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摘要:
高原难愈性创面受低氧、强紫外线、高寒等不利条件影响,细胞功能损伤严重,再上皮化受阻,创面愈合延迟甚至不愈合。常规清创引流、功能性敷料等多种传统治疗手段疗效差,患者不仅住院时间长,还可能因创面长期不愈合而导致其他并发症。本文报道1例长达2个月未愈合的高原难愈性创面患者,采用血小板裂解液凝胶治疗2次后,创面完全愈合。该治疗方式为高原难愈性创面患者提供了新的治疗思路,值得临床借鉴。
Abstract:Plateau refractory wounds are affected by adverse conditions such as hypoxia, strong ultraviolet rays, and frigid, which can cause serious cell function damage, hinder re-epithelialization, and delay or even stop the healing of wounds. Conventional debridement and drainage, functional dressings and other traditional treatments have poor efficacy on this type of wound. Not only do patients have to endure long hospital stays, but they may also suffer from other complications due to long-term non-healing of wounds. In this paper, we report a patient with a plateau refractory wound that had not healed for 2 months. After two applications of platelet lysate gel treatment, the wound healed completely. This treatment method provides a new treatment approach for patients with plateau refractory wounds, which is worthy of clinical reference.
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Keywords:
- plateau patients /
- refractory wounds /
- platelet lysate gel
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经过一天烈日的炙烤,住院部外面的地表温度已经高达40 ℃,进进出出需要加强监护的患者还在不断增加,面对监护室内堆积如山的病患,大家的心情已经烦躁不安。高速周转的病房似乎又经历了一波“大洗牌”,病床上躺着不同的面孔,交班正仔细且有序地进行着。“号外……又有新病人要从急诊科转入,目前鼻导管10 L/min吸氧中,呼吸困难,需要重新评估插管指征......”值班护士小罗一边接听着电话,一边冲大家喊道。此刻空气仿佛凝住了一般,最尴尬的事情莫过如此——在交班时要来病人。“大家先交班,速战速决,准备收病人......”作为今天当值的高年资主治医师,我立刻说道。
伴随着转运车的声音,病人送来了,大家立刻围了上去,按照平时标准动作过床、吸氧、完成心电监护连接。我走到病床边,那是一位白发苍苍、胸前皮下还隐约有一枚“勋章”的爷爷,一看心电监护,我本能地反应那枚东西应该是心脏永久起搏器。为了判断病人意识及症状,我拍了拍老人肩膀,问道:“爷爷,您知道这是在哪儿吗?”老人没有回答,但是眼睛在不停地转动,嘴巴似乎要表达什么,带着一点儿北方口音,但听得不太清楚。我瞬时像明白了什么,于是俯下身去对着他的耳朵大声喊道:“爷爷,您知道这是在哪儿吗?您是不是听得不太清楚?”老人摇了摇头,又点了点头。
此时,我身旁一位经验丰富的“老医生”冲我扬了扬手中的听诊器听筒,我第一反应是她要听诊,于是连忙说道:“我来吧。”但她却直接把听头给爷爷戴上了,并对着听筒大声说道:“老爷子,这样能听清吗?”老人喃喃地回答:“听清了,听清了……”慢慢地,他紧崩的神情似乎也逐渐舒展开来。经过一系列问诊和针对性的处理后,爷爷慢慢睡着了。
病人急性呼吸窘迫的病因尚未完全明确,依然有病情随时加重的危险,依照惯例,我们立即联系家属了解老人的病史并进行谈话签字。通过与家属充分沟通,我们了解到了爷爷的慢性病史以及本次发病的诱因,还得知爷爷听力不好,这几天辗转各大医院,一直没休息好,病情也越来越重了。好在经过我们悉心的治疗和照顾,两周后爷爷终于出院了!
门诊复诊时,我看到爷爷耳朵上多了一副助听器,便打趣道:“爷爷,现在声音清楚多了吧?”爷爷笑着回答:“这玩意儿还是没有你们给我戴的东西听得清楚。”我和家属听完都哈哈大笑起来……
后记
听诊器的发明已有近200年的历史,其除了可以帮助医生完成重要的听诊检查外,在某些情况下还可以成为与病人沟通的桥梁。从法国医生雷奈克为了诊治患者,第一次提出“听诊器”的概念,到吴孟超院士在冬天查房时先用双手捂热听诊器再为患者听诊,再到为了能让患者听清楚,发现听诊器的新用途……不同听诊器的故事中,有不同的主人公以及不同的场景,但伴随的都是那份来自医生的爱,那份给予患者温暖的爱。病人与医生之间的第一步,是沟通,是了解,但病人在任何时候和任何状态下,都一定是需要帮助的那个人。任何人在面对身体的病痛时,或是因为没有足够专业的知识,或是因为疾病带来的切肤之痛,无论是酸胀、麻木、疼痛、无力,还是其他任何一种异样的感觉,都会让其内心产生对于异常表现的无限猜测以及随之而来的焦虑、恐慌。初入医学院时的我,心里想的只是如何掌握高精尖的各种医学技术,如何把病看好。进入医院工作多年以后,特别是在经历新型冠状病毒感染疫情后,我深切地体会到,不管医生的技术有多精湛,医疗水平有多高超,医生的关怀和援助永远都是病人最坚实的情感堡垒。治病一定是依靠科学,但让病人感觉到舒服却更需要医生对于患者那颗帮助的心。从医和患这层关系构建起来的那一刻起,他们就不该是对立的,而是共生的,更是共情的,感同身受、同气连枝才是医治疾病的起点,更是每一个合格医生毕生追求的终点。
临床医生正如其名字一样,需要站在床边仔细观察病人。观察的目的除正确诊断病情外,更重要的是察觉病人最需要的帮助是什么。故事中的老人一直处于听不清周围声音的状态,这时候病人可能会感到恐惧与烦躁,甚至会导致病情恶化,而一次仔细的观察就能够使问题迎刃而解。一个小小的听诊器,以及听诊器带来的这份“逆向思维”,彰显的不仅是一种临床采集病史的技巧,更是医生把心打开,试图去侧耳倾听病人诉说的耐心,以及尽其所能去关爱病人的慈悲。
因此,听诊器的故事,讲述的不是一种疾病的诊断,更不是一个病例的转归,听诊器联通的亦非症状与诊断,心跳与鼓膜,而是受伤的心和呵护的手,告诉我你哪里不舒服,我一定会想办法听到你的诉说,也一定会陪着你直到疾病消散。把痛苦告诉我,把希望传给你,这才是听诊器的真正意义所在,才是医生和病人最正确的相处方式。一如美国医生特鲁多对医生这个职业的经典描述——有时是治愈,常常是帮助,总是去安慰!
作者贡献:赵琴负责撰写论文;王海莹负责收集病例资料;王辉提出修改意见;张进进、邢颜超进行选题设计、指导论文写作并终审校对。利益冲突:所有作者均声明不存在利益冲突注:本文发表已获得患者知情同意。 -
图 1 血小板裂解液凝胶治疗前,患者创面大小约2.5 cm×2.5 cm,深约1 cm,周围皮肤弥漫性红肿,呈蜂窝样缺损,可见血性渗出物
Figure 1. Before platelet lysate gel treatment, the size of the wound was about 2.5 cm×2.5 cm, and the depth was about 1cm, and the surrounding skin was diffuse red and swollen, showing honeycomb-like defects, and bloody exudate could be seen
图 4 血小板裂解液凝胶治疗后创面表观变化
A.治疗后3 d,创面部分愈合并结痂;B.治疗后6 d,创面结痂脱落,红肿消退;C.治疗后9 d,创面完全愈合
Figure 4. Apparent changes in wound surface after platelet lysate gel treatment
A.3 days after treatment, the wound partially healed and scabbed; B.6 days after treatment, the wound scab fell off and the redness and swelling subsided; C.9 days after treatment, the wound was completely healed
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