The role of debridement in wound repair: a comprehensive review from history to current situation
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摘要: 清创是创面修复的关键措施。该文回顾了清创的历史、理念变化、方法及其在创面修复中的作用机制和精准清创技术的前沿进展, 总结分析了清创在创面修复应用中面临的人才培养不足、数字化或智能化不充分、清创程度难以界定、临床指南及研究不充足等问题并提出应对策略。目前已有多种精准清创技术被研发并用于临床, 但尚不能替代外科清创, 而如何整合这些技术实现优势互补成为未来的研究方向。此外, 随着人工智能在医疗领域的深入应用, 清创也会逐渐朝向数字化和智能化发展。Abstract: Debridement remains a fundamental procedure in wound repair. This paper reviewed the history, concept evolution, methods, and mechanisms in wound repair of debridement, and the cutting-edge progress of precise debridement technology. It also summarized and analyzed the challenges of debridement applied in wound repair, such as insufficient talent training, inadequate digitization and intelligence, difficulty in defining debridement extent, and insufficient clinical guideline and research, and proposed countermeasures. At present, multiple precision debridement technologies have emerged and been applied in clinical practice, while surgical debridement retains its irreplaceable status. Future research direction includes optimizing multimodal integration of these approaches to leverage their complementary benefits. Furthermore, with the deepening application of artificial intelligence in the medical field, debridement will gradually move towards digitalization and intelligence.
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Key words:
- Debridement /
- Infection /
- Artificial intelligence /
- Wound repair /
- Chronic wound
本文亮点(1) 回顾了清创的历史、理念变化、方法及其在创面修复中的作用机制和精准清创技术的前沿进展。(2) 总结分析了清创在我国创面修复中应用面临的问题及应对策略, 展望了未来的发展方向。 -
参考文献
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表 1 常见清创方法的相关情况
Table 1. Relevant information of common debridement methods
清创方法 定义 优点 不足 适应证 机械清创 通过物理方法（如纱布擦拭、冲洗、刷洗）去除坏死组织 操作简单, 成本低, 可快速去除表面坏死组织 疼痛明显, 可能损伤健康组织, 需频繁更换敷料, 存在出血和感染风险 表浅创面、伴少量坏死组织的创面 外科清创 使用手术器械（如手术刀、剪刀）切除坏死组织 清创快速彻底, 可清除大量坏死组织 需专业人员操作, 严格的无菌操作, 有出血或感染风险, 可能损伤健康组织, 创伤大 急性感染创面、坏疽、伴深部组织坏死的创面 自溶清创 利用创面渗出液中的酶和水分软化并溶解坏死组织 无创, 疼痛轻, 对健康组织损伤小 耗时长（数天至数周）, 周围皮肤浸渍, 可能加重感染, 需频繁评估创面及创周情况 慢性非感染创面、伴少量坏死组织或渗液的创面, 有手术禁忌的患者或选择保守治疗的患者 酶学清创 使用外源性酶（如胶原酶）选择性分解坏死组织 对健康组织损伤小, 操作简便 疼痛, 应用的外部环境（pH值和温度等）较为严苛, 成本较高, 菌血症发生风险增加, 可能引发过敏反应 伴少量坏死组织的创面、慢性非感染创面、有手术禁忌的患者或选择保守治疗的患者 生物清创 使用医用蛆虫选择性清除坏死组织并分泌抗菌物质 对健康组织损伤小, 有抗菌作用 费用高, 患者心理抵触, 需专业人员操作, 短暂疼痛, 不适用于有较硬黑痂、肌腱或骨外露的创面 坏死组织较多的创面、经传统清创治疗无效的创面 水动力清创 利用高压水流或水动力清创系统精确清除坏死组织 精准控制, 对健康组织损伤小 设备昂贵, 需专业人员操作且需多次操作, 可能引起疼痛或细菌播散, 不适用于Ⅲ度烧伤 伴大面积坏死组织的创面, 需精细处理区域的创面, 复杂创面的辅助清创 超声清创 利用超声波能量破坏坏死组织并促进血液循环 微创, 促进血液循环, 减少细菌负荷 设备昂贵, 需专业人员操作, 清创不彻底, 不适用于Ⅲ度烧伤 慢性创面, 肛周等特殊部位的创面 
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