術後傷口怎麼照顧 - 凡士林可以取代所有抗生素藥膏

 

 

 

術後傷口怎麼照顧 - 凡士林可以取代所有抗生素藥膏

 

 

 

術後傷口怎麼照顧?醫師:一罐凡士林,可以取代所有抗生素藥膏!

 

 

凡士林(圖) 


還用抗生素藥膏擦皮膚外科傷口?你可能浪費錢卻換來更多問題


有時幫開刀的病人拆線時,看到傷口附近很紅。

『你覺得傷口附近有什麼感覺?』筆者問。

 

『是不會痛啦!可是最近幾天變得很癢,我想可能是快好了才會這樣。』病人不以為意。

『那你對藥膏過敏了啦!』

原來病人很認真擦藥、換藥,沒想到適得其反,居然造成傷口出現接觸性皮膚炎了。說起來筆者也要付點責任,因為那條抗生素藥膏正是筆者開出去的。

但是,這真的是不得已的。每次要幫病人手術,筆者常常會刻意『忘記』開那條抗生素藥膏。結果十次裡面有十一次病人都會跑回來敲門說:『醫師,你忘記開抗生素藥膏了。』每次向病人解釋這種傷口不用擦抗生素藥膏的理由,講了好幾次病人都不能接受,看著後面候診的幾十個病人,最後也只能隨波逐流了。

到底要不要開抗生素藥膏給一般非感染性的皮膚外科傷口(第一級/清潔傷口)?
早期認為避免感染可以讓傷口癒合較好,所以建議給病人抗生素回家換藥。然而有些外用的抗生素會使傷口附近出現接觸性皮膚炎,況且一般情況下傷口的表皮在兩天之內就會長好,連要發展出感染(一般要至少三天)都不太容易。因此有些人開始挑戰術後傷口要用抗生素的說法:

1996年,有人拿992名患者的1249個傷口做比較,一半用抗生素藥膏(bacitracin),一半用凡士林(petrolatum)。結果兩者傷口的感染率沒有差異,但有些用抗生素藥膏的人出現接觸性皮膚炎,用凡士林的人則完全沒有。凡士林完勝。(發表於美國醫學會期刊)

2005年,有人拿147隻耳朵做Mohs(逐片切除腫瘤,邊切邊用顯微鏡看,直到切乾淨為止)手術後的傷口來實驗,分別擦抗生素藥膏(gentamicin)與凡士林,結果發現兩者發現化膿性(感染性)軟骨炎的比例差不多,但擦抗生素藥膏的傷口明顯較容易產生發炎性(非感染性)軟骨炎。凡士林完勝。(發表於皮膚外科期刊)

2006年,另一群人比較用密封式敷料(像Tegaderm等防水薄膜)的729個傷口,一組完全不擦、一組擦石蠟(paraffine)、一組擦抗生素藥膏(mupirocin),結果發現三者的感染率與併發症完全沒有差異。(發表於英國外科期刊)

2011年,拿三十位移除脂漏性老化(老人斑)志願者的傷口來實驗,在每個受試者身上移除兩塊類似的老人斑,一個傷口擦抗生素藥膏( polymyxin B sulfate+bacitracin),另一個擦凡士林,採用雙盲的方式來進行。結果兩者癒合的狀況完全一樣,但是有些擦抗生素的傷口又出現了接觸性皮膚炎。這次又是凡士林完勝。(發表於美國皮膚科醫學會期刊)

經過了十幾年的論戰,目前學界已經有共識:對於一般非感染性的皮膚外科傷口(第一級/清潔傷口)根本不需要使用外用抗生素,用了反而會有接觸性皮膚炎的問題。從經濟面看,抗生素藥膏的花費ˋ也造成了巨量的醫療資源浪費。建議可以用凡士林或是石蠟取代。

然而,由於民眾早已習慣傷口要擦抗生素藥膏,加上健保也給付這些項目,使得每天我們都被迫要開立這些處方給病人。如果不開立,就要花上大量的時間向病人解釋,或是受到病人無謂的質疑。如果真要遏止這種有害無益、浪費物力的醫療行為,就應該將這段事實寫入國中小健康教育課本,並且由政府帶頭宣傳才行。

目前如果政府財政有問題,筆者建議可以製作簡明、大字的公定海報,供所有醫療院所下載輸出,貼在診間教育民眾,這才是真正解決健保浪費,改善醫療品質的務實做法。

好吧,就由我來做海報,拋磚引玉好了。如果覺得還可以,也歡迎大家使用,寫明出處即可。


※結論:一般沒有感染的皮膚外科傷口(手術後的傷口),可以用凡士林/石蠟/防水敷料覆蓋就好,根本不需要擦外用抗生素。https://health.udn.com/health/story/5971/3744677

參考資料:

1.Smack DP, Harrington AC, Dunn C, . Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA. 1996;276:972–7

2. Campbell RM, Perlis CS, Fisher E, . Gentamicin ointment versus petrolatum for management of auricular wounds. Dermatol Surg. 2005;31:664–9

3. Dixon AJ, Dixon MP, Dixon JB. Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing. Br J Surg. 2006;93:937–43

4. Draelos ZD, Rizer RL, Trookman NS. A comparison of postprocedural wound care treatments: do antibiotic-based ointments improve outcomes? J Am Acad Dermatol. 2011;64:S23–9

5. Saco M, Howe N, Nathoo R, Cherpelis B. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: asystematic review and meta-analysis. J Dermatolog Treat. 2015 Apr;26(2):151-8.

 

 

 

 

 

 

韓國瑜美國行 - 韓國瑜哈佛演講中英文對照全文

 

 

 

 

 

 

韓國瑜美國行 - 韓國瑜哈佛演講中英文對照全文 

 

 

韓國瑜自我解嘲說「土包子進哈佛,作夢都想不到」。

 


自嘲「土包子進哈佛」 韓國瑜演講中英文對照全文

高雄市長韓國瑜美東時間11日下午到哈佛大學閉門式演講及座談,韓以「The Power of Down to Earth —They Talk the Talk, I Walk the Walk」發表英文演說,韓自我解嘲說「土包子進哈佛,作夢都想不到」,他也談到,自己不認為有「韓流」旋風,非常清楚能選上市長的原因,不是因為他個人,而是民心。

 

韓國瑜中、英演講稿如下:

The Power of Down to Earth —They Talk the Talk, I Walk the Walk


Good afternoon, Director Szonyi, Director Goldstein, ladies and gentlemen, this is my greatest honor and pleasure to be here today and to begin with, I would like to express my appreciation for the long term friendship between the United States and the R. O. C., and for the support from the US government and its people, so we can engage and cooperate closely. I am more than honored to have this amazing opportunity standing at this podium, in front of the distinguished scholars at the Fairbank Center for Chinese Studies, the most esteemed institution of Chinese Studies in the world, to share my story and to talk about what I think and what I want to do as Mayor of Kaohsiung.

In Taiwan, there are a lot of people calling me a “produce vendor.” Mainly because I worked in a local agricultural products marketing company before I ran in the Mayor election. The media often describes me with the term “down to earth,” and few individuals even name me “country bumpkin” for my humble origins, and my rather direct and unrefined language. Well today, this bald country bumpkin from Taiwan is standing before you, on the campus of one of the most prestigious universities in the world: Harvard! A few months ago, many could not have imagined this, even in their wildest dreams!

What brings me to Harvard today, is the fact that last November, I won an election in Southern Taiwan that nobody thought I could possibly win. Besides, people are saying that I single-handedly reshaped the politics of Taiwan. They are calling this wide-spread political current the “hanliu” or “Han wave.”

However, I don’t believe in “hanliu” or “Han Wave” because I know very well that what brings me to the Mayor position and to speak to you today, is not me as an individual, but is the will of the people. People in Taiwan, especially in Kaohsiung, have had enough of the unproductive government, enough of all the nonsense of ideological manipulation, and enough of pathetic politicians who only talk without making worthy actions.

The reason behind our success, is not because I am at any rate a great person. It is because Taiwans current ruling party is not doing a good job. They have disappointed the people, so the people want something different. In fact, the people of Taiwan dislike not just the DPP, but they are tired of all of traditional politicians. Especially those politicians who come up with fancy slogans and empty promises. They dont know, and they dont care what the people really need. They only talk the talk, but me, I walk the walk.

I walk to the people from all walks of life, with an emphasis on socially vulnerable groups. I insist to stay overnight in different folks’ places once a month, to get close to their real life. I have stayed in an orphanage, a fisherman’s association, a taxi driver’s home and will stay in many others’ places as well. I also walk to the world, to Mainland China, to Southeast Asia, to America and hopefully to more other places in the world. This is not because I like to be Mr. Fogg who travelled around the world in 81 days, but because Kaohsiung deserves more visibility and opportunities. Kaohsiung has been isolated and closed off for too long. As a result, the economy and population are sadly declining. We need to walk out to the world to promote our produce and products, to attract more visitors, and to carry out what I advocate loudly for, “Export Goods Out, Welcome People In, Let Kaohsiung Prosper!” 貨出得去、人進得來、高雄發大財!

You might be curious how come I am so down to earth and not a stereotypical politician. Actually, once, I was one of the politicians people look down on. I had been councilor and congressman for over 10 years. And one day, I came to face the truth that I didn’t do a good job as a politician, so I just decided not to run for the next round of elections. Therefore, I fell out of the upper down to the earth. I have been down to earth ever since and stayed on it as a Mayor now. I know what the people really want – I was one of them, I had hope for the government, that the people in power can do good things for us. I know deep down peoples needs are simple and humble. People want to enjoy peace and security; want a government that can get things done; want to make money; and most importantly, want to have good life.

When I first settled in Kaohsiung, I worked as Director of KMTs Kaohsiung Chapter and we had no funding at all. The DPP had ruled Kaohsiung for more than 20 years, so no one thought I was even close to winning. I had a very hard time raising campaign funds. So when I announced to run for the Mayor election, I went with the slogan “one bottle of water and one bowl of pork rice.” That was all I could provide to the supporters at rallies and gatherings – and most of the time, no pork rice, only a bottle of water! Yet, the reason I did that was not only because we were short of money, but also because I would like to do things differently. I will not be the politician that people dislike anymore. “One bottle of water” is totally against the traditional way of campaigning. Theres an old saying that “you dont need to learn how to win an election as long as you have money.” Back then a lot of people in Kaohsiung warned me that it would be impossible to win the election. I had nothing and my hands were empty, so that made me a non-stereotypical candidate. I was down to earth, down with the crowd and got closer to them. The people who came to my rallies and gatherings were not there for give-away gifts or buffets, they came to support!

What did I give them in return for their support? A response, a response to their worries and anxiety, a response so outspoken that only a country bumpkin would say it out loud to the people: we want to make big money! You are probably familiar with my campaign slogan, “Export Goods Out, Welcome People In, Let Kaohsiung Prosper.” And “100% for better economy and 0 % for political calculations.” Right now, Taiwan is full of political calculations especially in the Cross Straits policies. As a sad result, Taiwans economy has been totally compressed with no room to grow. I have listened to the people, and that is not what they want! What people really want are better incomes, good livings, peace with Mainland China, and mutual respect. That is why I am doing 100% for a better economy and 0% for political calculations.

In the meantime, as a region that is heavily trade oriented, our worst nightmare is to be marginalized. When countries around the world are actively promoting free trade, signing free trade agreements and engaging in regional economic integrations, Taiwan is excluded, and that is not okay for our economic development. The complications and difficulties of achieving regional economic integration is based on the relationship across the Taiwan Straits. To any political leader of Taiwan, the biggest challenge is to maintain peace and stability across the Taiwan Straits, and to ensure Taiwan is not excluded from important international activities.

No one wishes to live in instability and chaos. We are all very clear that the only military threat to Taiwan comes from Beijing. Like Ive said time and again, we have no doubt that the people of Taiwan are determined to strive for democracy. Yet at the same time, we must not doubt the Beijing’s determination for unification. While it is important to strengthen our defense capabilities, we must not blind ourselves to the fact that Beijing has immense military powers. What we must to do is to strive for peaceful coexistence with Mainland China, and to use wisdom to avoid potential conflicts. This is what the people of Taiwan need. We need to face the fact that Mainland China has risen, and to avoid unnecessary confrontations. After all, “War has no winners and peace, no losers.”

Yet in these 3 short years, the international community is once again worried that conflict may erupt in the Taiwan Straits. Beijing is once again threatening unification by military force. President Tsai is talking about how many days Taiwan can hold out until international aid arrives. The Premier of our Executive Yuan is talking about taking the battles into the streets and fighting with fists and broomsticks. These scenarios of violence and bloodshed are not what the people of Taiwan are wishing for!

I believe “Export Goods Out, Welcome People In, Let Kaohsiung Prosper,” is what Kaohsiung people wishing for, and in this sense I see the 92 Consensus is practical and realistic. My view on the 92 Consensus is naturally “One China, Respective Interpretations” based on Constitution and The Act, certainly not “One Country Two Systems,” like Macau or Hong Kong. Some people say that the Beijing does not recognize “One China, Respective Interpretations.” I would like to point out that in the 8 years under KMT’s rule, Beijing certainly did not refuse to interact with us because of KMT’s stance on 92 Consensus. In fact, during those 8 years, we signed many agreements, participated in many international activities, and more countries had granted us visa-waiver status.

In the course of my campaign as Mayor of Kaohsiung, I stressed the importance of economy. My basis for Cross Straits Relations is the ‘92 Consensus. My winning the election showed that the people of Taiwan did not reject my stance on this matter. I openly shout out to President Tsai and her administration. If they are not willing to recognize the ‘92 Consensus, then they must conceive some new ideals and concrete measures so that they can sustain peace and security in the Taiwan Straits and ensure Taiwans economic development. They must somehow enable the people of Taiwan to continuously live in freedom and democracy. So far, they have come up empty.

The United States is without a doubt a very important friend to Taiwan ROC. The US has been our ally in terms of economics, security, military, and politics. We had the Mutual Defense Treaty, and afterwards we have the Taiwan Relations Act, which provides Taiwan with military defense capabilities. The US is also our important trade partner, and our mutual collaborations over the years have given Taiwan a secure and peaceful environment that allowed for our great economic and political developments. We cannot, and should not, drag our American friends down because we are not able to handle the Cross Straits relations effectively. It is one thing to befriend our American allies but its something else to take the American friendship for granted. We must assume our share of the responsibility to secure peace in the Taiwan Straits so that our people can live in democracy and prosperity.

To conclude, the reason I won the election is because the Kaohsiung people agree with my down to earth call for revitalizing the economy and upholding the stability. Actually most of the people in Taiwan all want, in my down to earth expression, “Taiwan is safe, and people are rich.” Since this is Harvard and there must be a lot of Christian friends here today, I would like to take a verse from the Bibles Book of Philippians as my closing remark. “Forgetting what is behind and straining toward what is ahead, I press on toward the goal.”

I pressed on walking the walk and that is the power of being down to earth. Without feet on the ground, we cannot walk.

Thanks again for inviting me and thank you all very much for listening. Thank you!

宋怡明主任、戈迪溫教授、女士們,先生們,今天我非常榮幸能在費正清中國研究中心這個世界上最受尊崇的中國研究機構之一,在諸位傑出學者和研究者的面前,分享我的一些經歷,談一談作為高雄市長,我的想法和我想做的事情。

在台灣,有很多人稱我為“賣菜郎”。主要是因為我在參加市長選舉之前曾在台北市的農產運銷公司工作。媒體也經常用“接地氣”這個詞來形容我,更有些人因為我卑微的出身和我直接了當又不加修飾的說話方式而講我是一個「土包子」。 然而今天,這個台灣的光頭土包子居然能夠來到這個世界上最負盛名的哈佛大學的講台上、站在你們面前。這是幾個月前,許多人作夢都想不到的!

今天我來到哈佛主要是因為在去年11月,我贏了一場選舉,沒有人認為我在台灣南部有任何可能獲勝的機會。也有人說我單槍匹馬地改變了台灣的政治景象、帶起了一種政治風潮,他們稱其為「韓流」。

但是,我不認為有韓流,因為我非常清楚我選上市長的原因,其實不是因為我個人,而是民心。台灣人民,特別是高雄的人民,已經受夠了無能的政府,意識形態的操縱,受夠這些政客光說不練、只會空口說白話。

我們成功勝選的背後原因並不是因為我是一個什麼了不起的人,而是因為台灣現任執政黨實在做得不好。政府讓人民失望,所以人民想要不一樣的選擇。事實上,台灣人民受夠的不僅是執政黨,而是厭倦了所有傳統的政治人物。特別是那些只會提出花哨口號和空洞承諾的政治人物。他們不知道,他們也不關心人們真正需要的是什麼。他們只說不做,但我,我付諸行動。

我用行動走向各行各業的人們,特別是社會較弱勢的族群。我堅持每個月選擇在一個不同的基層地點過夜,以便近距離了解這些民眾的生活情況。我已經夜宿過孤兒院、漁會、計程車運將的家,未來也將在更多其他的基層地方過夜。

我也實際走向世界,去了中國大陸、去了東南亞、現在還來到美國,未來希望走向世界其他地方。 這不是因為我想變成在81天內環遊世界的Mr. Fogg,而是因為高雄應該獲得更多的知名度和機會。高雄已被隔離且封閉太久。長期下來造成經濟衰退、人口減少。我們需要走向世界,推廣我們的城市和產品,吸引更多的人來高雄,並且落實我所希望的“貨出得去,人進得來,高雄發大財!”

你們也許會疑惑為什麼我說話做是如此接地氣又不像典型的政治人物。事實上,我也曾經是民眾看不順眼的那種政治人物。我擔任議員和立委超過10年。直到有一天,我意識到自己並沒有做好一個政治人物的事實,所以我就決定不選了。然後,我從人人稱羨的民意代表變回一個基層民眾。從那以後,我就一直在基層、接地氣,現在即使是市長,也是如此。我知道人們真正想要的是什麼 — 因為我曾經也是其中之一,對政府懷抱希望,期許掌權者可以為我們人民謀福祉。我深知人民的需求是簡單而且卑微的。人民希望享受和平與安全; 希望有一個能做實事的政府; 民眾想賺到錢; 最重要的是,每個人都想擁有美好的生活。

當我一開始落腳高雄的時候,我出任國民黨高雄市黨部的主委。我們沒有資金,加上民進黨已經統治高雄20多年,所以沒有人認為我會有任何機會勝選,因此非常難籌措競選資金。因此,當我宣布競選市長選舉時,我的口號是「一瓶礦泉水和一碗滷肉飯」。這是我在造勢會和集會上所能向支持者提供的 — 大多數時候,連滷肉飯也沒有,只有一瓶礦泉水!然而,這樣做的原因不僅是因為我們沒有什麼錢,也是因為我認為台灣選舉的方式應該要有所改變。我不要再成為人民不喜歡的那種政治人物。「一瓶礦泉水」完全違背了傳統的競選方式。有一句老話:「只要你有錢,你就不需要知道怎麼選舉。」所以當時很多人警告我,要勝選是不可能的,因為我什麼都沒有,我兩手空空,但也這樣讓我成為一個非典型的國民黨候選人,我跟民眾站在一起、聽他們的聲音、了解他們的需要。來到我的聚會或造勢會的人不是為了免費禮物或餐點,他們就是單純的來支持!

而我如何回應他們的支持呢?我針對他們的擔憂和焦慮做出了回應,一個直言不諱的回應、一個只有土包子才會對著大家大聲喊出來:我們要賺大錢!

你們可能聽過我的競選口號,「貨出得去,人進得來,高雄發大財!」和「經濟100分、政治0分”」。現在,台灣就是充斥著政治計算,特別是在兩岸政策方面的問題上,也因此台灣經濟空間受到壓縮,難以成長。我知道民眾的想法,這不是他們想要的!人民真正想要的是有

更好的收入、優渥的生活、與中國大陸和平共處、並且雙方相互尊重。這就是為什麼我認為經濟要100分,而政治必須是0分。

同時,作為一個以貿易為主要導向的地區,我們最糟糕的噩夢就是被邊緣化。當世界各國積極推動自由貿易,簽署自由貿易協定和參與區域經濟體時,台灣都被排除在外,這對我們的經濟發展來說是不行的。實現區域經濟體的複雜性和困難是和兩岸關係的狀況息息相關的。對台灣的任何政治領導人來說,最大的挑戰是維護台灣海峽的和平與穩定,確保台灣不被排除在重要的國際活動之外。

沒有人希望生活在不穩定和混亂之中。我們都非常清楚台灣唯一的軍事威脅來自北京。就像我一再說過,我們不用懷疑台灣人民追求民主的決心,但與此同時,我們也不用懷疑北京追求統一的決心。雖然加強我們的防禦能力很重要,但我們不能對北京擁有強大軍事力量的這一事實視而不見。我們要做的是努力與中國大陸和平共處,用智慧避免潛在的衝突。這是台灣人民所需要的。我們需要面對中國大陸崛起的事實,並且避免不必要的對抗。

然而,在民進黨執政的這短短三年裡,國際社會開始再次擔心台灣海峽可能會爆發衝突。中國大陸的領導人再度提到武統,我們的總統蔡英文談的是台灣在國際援助到來前可以撐幾天,而我們的行政院院長更說要戰到街頭、山區,要民眾拿出掃帚出來和敵軍打架,但是,這些暴力和流血場面絕不是台灣人民所希望的!

我認為「貨出得去、人進得來、高雄發大財」才是高雄人民所希望的,而作為高雄市長,我想把高雄帶到世界,我認為92共識是切實可行的。我對92共識的看法當然是根據憲法和《兩岸人民關係條例》為基礎的“一個中國各自表述。”雖然有人說北京並不承認“一個中國各自表述,”但我想指出,在國民黨執政的8年裡,對於國民黨的 92共識立場,北京沒有拒絕和我們互動交流。事實上,在這8年中,我們簽署了不少協議,參加了許多國際活動,而且更多的國家給予我們免簽的待遇。

在我作為高雄市長的競選過程中,我強調經濟為主,但是在兩岸關係的基礎上,我主張就是九二共識,而人民並沒有排斥這樣的主張。我也公開對蔡總統和她的政府提出呼籲,如果他們不願意承認「九二共識」,就應該拿出一套新的主張和具體作為,以維護台灣海峽的和平與安全,確保台灣的經濟發展,能夠讓台灣人民繼續生活在自由民主之中。但到目前為止,他們什麼也沒有提出來。

毫無疑問地,美國是中華民國最重要的朋友之一,在經濟、安全、軍事和政治各方面都一直是我們的盟友。我們之前有《共同防禦條約》,之後也有《台灣關係法》,提供台灣防衛的力量。不只如此,美國也是我們重要的貿易夥伴,多年來我們共同合作為台灣提供了一個和平安定的環境,使我們的經濟和民主政治得以發展實現。

然而,我們不能也不應該拖累我們的美國盟友,不能因為我們無法妥善處理兩岸關係問題,而把我們的美國朋友拖下水。與我們的美國盟友友好親善是一回事,但將美國友誼視為理所當然卻是另一回事。我們必須承擔台灣在國際情勢和兩岸關係中應盡的責任,讓台灣人民能夠持續生活在民主和繁榮之中。

總之,這次的勝選主要是因為高雄人民同意我振興經濟、追求安定的接地氣呼籲。事實上,若用我接地氣的說法來講,大多數台灣人民所想要的,就是「台灣安全、人民有錢」。因為是在哈佛,今天這裡肯定有不少基督徒朋友們,我想從聖經中摘讀一節經文做為今天的結語:「忘記背後,努力向前,向著標竿直跑。」

我會一直腳踏實地,這就是所謂的接地氣。只有腳踏實地,我們才能持續前進。再次感謝您們的邀請,非常謝謝大家的聆聽。謝謝!https://udn.com/news/story/6656/3751638

 


影片: 韓國瑜哈佛演說