MOIST：慢性创面局部管理新理念及其临床意义

王晓慧; 宫晓艳; 陈婷; 蔡红琳; 赵珍妮; 陈卓颖; 王凯丽

doi:10.3760/cma.j.cn501225-20250228-00103

MOIST：慢性创面局部管理新理念及其临床意义

doi: 10.3760/cma.j.cn501225-20250228-00103

1.
浙江大学医学院附属邵逸夫医院伤口造口专科,杭州　310016
2.
浙江大学医学院附属邵逸夫医院护理部,杭州　310016
3.
浙江大学医学院附属邵逸夫医院重症医学科,杭州　310016

基金项目:

浙江省卫生健康行业科技计划一般项目 2025HY0455

详细信息

通讯作者:
王凯丽,Email：wangkaili@srrsh.com

计量
- 文章访问数: 0
- HTML全文浏览量: 0
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-28
- 网络出版日期: 2026-09-21

MOIST: a new concept for local management of chronic wound and its clinical significance

1.
Wound and Ostomy Care Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
2.
Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
3.
Department of Critical Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

Funds:

General Project of Health Industry Science and Technology Plan of Zhejiang Province 2025HY0455

More Information

Corresponding author: Wang Kaili, Email: wangkaili@srrsh.com

摘要

摘要: 慢性创面的修复是一个多因素交织的医学难题,其诊断、治疗和护理过程环节多、难度大,给医患双方均带来沉重的负担。随着临床医学的发展,创面局部治疗的新技术和新方法也在不断涌现。创面管理原则为医务人员提供循证框架,从而规范临床实践。MOIST（M：湿度平衡,O：氧气平衡,I：感染控制,S：支持策略,T：组织管理）理念由德国专家学组于2017年首次提出,并于2023年由跨学科专家组更新,旨在为慢性创面的治疗与护理提供规范化指导。目前,该理念已在国际范围内推广应用,兼具教育工具与临床实践指导功能。该文以MOIST理念为基础,围绕慢性创面管理的核心问题,系统阐述其重点、难点及最新进展,以期为临床实践提供循证依据。
- 伤口愈合 /
- 感染控制 /
- 循证实践 /
- 湿度 /
- 慢性创面
Abstract: The repair of chronic wounds is a complex medical challenge involving multiple factors. The diagnosis, treatment, and nursing process are intricate and challenging, imposing a heavy burden on both patients and healthcare providers. With the advancement of clinical medicine, new technologies and methods for local wound treatment are constantly emerging. The wound management principles provide an evidence-based framework for medical staff to standardize clinical practice. The MOIST (M: moisture balance, O: oxygen balance, I: infection control, S: support strategy, T: tissue management) concept was proposed for the first time by a German expert group in 2017 and was updated by an interdisciplinary expert group in 2023, aiming to provide standardized guidance for the treatment and care of chronic wounds. Currently, this concept has been widely applied internationally and has both educational and clinical practice guidance functions. Based on the MOIST concept and focusing on the essential issues in chronic wound management, this article systematically elaborates on the key points, difficulties, and latest progress, with the aim of providing an evidence-based reference for clinical practice.
- Wound healing /
- Infection control /
- Evidence-based practice /
- Humidity /
- Chronic wounds
所有作者声明不存在利益冲突

HTML全文

参考文献(50)

[1]	NierenbergNE,LevineJM.Infectious aspects of chronic wounds[J].Clin Geriatr Med,2024,40(3):471-480.DOI: 10.1016/j.cger.2024.03.001.
[2]	GravesN,PhillipsCJ,HardingK. A narrative review of the epidemiology and economics of chronic wounds[J].Br J Dermatol,2022,187(2):141-148.DOI: 10.1111/bjd.20692.
[3]	BosanquetDC,HardingKG.Wound healing: potential therapeutic options[J].Br J Dermatol,2022,187(2):149-158.DOI: 10.1111/bjd.20772.
[4]	SchultzGS,SibbaldRG,FalangaV,et al.Wound bed preparation: a systematic approach to wound management[J].Wound Repair Regen,2003,11Suppl 1:S1-28.DOI: 10.1046/j.1524-475x.11.s2.1.x.
[5]	SchultzGS,BarilloDJ,MozingoDW,et al.Wound bed preparation and a brief history of TIME[J].Int Wound J,2004,1(1):19-32.DOI: 10.1111/j.1742-481x.2004.00008.x.
[6]	DissemondJ, AssenheimerB, EngelsP, et al. M.O.I.S.T. - a concept for the topical treatment of chronic wounds[J]. J Dtsch Dermatol Ges, 2017, 15(4):443-445.DOI: 10.1111/ddg.13215.
[7]	DissemondJ,AssenheimerB,GerberV,et al.M.O.I.S.T. concept for the local therapy of chronic wounds[J].Dtsch Med Wochenschr,2023,148(7):400-405.DOI: 10.1055/a-1987-4999.
[8]	WINTERGD.Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig[J].Nature,1962,193:293-294.DOI: 10.1038/193293a0.
[9]	HinmanCD,MaibachH. Effect of air exposure and occlusion on experimental human skin wounds[J].Nature,1963,200:377-378.DOI: 10.1038/200377a0.
[10]	刘子怡,张旭娟,蔡子松,等. 湿性愈合研究进展[J]. 生物技术进展,2023,13(4):534-541. DOI: 10.19586/j.2095-2341.2023.0010.
[11]	NuutilaK,ErikssonE.Moist wound healing with commonly available dressings[J].Adv Wound Care (New Rochelle),2021,10(12):685-698.DOI: 10.1089/wound.2020.1232.
[12]	StoicaAE,ChircovC,GrumezescuAM.Hydrogel dressings for the treatment of burn wounds: an up-to-date overview[J].Materials (Basel),2020,13(12):2853.DOI: 10.3390/ma13122853.
[13]	刘强,孙凯,杨建群,等.慢性伤口创面湿度检测仪的设计与应用评价[J].中国医学装备,2023,20(7):157-161.DOI: 10.3969/J.ISSN.1672-8270.2023.07.032.
[14]	蔡程浩,韩春茂,王新刚.创面外部微环境因素对创面愈合影响的研究进展[J].中华烧伤与创面修复杂志,2024,40(5):489-494.DOI: 10.3760/cma.j.cn501225-20230827-00067.
[15]	GuptaS,MujawdiyaP,MaheshwariG,et al.Dynamic role of oxygen in wound healing: a microbial, immunological, and biochemical perspective[J].Arch Razi Inst,2022,77(2):513-523.DOI: 10.22092/ARI.2022.357230.2003.
[16]	JamesCV,ParkSY,AlabiD,et al.Effect of topical oxygen therapy on chronic wounds[J].Surg Technol Int,2021,39:51-57.DOI: 10.52198/21.STI.39.WH1456.
[17]	FrykbergR,AndersenC,ChadwickP,et al.Use of topical oxygen therapy in wound healing[J].J Wound Care,2023,32(Sup8b):S1-S32.DOI: 10.12968/jowc.2023.32.Sup8b.S1.
[18]	KhanN,HalasehFF,PillaiK,et al.Hyperbaric and topical oxygen therapies in thermal burn wound healing: a review[J].J Wound Care,2023,32(Sup2):S20-S30.DOI: 10.12968/jowc.2023.32.Sup2.S20.
[19]	CatesNK,KimPJ.Topical oxygen therapy for wound healing: a critical evaluation[J].Surg Technol Int,2022,40:33-36.DOI: 10.52198/22.STI.40.WH1492.
[20]	FrykbergRG.Topical wound oxygen therapy in the treatment of chronic diabetic foot ulcers[J].Medicina (Kaunas),2021,57(9):917.DOI: 10.3390/medicina57090917.
[21]	SunXK,LiR,YangXL,et al.Efficacy and safety of topical oxygen therapy for diabetic foot ulcers: an updated systematic review and meta-analysis[J].Int Wound J,2022,19(8):2200-2209.DOI: 10.1111/iwj.13830.
[22]	贺婷,袁丽,杨小玲.血红蛋白喷剂在慢性创面中的作用研究进展[J].中华烧伤与创面修复杂志,2022,38(9):892-896.DOI: 10.3760/cma.j.cn501120-20210727-00261.
[23]	WinaikosolK,PunyavongP,JenwitheesukK,et al.Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray: case report and literature review[J].J Wound Care,2020,29(8):452-456.DOI: 10.12968/jowc.2020.29.8.452.
[24]	DemirL. Efficacy of combined hyperbaric oxygen therapy and topical haemoglobin spray in treating hard-to-heal sloughy wounds[J].J Wound Care, 2024,33(10):796-802. DOI: 10.12968/jowc.2024.0026.
[25]	Babadagi-HardtZ, EngelsP, KanyaS. Wound management with compression therapy and topical hemoglobin solution in a patient with Budd-Chiari syndrome[J]. J Dermatol Case Rep, 2014, 8(1):20-23. DOI: 10.3315/jdcr.2014.1165.
[26]	SwansonT,OuseyK,HaeslerE,et al.IWII Wound Infection in Clinical Practice consensus document: 2022 update[J].J Wound Care,2022,31(Sup12):S10-S21.DOI: 10.12968/jowc.2022.31.Sup12.S10.
[27]	Cwajda-BiałasikJ,MościckaP,SzewczykMT.Antiseptics and antimicrobials for the treatment and management of chronic wounds: a systematic review of clinical trials[J].Postepy Dermatol Alergol,2022,39(1):141-151.DOI: 10.5114/ada.2022.113807.
[28]	CharlesA, MalaniPN. Skin antisepsis to prevent surgical site infections: implications for global surgery[J] . JAMA, 2024,332(7):550. DOI: 10.1001/jama.2024.9622.
[29]	MaloneM,SchultzG.Challenges in the diagnosis and management of wound infection[J].Br J Dermatol,2022,187(2):159-166.DOI: 10.1111/bjd.21612.
[30]	SeckamAM,Twardowska-SauchaK,HeggemannJ,et al.Clinical performance and quality of life impact of an absorbent bacteria-binding foam dressing[J].Br J Nurs,2021,30(5):S21-S30.DOI: 10.12968/bjon.2021.30.5.S21.
[31]	YadavJP,SinghAK,GrishinaM,et al.Insights into the mechanisms of diabetic wounds: pathophysiology, molecular targets, and treatment strategies through conventional and alternative therapies[J].Inflammopharmacology,2024,32(1):149-228.DOI: 10.1007/s10787-023-01407-6.
[32]	张利祥负载浓缩生长因子的甲基丙烯酰化水凝胶促进创面修复的研究重庆陆军军医大学2023 张利祥. 负载浓缩生长因子的甲基丙烯酰化水凝胶促进创面修复的研究[D]. 重庆:陆军军医大学,2023.
[33]	周日兴,董永盛,周旺标.自体富血小板血浆治疗1例血友病A患者膝关节术后慢性难愈合创面[J].中华烧伤与创面修复杂志,2022,38(4):369-372.DOI: 10.3760/cma.j.cn501120-20210202-00045.
[34]	NasiryD,KhalatbaryAR,NooriA,et al.Accelerated wound healing using three-dimensional amniotic membrane scaffold in combination with adipose-derived stem cells in a diabetic rat model[J].Tissue Cell,2023,82:102098.DOI: 10.1016/j.tice.2023.102098.
[35]	KerstanA,DieterK,Niebergall-RothE,et al.Allogeneic ABCB5⁺ mesenchymal stem cells for treatment-refractory chronic venous ulcers: a phase I/IIa clinical trial[J].JID Innov,2022,2(1):100067.DOI: 10.1016/j.xjidi.2021.100067.
[36]	KandhwalM,BehlT,SinghS,et al.Role of matrix metalloproteinase in wound healing[J].Am J Transl Res,2022,14(7):4391-4405.
[37]	Tardáguila-GarcíaA,García-MoralesE,García-AlaminoJM,et al.Metalloproteinases in chronic and acute wounds: a systematic review and meta-analysis[J].Wound Repair Regen,2019,27(4):415-420.DOI: 10.1111/wrr.12717.
[38]	DissemondJ,AugustinM,DietleinM,et al.Efficacy of MMP-inhibiting wound dressings in the treatment of chronic wounds: a systematic review[J].J Wound Care,2020,29(2):102-118.DOI: 10.12968/jowc.2020.29.2.102.
[39]	EdmondsM,Lázaro-MartínezJL,Alfayate-GarcíaJM,et al.Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial[J].Lancet Diabetes Endocrinol,2018,6(3):186-196.DOI: 10.1016/S2213-8587(17)30438-2.
[40]	王晓琳,李靖,边永钎,等.pH值对人真皮微血管内皮细胞成管的影响及其分子机制[J].中华烧伤与创面修复杂志,2023,39(7):662-670. DOI: 10.3760/cma.j.cn501225-20220930-00429.
[41]	王越,李贤,赵伟,等.pH值对慢性创面愈合的影响研究进展[J].中华烧伤杂志,2019,35(6):474-476.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.016.
[42]	吴小泉pH响应型抗菌材料的制备及促伤口愈合性能研究淮安淮安大学2022 吴小泉. pH响应型抗菌材料的制备及促伤口愈合性能研究[D]. 淮安:淮安大学,2022.
[43]	尹祖秀,黄婷婷,王建英,等.pH响应型抗菌水凝胶伤口敷料的制备及促愈合性能[J].高分子材料科学与工程,2024,40(4):29-39.DOI: 10.16865/j.cnki.1000-7555.2024.0070.
[44]	FernandezR, GriffithsR. Water for wound cleansing[J]. Cochrane Database Syst Rev, 2008(1):CD003861. DOI: 10.1002/14651858.CD003861.
[45]	StrohalR,DissemondJ,Jordan O'BrienJ,et al.An updated overview and clarification of the principle role of debridement[J].J Wound Care,2013,22 Suppl:S1-S52.DOI: 10.12968/jowc.2013.22.Sup1.S1.
[46]	DarjiD,PerseJ,ArnoldY.Stepwise surgical technique used to treat recalcitrant pretibial ulcerations: a case series[J].Wounds,2023,35(1):E47-E52.DOI: 10.25270/wnds/21080.
[47]	谭谦.进一步提高对慢性创面传统治疗方法的认识[J].中华烧伤杂志,2021,37(5):410-412.DOI: 10.3760/cma.j.cn501120-20210413-00128.
[48]	袁宇,张瑞东,程义恒,等.负压创面疗法联合富血小板血浆技术治疗糖尿病足溃疡的可行性研究[J].中华糖尿病杂志,2024,16(11):1247-1254.DOI: 10.3760/cma.j.cn115791-20240408-00162.
[49]	魏惠燕,胡宏鸯,王达,等. 微动力负压敷料应用于造口回纳术后切口感染早期干预的护理体会[J]. 护理与康复,2022,21(7):68-69,71. DOI: 10.3969/j.issn.1671-9875.2022.07.020.
[50]	S.T理论在3、4期压力性损伤临床实践中的应用研究[J/OL]. 临床普外科电子杂志,2021,7(3):57-61[2025-02-28].https://d.wanfangdata.com.cn/periodical/CiBQZXJpb2RpY2FsQ0hJU29scjkyMDI2MDcyNzAzMTgxMhISbGNwd2tkenp6MjAyMTAzMDEzGghpOWZyaGszcA%3D%3D. DOI: 10.3969/j.issn.2095-5308.2021.03.013.