系统评估患者的全身状况和创面的局部特征。治疗原则包括控制或减缓原发病的发展、营养支持、感染控制、改善循环和封闭创面,同时关注创面的水分平衡,并根据不同类型创面选择合理的治疗方案。治疗目标是在条件允许的情况下尽量闭合创面,或在某些状况下适合选择姑息性管理。未来,智能穿戴、大数据和人工智能领域的发展将对老年难愈性创面的评估与治疗产生重大推动作用。该共识由中国老年医学学会烧创伤分会组织国内创面修复及相关领域的专家共同制订,旨在建立覆盖预防、评估、治疗、康复的全流程规范,推动老年难愈性创面诊断和治疗的标准化与智能化,为临床提供高效、同质化的解决方案。Abstract: Early prevention and standardized management of refractory wounds in the elderly are very important for improving prognosis, reducing disability rate, and improving the quality of life of patients. For the diagnosis and treatment of refractory wounds in the elderly, it is necessary to comprehensively consider the primary disease or comorbidity of patients and systematically evaluate the overall condition and the local characteristics of wounds of patients. The treatment principles include controlling or slowing down the development of the primary disease, nutritional support, infection control, improving circulation, sealing wounds, and paying attention to the water balance of wounds, at the same time selecting a reasonable treatment plan according to different types of wounds. The goal of treatment is to close the wound as much as possible if conditions permit, while in some cases, palliative management may be appropriate. In the future, the development of smart wear, big data, and artificial intelligence will play a significant role in promoting the assessment and treatment of refractory wounds in the elderly. The Burns and Trauma Branch of Chinese Geriatrics Society organized domestic experts engaged in wound repair and related fields to jointly formulate this consensus, aiming to establish a full-process standard covering prevention, assessment, treatment, and rehabilitation and to promote the standardization and intelligence of diagnosis and treatment of refractory wounds in the elderly, thus providing efficient and homogeneous solutions for clinical practice.
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Key words:
- Aged /
- Refractory wound /
- Assessment /
- Treatment /
- Expert consensus
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参考文献
(118) [1] 陶克,曹涛,郝彤.糖尿病足溃疡血管形成障碍的机制及干预策略[J].中华烧伤与创面修复杂志,2025,41(2):120-126.DOI: 10.3760/cma.j.cn501225-20241204-00474. [2] FalangaV, IsseroffRR, SoulikaAM, et al. Chronic wounds[J]. Nat Rev Dis Primers, 2022,8(1):50. DOI: 10.1038/s41572-022-00377-3. [3] WickeC,BachingerA,CoerperS,et al.Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized Wound Care Center[J].Wound Repair Regen,2009,17(1):25-33.DOI: 10.1111/j.1524-475X.2008.00438.x. [4] CheungC.Older adults and ulcers: chronic wounds in the geriatric population[J].Adv Skin Wound Care,2010,23(1):39-44; quiz 45-46.DOI: 10.1097/01.ASW.0000363487.01977.a9. [5] WangXQ,ChenPJ.Population ageing challenges health care in China[J].Lancet,2014,383(9920):870.DOI: 10.1016/S0140-6736(14)60443-8. [6] FengZ,LiuC,GuanX,et al.China's rapidly aging population creates policy challenges in shaping a viable long-term care system[J].Health Aff (Millwood),2012,31(12):2764-2773.DOI: 10.1377/hlthaff.2012.0535. [7] DonohueJM,PincusHA.Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment[J].Pharmacoeconomics,2007,25(1):7-24.DOI: 10.2165/00019053-200725010-00003. [8] HardingKG,MorrisHL,PatelGK.Science, medicine and the future: healing chronic wounds[J].BMJ,2002,324(7330):160-163.DOI: 10.1136/bmj.324.7330.160. [9] MakrantonakiE,WlaschekM,Scharffetter-KochanekK.Pathogenesis of wound healing disorders in the elderly[J].J Dtsch Dermatol Ges,2017,15(3):255-275.DOI: 10.1111/ddg.13199. [10] LeBlancK,LangemoD,WooK,et al.Skin tears: prevention and management[J].Br J Community Nurs,2019,24(Suppl 9):S12-18.DOI: 10.12968/bjcn.2019.24.Sup9.S12. [11] Al-NuaimiY,SherrattMJ,GriffithsCE.Skin health in older age[J].Maturitas,2014,79(3):256-264.DOI: 10.1016/j.maturitas.2014.08.005. [12] FarageMA,MillerKW,BerardescaE,et al.Clinical implications of aging skin: cutaneous disorders in the elderly[J].Am J Clin Dermatol,2009,10(2):73-86.DOI: 10.2165/00128071-200910020-00001. [13] MartinengoL,OlssonM,BajpaiR,et al.Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies[J].Ann Epidemiol,2019,29:8-15.DOI: 10.1016/j.annepidem.2018.10.005. [14] StaraceM,CarpaneseMA,PampaloniF,et al.Management of malignant cutaneous wounds in oncologic patients[J].Support Care Cancer,2022,30(9):7615-7623.DOI: 10.1007/s00520-022-07194-0. [15] LyundupAV,BalyasinMV,MaksimovaNV,et al.Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies[J].Int Wound J,2022,19(4):871-887.DOI: 10.1111/iwj.13688. [16] GouldL,AbadirP,BremH,et al.Chronic wound repair and healing in older adults: current status and future research[J].J Am Geriatr Soc,2015,63(3):427-438.DOI: 10.1111/jgs.13332. [17] JärbrinkK,NiG,SönnergrenH,et al.Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review[J].Syst Rev,2016,5(1):152.DOI: 10.1186/s13643-016-0329-y. [18] NelsonEA,AdderleyU.Venous leg ulcers[J].BMJ Clin Evid,2016:1902. [19] MargolisDJ,BilkerW,SantannaJ,et al.Venous leg ulcer: incidence and prevalence in the elderly[J].J Am Acad Dermatol,2002,46(3):381-386.DOI: 10.1067/mjd.2002.121739. [20] GouldLJ, AbadirPM, White-ChuEF. Age, frailty, and impaired wound healing[M]//Rosenthal R, Zenilman M, Katlic M. Principles and practice of geriatric surgery.Cham: Springer. https://doi.org/10.1007/978-3-319-47771-8_27. doi: 10.1007/978-3-319-47771-8_27 [21] 陈雪莲,刘琰.程序性细胞死亡在慢性难愈合创面炎症反应中的作用研究进展[J].中华烧伤与创面修复杂志,2024,40(10):991-995.DOI: 10.3760/cma.j.cn501225-20240123-00029. [22] BaumgartenM,MargolisD,BerlinJA,et al.Risk factors for pressure ulcers among elderly hip fracture patients[J].Wound Repair Regen,2003,11(2):96-103.DOI: 10.1046/j.1524-475x.2003.11204.x. [23] FarageMA,MillerKW,ElsnerP,et al.Intrinsic and extrinsic factors in skin ageing: a review[J].Int J Cosmet Sci,2008,30(2):87-95.DOI: 10.1111/j.1468-2494.2007.00415.x. [24] BontéF,GirardD,ArchambaultJC,et al.Skin changes during ageing[J].Subcell Biochem,2019,91:249-280.DOI: 10.1007/978-981-13-3681-2_10. [25] SenCK,GordilloGM,RoyS,et al.Human skin wounds: a major and snowballing threat to public health and the economy[J].Wound Repair Regen,2009,17(6):763-771.DOI: 10.1111/j.1524-475X.2009.00543.x. [26] GuptaS, SagarS, MaheshwariG, et al. Chronic wounds: magnitude, socioeconomic burden and consequences[J]. Wounds Asia, 2021, 4(1): 8-14. [27] ZhaoR,LiangH,ClarkeE,et al.Inflammation in chronic wounds[J].Int J Mol Sci,2016,17(12):2085.DOI: 10.3390/ijms17122085. [28] AlamW,HassonJ,ReedM.Clinical approach to chronic wound management in older adults[J].J Am Geriatr Soc,2021,69(8):2327-2334.DOI: 10.1111/jgs.17177. [29] MurphyC, AtkinL, SwansonT, et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene[J]. J Wound Care, 2020, 29(Suppl 3b):S1-26. DOI: 10.12968/jowc.2020.29.Sup3b.S1. [30] 韩春茂,乔亮,王新刚,等.伤口卫生系列国际专家共识的解读[J].浙江医学,2023,45(4):337-341.DOI: 10.12056/j.issn.1006-2785.2023.45.4.2023-389. [31] KremerM,BurkemperN.Aging skin and wound healing[J].Clin Geriatr Med,2024,40(1):1-10.DOI: 10.1016/j.cger.2023.06.001. [32] Van de KerkhofPC, Van BergenB, SpruijtK, et al. Age-related changes in wound healing[J]. Clin Exp Dermatol, 1994, 19(5):369-374. DOI: 10.1111/j.1365-2230.1994.tb02684.x. [33] PittmanJ.Effect of aging on wound healing: current concepts[J].J Wound Ostomy Continence Nurs,2007,34(4):412-415; quiz 416-417.DOI: 10.1097/01.WON.0000281658.71072.e6. [34] RobertsSB,RosenbergI.Nutrition and aging: changes in the regulation of energy metabolism with aging[J].Physiol Rev,2006,86(2):651-667.DOI: 10.1152/physrev.00019.2005. [35] BlairMJ,JonesJD,WoessnerAE,et al.Skin structure-function relationships and the wound healing response to intrinsic aging[J].Adv Wound Care (New Rochelle),2020,9(3):127-143.DOI: 10.1089/wound.2019.1021. [36] El MohtadiM,WhiteheadK,Dempsey-HibbertN,et al.Estrogen deficiency - a central paradigm in age-related impaired healing?[J].EXCLI J,2021,20:99-116.DOI: 10.17179/excli2020-3210. [37] BrincatM,VersiE,MonizCF,et al.Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy[J].Obstet Gynecol,1987,70(1):123-127. [38] KimuraT,WatanabeY,TokuokaS,et al.Utility of skin perfusion pressure values with the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification system[J].J Vasc Surg,2019,70(4):1308-1317.DOI: 10.1016/j.jvs.2019.01.045. [39] SørensenLT.Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis[J].Arch Surg,2012,147(4):373-383.DOI: 10.1001/archsurg.2012.5. [40] EmingSA,MartinP,Tomic-CanicM.Wound repair and regeneration: mechanisms, signaling, and translation[J].Sci Transl Med,2014,6(265):265sr6.DOI: 10.1126/scitranslmed.3009337. [41] DingX,KakanjP,LeptinM,et al.Regulation of the wound healing response during aging[J].J Invest Dermatol,2021,141(4S):1063-1070.DOI: 10.1016/j.jid.2020.11.014. [42] AshcroftGS,HoranMA,FergusonMW.The effects of ageing on cutaneous wound healing in mammals[J].J Anat,1995,187 ( Pt 1):1-26. [43] ShvedovaM,Samdavid ThanapaulRJR,ThompsonEL,et al.Cellular senescence in aging, tissue repair, and regeneration[J].Plast Reconstr Surg,2022,150:4S-11S.DOI: 10.1097/PRS.0000000000009667. [44] LoescheM,GardnerSE,KalanL,et al.Temporal stability in chronic wound microbiota is associated with poor healing[J].J Invest Dermatol,2017,137(1):237-244.DOI: 10.1016/j.jid.2016.08.009. [45] GosainA,DiPietroLA.Aging and wound healing[J].World J Surg,2004,28(3):321-326.DOI: 10.1007/s00268-003-7397-6. [46] 邵春海,冯学山,刘景芳.住院老年病人营养不良状况及其影响因素分析[J].中国老年学杂志,2008,28(22):2260-2261.DOI: 10.3969/j.issn.1005-9202.2008.22.032. [47] KarukondaSR,FlynnTC,BohEE,et al.The effects of drugs on wound healing--part II. Specific classes of drugs and their effect on healing wounds[J].Int J Dermatol,2000,39(5):321-333.DOI: 10.1046/j.1365-4362.2000.00949.x. [48] GuigozY.The Mini Nutritional Assessment (MNA) review of the literature--what does it tell us?[J].J Nutr Health Aging,2006,10(6):466-485; discussion 485-487. [49] JensenGL, McGeeM, BinkleyJ. Nutrition in the elderly[J]. Gastroenterol Clin North Am, 2001,30(2):313-334. DOI: 10.1016/s0889-8553(05)70184-9. [50] GuoS,DipietroLA.Factors affecting wound healing[J].J Dent Res,2010,89(3):219-229.DOI: 10.1177/0022034509359125. [51] McDanielJC, BrowningKK. Smoking, chronic wound healing, and implications for evidence-based practice[J]. J Wound Ostomy Continence Nurs, 2014,41(5):415-423; quiz E1-2. DOI: 10.1097/WON.0000000000000057. [52] GreiffensteinP,MolinaPE.Alcohol-induced alterations on host defense after traumatic injury[J].J Trauma,2008,64(1):230-240.DOI: 10.1097/TA.0b013e318158a4ad. [53] PierpontYN, DinhTP, SalasRE, et al. Obesity and surgical wound healing: a current review[J]. ISRN Obes, 2014:638936. DOI: 10.1155/2014/638936. [54] BowersS,FrancoE.Chronic wounds: evaluation and management[J].Am Fam Physician,2020,101(3):159-166. [55] FrangezI,CankarK,BanFrangez H,et al.The effect of LED on blood microcirculation during chronic wound healing in diabetic and non-diabetic patients-a prospective, double-blind randomized study[J].Lasers Med Sci,2017,32(4):887-894.DOI: 10.1007/s10103-017-2189-7. [56] NagyFT,OlajosD,VattayB,et al.Dynamic perfusion computed tomography for the assessment of concomitant coronary artery disease in patients with a history of percutaneous transluminal angioplasty for chronic limb-threatening ischemia-a pilot study[J].J Cardiovasc Dev Dis,2023,10(11):443.DOI: 10.3390/jcdd10110443. [57] CriquiMH,MatsushitaK,AboyansV,et al.Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the american heart association[J].Circulation,2021,144(9):e171-e191.DOI: 10.1161/CIR.0000000000001005. [58] BambergR, SullivanPK, Conner-KerrT. Diagnosis of wound infections: current culturing practices of U.S. wound care professionals[J]. Wounds:a Compendium of Clinical Research and Practice, 2002, 14:314-328. [59] DouglasWS,SimpsonNB.Guidelines for the management of chronic venous leg ulceration. Report of a multidisciplinary workshop. British Association of Dermatologists and the Research Unit of the Royal College of Physicians[J].Br J Dermatol,1995,132(3):446-452.DOI: 10.1111/j.1365-2133.1995.tb08681.x. [60] WooKY,SibbaldRG.A cross-sectional validation study of using NERDS and STONEES to assess bacterial burden[J].Ostomy Wound Manage,2009,55(8):40-48. [61] Wound infection in clinical practice. An international consensus[J]. Int Wound J, 2008, 5 Suppl 3(Suppl 3):iii-11. DOI: 10.1111/j.1742-481X.2008.00488.x. [62] StallardY.When and how to perform cultures on chronic wounds?[J].J Wound Ostomy Continence Nurs,2018,45(2):179-186.DOI: 10.1097/WON.0000000000000414. [63] LiS,RenickP,SenkowskyJ,et al.Diagnostics for wound infections[J].Adv Wound Care (New Rochelle),2021,10(6):317-327.DOI: 10.1089/wound.2019.1103. [64] ChaurasiaA,OjhaV,BonalO,et al.Non-healing wounds: a delayed wound infection by mycobacterium tuberculosis[J].J Obstet Gynaecol India,2020,70(3):225-229.DOI: 10.1007/s13224-020-01320-w. [65] BowlerPG,DaviesBJ,JonesSA.Microbial involvement in chronic wound malodour[J].J Wound Care,1999,8(5):216-218.DOI: 10.12968/jowc.1999.8.5.25875. [66] BowlerPG,DuerdenBI,ArmstrongDG.Wound microbiology and associated approaches to wound management[J].Clin Microbiol Rev,2001,14(2):244-269.DOI: 10.1128/CMR.14.2.244-269.2001. [67] SalcidoR,LeeA,AhnC.Heel pressure ulcers: purple heel and deep tissue injury[J].Adv Skin Wound Care,2011,24(8):374-380; quiz 381-382.DOI: 10.1097/01.ASW.0000403250.85131.b9. [68] DerwinR, PattonD, StrappH, et al. Wound pH and temperature as predictors of healing: an observational study[J]. J Wound Care, 2023,32(5):302-310. DOI: 10.12968/jowc.2023.32.5.302. [69] MeloAF, de Mendonça DantasV, ChavagliaSRR, et al. Construction, validationand reliability of an instrument for evaluation and evolution of chronic wounds[J]. Bioscience Journal, 2019, 35(4): 1290-1299. [70] VerasJ,CoelhoLS,NetoL,et al.Identification of biomarkers in diabetic nails by Raman spectroscopy[J].Clin Chim Acta,2023,544:117363.DOI: 10.1016/j.cca.2023.117363. [71] AswathanarayanJB,RaoP,HmS,et al.Biofilm-associated infections in chronic wounds and their management[J].Adv Exp Med Biol,2023,1370:55-75.DOI: 10.1007/5584_2022_738. [72] ByeonJ,BlizinskyKD,PersaudA,et al.Insights into the skin microbiome of sickle cell disease leg ulcers[J].Wound Repair Regen,2021,29(5):801-809.DOI: 10.1111/wrr.12924. [73] BekenyJC,ZolperEG,SteinbergJS,et al.Free tissue transfer for patients with chronic lower extremity wounds[J].Clin Plast Surg,2021,48(2):321-329.DOI: 10.1016/j.cps.2021.01.004. [74] HornSD,FifeCE,SmoutRJ,et al.Development of a wound healing index for patients with chronic wounds[J].Wound Repair Regen,2013,21(6):823-832.DOI: 10.1111/wrr.12107. [75] O'DonnellTFJr,PassmanMA,MarstonWA,et al.Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum[J].J Vasc Surg,2014,60(2Suppl):S3-59.DOI: 10.1016/j.jvs.2014.04.049. [76] 陈鹤鸣,张晓军,陈浩,等. 机体炎症水平、营养状况与难愈性糖尿病足发生和转归的关系研究[J]. 华西医学,2019,34(12):1401-1406. DOI: 10.7507/1002-0179.201906154. [77] BrookesJDL,JayaJS,TranH,et al.Broad-ranging nutritional deficiencies predict amputation in diabetic foot ulcers[J].Int J Low Extrem Wounds,2020,19(1):27-33.DOI: 10.1177/1534734619876779. [78] DebatsIB,WolfsTG,GotohT,et al.Role of arginine in superficial wound healing in man[J].Nitric Oxide,2009,21(3/4):175-183.DOI: 10.1016/j.niox.2009.07.006. [79] LevensonSM,GruberCA,RetturaG,et al.Supplemental vitamin A prevents the acute radiation-induced defect in wound healing[J].Ann Surg,1984,200(4):494-512.DOI: 10.1097/00000658-198410000-00011. [80] MolnarJA, UnderdownMJ, ClarkWA. Nutrition and chronic wounds[J]. Adv Wound Care (New Rochelle), 2014, 3(11):663-681. DOI: 10.1089/wound.2014.0530. [81] AlinoviA, BassissiP, PiniM. Systemic administration of antibiotics in the management of venous ulcers. A randomized clinical trial[J]. J Am Acad Dermatol, 1986,15(2Pt 1):186-191. DOI: 10.1016/s0190-9622(86)70154-0. [82] Local applications to wounds--I. Cleansers, antibacterials, debriders[J].Drug Ther Bull,1991,29(24):93-95. [83] CooperR. A review of the evidence of the use of topical antimicrobial agents in wound care[J]. World Wide Wounds, 2005, 1(1):1-15. [84] RodeheaverGT.Pressure ulcer debridement and cleansing: a review of current literature[J].Ostomy Wound Manage,1999,45(1A Suppl):S80-85; quiz 86S-87S. [85] QaseemA, HumphreyLL, ForcieaMA, et al. Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians[J]. Ann Intern Med, 2015, 162(5):370-379. DOI: 10.7326/M14-1568. [86] EronLJ,LipskyBA,LowDE,et al.Managing skin and soft tissue infections: expert panel recommendations on key decision points[J].J Antimicrob Chemother,2003,52Suppl 1:i3-17.DOI: 10.1093/jac/dkg466. [87] DeHartD. Osteomyelitis associated with pressure sores[J]. Arch Intern Med, 1994, 154(21):2501. [88] CefaluJE,BarrierKM,DavisAH.Wound infections in critical care[J].Crit Care Nurs Clin North Am,2017,29(1):81-96.DOI: 10.1016/j.cnc.2016.09.009. [89] GouldLJ. Surgical aspects of wound care in older adults[J]. Clin Geriatr Med, 2024, 40(3):459-470. DOI: 10.1016/j.cger.2023.12.012. [90] ZulkowskiK. Understanding moisture-associated skin damage, medical adhesive-related skin injuries, and skin tears[J]. Adv Skin Wound Care, 2017, 30(8):372-381. DOI: 10.1097/01.ASW.0000521048.64537.6e. [91] Blume-PeytaviU,KottnerJ,SterryW,et al.Age-associated skin conditions and diseases: current perspectives and future options[J].Gerontologist,2016,56Suppl 2:S230-242.DOI: 10.1093/geront/gnw003. [92] FrankC. Approach to skin ulcers in older patients[J]. Can Fam Physician, 2004,50:1653-1659. [93] KrankeP,BennettMH,Martyn-St JamesM,et al.Hyperbaric oxygen therapy for chronic wounds[J].Cochrane Database Syst Rev,2015,2015(6):CD004123.DOI: 10.1002/14651858.CD004123.pub4. [94] MisraS,ShishehborMH,TakahashiEA,et al.Perfusion assessment in critical limb ischemia: principles for understanding and the development of evidence and evaluation of devices: a scientific statement from the American Heart Association[J].Circulation,2019,140(12):e657-e672.DOI: 10.1161/CIR.0000000000000708. [95] OuseyK,CuttingKF,RogersAA,et al.The importance of hydration in wound healing: reinvigorating the clinical perspective[J].J Wound Care,2016,25(3):122, 124-130.DOI: 10.12968/jowc.2016.25.3.122. [96] CorneliaW, Uta-ChristinaH, PeterE, et al.Clinical efficacy of dressings for treatment of heavily exuding chronic wounds[J].Chronic Wound Care Management & Research, 2015, 2:101. DOI: 10.2147/CWCMR.S60315. [97] 姚泽欣,付小兵,程飚.慢性创面愈合新理念:姑息性创面治疗的研究进展[J].中华烧伤杂志,2020,36(8):754-757.DOI: 10.3760/cma.j.cn501120-20190929-00388. [98] JaulE.Non-healing wounds: the geriatric approach[J].Arch Gerontol Geriatr,2009,49(2):224-226.DOI: 10.1016/j.archger.2008.08.005. [99] IzadiK, GanchiP. Chronic wounds[J]. Clin Plast Surg, 2005, 32(2):209-222. DOI: 10.1016/j.cps.2004.11.011. [100] AllmanRM. Pressure ulcer prevalence, incidence, risk factors, and impact[J]. Clin Geriatr Med, 1997,13(3):421-436. [101] JaulE. Setting up a dedicated pressure ulcer unit in a geriatric ward[J]. J Wound Care, 2003,12(4):131-133. DOI: 10.12968/jowc.2003.12.4.26488. [102] LangemoDK,BlackJ,National Pressure Ulcer Advisory Panel.Pressure ulcers in individuals receiving palliative care: a National Pressure Ulcer Advisory Panel white paper[J].Adv Skin Wound Care,2010,23(2):59-72.DOI: 10.1097/01.ASW.0000363502.84737.c8. [103] DubskýM,FejfarovaV,BemR,et al.Pain management in older adults with chronic wounds[J].Drugs Aging,2022,39(8):619-629.DOI: 10.1007/s40266-022-00963-w. [104] FalangaV,BremH,EnnisWJ,et al.Maintenance debridement in the treatment of difficult-to-heal chronic wounds. Recommendations of an expert panel[J].Ostomy Wound Manage,2008,Suppl:2-13; quiz 14-15. [105] BlackJ.Pressure necrosis in geriatric patients[M].Cham:Springer, 2024. [106] NoorS, KhanRU, AhmadJ. Review understanding diabetic foot infection and its management[J]. Diabetes Metab Syndr, 2017, 11(2):149-156.DOI: 10.1016/j.dsx.2016.06.023. [107] KleinRJ.Using negative pressure wound therapy with instillation and dwell time to create a path to closure for older patients with chronic wounds: a retrospective case series[J].Wound Manag Prev,2022,68(2):16-21. [108] YangC,GossSG,AlcantaraS,et al.Effect of negative pressure wound therapy with instillation on bioburden in chronically infected wounds[J].Wounds,2017,29(8):240-246. [109] 李明锐,王玉川,唐燕,等.改良促血管再生方案辅助高压氧对老年糖尿病足溃疡患者创面修复影响的研究[J].中国糖尿病杂志,2020,28(7):504-509.DOI: 10.3969/j.issn.1006-6187.2020.07.005. [110] ZhaoE,TarkinIS,MoloneyGB.Subcuticular barbed suture and skin glue wound closure decreases reoperation and length of stay in geriatric hip fractures when compared with staples[J].J Am Acad Orthop Surg Glob Res Rev,2021,5(10):e21.00205.DOI: 10.5435/JAAOSGlobal-D-21-00205. [111] KolimiP,NaralaS,NyavanandiD,et al.Innovative treatment strategies to accelerate wound healing: trajectory and recent advancements[J].Cells,2022,11(15):2439.DOI: 10.3390/cells11152439. [112] GünterCI,MachensHG.New strategies in clinical care of skin wound healing[J].Eur Surg Res,2012,49(1):16-23.DOI: 10.1159/000339860. [113] YaoZ, NiuJ, ChengB. Prevalence of chronic skin wounds and their risk factors in an inpatient hospital setting in Northern China[J]. Adv Skin Wound Care, 2020,33(9):1-10. DOI: 10.1097/01.ASW.0000694164.34068.82. [114] IizakaS,OkuwaM,SugamaJ,et al.The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care[J].Clin Nutr,2010,29(1):47-53.DOI: 10.1016/j.clnu.2009.05.018. [115] HollowayS.Skin considerations for older adults with wounds[J].Br J Community Nurs,2019,24(Suppl 6):S15-19.DOI: 10.12968/bjcn.2019.24.Sup6.S15. [116] CheungC. Older adults, falls, and skin integrity[J]. Adv Skin Wound Care, 2017, 30(1):40-46. DOI: 10.1097/01.ASW.0000508713.25077.d6. [117] GoswamiAG,BasuS,ShuklaVK.Wound healing in the golden agers: what we know and the possible way ahead[J].Int J Low Extrem Wounds,2022,21(3):264-271.DOI: 10.1177/15347346211037841. [118] SaldivarRT,TewWP,ShahrokniA,et al.Goals of care conversations and telemedicine[J].J Geriatr Oncol,2021,12(7):995-999.DOI: 10.1016/j.jgo.2021.02.016. -
Table 1. 2011版牛津大学循证医学中心证据等级标准
证据级别 具体描述 1级 基于随机对照试验或单人交叉临床试验的系统性文献回顾,对随机性研究的系统综述 2级 随机对照试验或效果显著的观察性研究 3级 非随机性、对照性队列研究或随访研究 4级 病例系列、病例对照研究或历史对照研究 5级 基于机制的推论 -