銀離子敷料於傷口照護之文獻回顧

A Literature Review of Silver Ion Dressings and Wound Care

傷口癒合是一個複雜的，動態的過程，需要更換失活和缺乏的細胞結構和組織層。一般來說癒合時間多小於六週歸類於急性傷口，急性傷口癒合包含炎症期、增生期和成熟期，但如果傷口癒合停滯在炎症期且沒有接受良好照護時，急性傷口將轉為慢性傷口進而增加護理的難度。依照傷口分類，可分為清潔傷口（clean-wounds）、清潔污染傷口（clean-contaminated wounds）、污染傷口（contaminated wounds）與髒或感染傷口（dirty or infected wounds），臨床上治療傷口感染以抗生素為主，換藥為輔。但是，過度抗生素使用，產生頑強抗藥性菌株，導致傷口感染無法痊癒，因此，良好的傷口護理概念與新一代的銀離子敷料發明，在互相配合下能有效的治療感染性傷口。然而現今有多種不同的銀離子敷料如Acticoat®、Aquacel Ag®、Urgotul SSD®、Contreet®、KoCarbonAg®等，每一個不同的銀離子敷料都有著不同的傷口照護成效。本文針對銀離子敷料於傷口照護成效進行文獻回顧，發現目前許多文獻多以乾淨傷口作為研究對象，但銀離子敷料不適用於乾淨傷口與清潔污染傷口，因此增加文獻判讀的偏誤。期盼未來能有更具參考性的研究，提供臨床人員有關不同銀離子敷料使用準則，以期提昇傷口照護品質。

Wound healing is a complex and dynamic process of replacing devitalized and missing cellular structures and tissue layers. The acute wound healing process includes inflammation, proliferation and maturation. In accordance with the wound healing period, a wound can be described as acute or chronic. Most acute wound healing time is less than six weeks, but if the wound infection is poorly controlled, acute wounds will become chronic wounds, which increase the difficulty of care. There are four kinds of wound classification divided into clean wounds, clean contaminated wounds, contaminated wounds and dirty or badly infected wounds. Clinical wound infection treatments include antibiotics for the mainstream, with dressing supplements. However, the excessive use of antibiotics can produce resistant strains that are tenacious. Therefore, good wound care dressings with silver ion invention can reduce the cases of wound infection. Today, the market includes a variety of different dressings, such as silver ions Acticoat®, Aquacel Ag®, Urgotulle SSD®, Contreet®, KoCarbonAg® etc., each with a different silver ion dressing giving different results for wound care. We reviewed the effectiveness of silver ion dressings on wound care. Most studies have focused on clean wounds, but silver ion dressings are not suitable for clean and cleancontaminated wounds,increasing the interpretation bias of the literature. Therefore, more references to the silver ion dressing effectiveness of wound care will be needed.