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王江宁教授团队难愈性创面诊疗病例精解
$54.61
王江宁教授糖尿病足综合诊疗知名专家团队是由北京市医院管理局于2018年4月2日批准的第四批市属医院知名专家团队(京医管医护〔2018〕10号),我团队打造了以创面愈合为核心的科室内多学科团队协作(multiple disciplinary team,MDT)综合治疗模式,规避了传统科室各自为政、单打独斗的局面,采用“联合作战”的方式,对患者进行全面检查和细致诊断,针对具体病情制定适合患者的诊疗方案。我团队拥有肢体矫形专家、骨科专家、血管外科专家、整形科专家、糖尿病足专家、营养科专家、血液净化专家、重症医学专家、疼痛科专家、支具工程师、创面治疗师及专业护师等成员,是一个科室的团队,而不是一个医院的团队。团队以外科综合治疗为主体,内科医师辅助管理,营养师参与饮食调整,康复技师指导功能锻炼,足病鞋制造师制造功能支具,足病治疗师进行日常护理。目前,科室内MDT模式被公认为是中国现有医疗条件下理想的糖尿病足慢性创面综合治疗模式。科室内MDT模式诊疗方式包括:①全身基础治疗(基础疾病的控制、全身并发症处理、抗菌药物应用等);②危重症管理(呼吸循环支持、血液净化技术)等技术手段;③合理膳食,低碳饮食控制血糖;④外科综合治疗(骨搬移、加压灌注、血管外科介入技术、清创、植皮及皮瓣技术、死骨去除、腰交感神经节阻滞术治疗疼痛、负压技术应用等);⑤其他治疗方式(生物制剂、微氧、臭氧等);⑥下肢减轻负重及肢体康复(支具、糖尿病足鞋、减负鞋垫、肢体的运动康复、适当的中医按摩防止关节屈曲畸形等);⑦科学适量运动;⑧中医中药。慢性难愈性创面,俗称溃疡,也称慢性伤口。国际伤口愈合学会对其定义为“无法通过正常有序且及时的修复过程达到解剖和功能上完整状态的创面”。临床上多指各种原因形成的创面经1个月以上治疗未能愈合,也无愈合倾向者,而这里所指的1个月并非时间,其有赖于创面大小、病因、个体一般健康状况等多种因素。通常,当创面每周不能缩小10%~15%或超过1个月不能缩小50%时,就被认为是慢性难愈性创面。本书展示了我团队临床治疗慢性难愈性创面的主要措施与体会,以病例分析的形式对糖尿病足溃疡创面、下肢缺血性疾病创面、神经病变创面、压力性损伤创面、肿瘤性创面等治疗中存在的问题进行总结与分析,综合介绍了外科常规清创、切开引流、换药(敷料应用)、蛆虫生物清创疗法、植皮及皮瓣技术、负压技术、皮肤牵张闭合器技术、下肢骨搬移技术、体外循环加压灌注技术、介入治疗、三维重建矫形支具及鞋具技术、营养综合管理及糖尿病患者危重症管理(呼吸循环支持、血液净化技术)等技术手段。本书是一本实战教学用书,也是对创面治疗有规范和引导作用的指南。期待从事创面修复行业的读者通过对本书的阅读能拓展对难愈性创面治疗的思路,进一步提升创面修复诊疗能力,也期待本书能提高本专业规范化水平。
主编简介王江宁,首都医科大学附属北京世纪坛医院矫形外科学科带头人,主任医师,教授,博士研究生导师。国际知名矫形专家,享受国务院政府特殊津贴专家。国际医学保肢协会副主席,中华预防医学会组织感染与损伤防治专业委员会主任委员,北京国际创面与糖尿病足论坛大会主席。*科技进步奖评审专家,国家自然科学基金行评专家。作为作者在SCI收录期刊发表30余篇论文。获国家*科技进步奖1项、省部级科技进步奖3项、国家发明专利2项、美国发明专利1项及印度发明专利1项。承担国家自然科学基金项目3项。
高磊,首都医科大学附属北京世纪坛医院矫形外科医师,糖尿病足知名专家团队成员之一。主要从事修复重建显微外科、矫形骨科专业工作。首都医科大学博士研究生,曾留学德国乌尔姆大学创伤骨科中心;在德国斯图加特人民医院Bad Cannstatt院区糖尿病足中心做访问学者;在德国赖讷MathiasSpital医院夏科氏足研究中心进行研究工作。在SCI收录期刊及国内核心期刊发表多篇论文。担任2项国家自然科学基金项目及3项首都医学特色项目的第二负责人。
目录001 脱细胞异体真皮在糖尿病足创面修复中的应用3例002 糖尿病足坏死性筋膜炎综合治疗1例003 可注射富血小板纤维蛋白修复糖尿病足溃疡1例004 下肢糖尿病性坏死性筋膜炎创面2例005 颈部糖尿病性坏死性筋膜炎创面1例006 皮瓣修复臀部糖尿病性坏死性筋膜炎创面1例007 糖尿病足合并骨髓炎难治性创面1例008 2型糖尿病足坏疽保肢1例009 难愈合压疮创面修复1例010 髋部难愈合创面修复1例011 臀部化脓性汗腺炎创面修复1例012 大面积压力性损伤3例013 糖尿病难治性创面1例014 难治性创面合并糖尿病周围血管病1例015 难愈合压力性损伤患者合并肺炎综合治疗1例016 腹股沟区难治性癌性创面2例017 面部放疗后癌症感染性创面1例018 软组织感染创面1例019 夏科氏足足底溃疡1例020 腰交感神经节射频毁损术治疗糖尿病性周围神经痛1例021 2型糖尿病合并复杂性化脓性汗腺炎1例022 重度感染合并骨髓炎1例023 ECMO局部灌注游离皮瓣修复糖尿病足创面1例024 ECMO技术治疗糖尿病足下肢缺血病变1例025 2型糖尿病性足坏疽合并大面积皮肤缺损1例026 糖尿病足矫形鞋3例附1 糖尿病足、糖尿病皮肤综合征的细胞机制及干细胞再生治疗的潜力附2 应用体外循环灌注游离皮瓣治疗糖尿病足创面的临床标准指南
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