背景
負壓傷口治療可追溯至18世紀，1997年Morykwas 等人透過動物實驗證實其可促進血流與肉芽組織生長，負壓傷口治療現已廣泛應用於糖尿病足、壓力性損傷及燒燙傷等臨床傷口治療。於1998年，Fleischmann 提出結合間歇性沖洗技術之「負壓傷口灌注式治療」(Negative Pressure Wound Therapy with Instillation and Dwell time, NPWTi-d)，該方法可加速清創或減少換藥頻率，Kim 團隊隨後於2013年發表了負壓傷口灌注式治療的共識指引，並於2020年進行了更新，儘管國際指引已確立，然而國內尚缺乏本土化且系統性的臨床實證指引。
研究目的
本研究旨在轉譯並在地化 Kim 等人(2020)發布之國際指引，並結合本土臨床需求，發展出具備實證基礎與臨床可行性的繁體中文版負壓傷口灌注式治療指引。
研究方法
本研究依循 Fervers 等人（2011）所整合之 ADAPTE 臨床指引改編框架，據此發展並建構適合在地化情境之流程，涵蓋三階段、九個模組與 24 個步驟，成繁體中文版臨床指引的轉譯與改編。內部專家首先以 AGREE II 臨床診療工具及修正版德菲法系統性審閱原指引品質，並在整合評估後擬定初稿，此初稿後續採納國內方法學專家與臨床實務專家之意見，針對治療適應症、溶液選擇、禁忌對象、換藥頻率及負壓設定等核心議題，提出具體且標準化之建議，旨在確保指引具備本土化實用性與臨床可行性。
研究結果與討論
本研究採用 ADAPTE 方法論，結合修正版德菲法，將 2020 年國際負壓傷口灌注式治療指引改編並發展為符合台灣臨床情境之繁體中文版指引，研究初期由內部專家使用AGREE II 臨床診療評估工具對原始國際指引進行品質評估，結果顯示該指引於「指引發展的嚴謹度」、「應用性」及「編製的公正客觀與獨立性」三個領域得分未達建議之 70% 門檻，然整體品質評分介於 5 至 6 分，顯示具備可接受之基礎品質，經專家共識後，確立作為中文化指引之初稿基礎，並依本土臨床需求進行調整。
在共識形成階段，第一輪修正版德菲法問卷結果顯示，十一項共識聲明及五十四項細則之評分高度集中於 4 至 5 分，四分位距均小於 2，每項通過比例皆達 80%，僅1-k「階段性／延遲截肢過渡傷口」及2-d「醋酸溶液（0.25% 至1.0%）」兩項細則，經專家討論後因國內實證不足而刪除，第二輪修正版德菲法結果中，各細則平均數介於 4.25 至 5 分之間，四分位距皆低於 2，每項通過比例均達 80%，部分項目更達 100% 共識，最終完成指引定稿。
外部專家以 AGREE II 臨床診療評估工具進行品質評估，結果顯示，本指引於「適用範圍與目的」（87.7%）、「權益相關人參與情形」（74.4%）、「指引清楚呈現」（74.4%）及「編製的公正客觀與獨立性」（85%）等領域均達建議門檻，顯示指引目的明確、結構清楚，且具備良好透明度與臨床可操作性；惟「指引發展的嚴謹度」（68.3%）及「應用性」（55%）未達建議標準，專家建議未來可強化文獻品質評估、臨床執行障礙與成本效益分析，並增列品質指標與檢核工具。整體品質評分介於 4 至 7 分，達中上水準。
本研究成功將國際負壓傷口灌注式指引轉化為符合台灣醫療體系與健保制度之臨床實務標準，並透過精確術語定義及檢核表之增補，降低臨床操作變異性，未來可考慮設計標準化流程或流程圖，以利種子教師培訓及本土多中心研究，持續提升指引之證據等級與臨床推廣價值。
結論
本研究成功開發出台灣首份具備實證基礎的在地化「負壓傷口灌注式治療」臨床指引，透過 ADAPTE 框架將國際標準與國內專家意見整合，此指引有效填補了國際理論與在地實務之間的差距，並針對適應症、溶液選擇及技術參數設定提供標準化規範，最終旨在提升台灣臨床環境中複雜傷口處理的醫療品質與安全性。

This study utilized the ADAPTE framework to systematically localize the 2020 international NPWTi-d consensus guidelines for the Taiwanese clinical context, employing the AGREE II instrument and a two-round Modified Delphi Method to ensure methodological rigor and expert consensus. Although the original guidelines showed limitations in certain quality domains, the adaptation process successfully refined 11 statements and 54 specific items, achieving a high consensus rate (80%–100%) and removing clinically incompatible options such as acetic acid solutions. The final Traditional Chinese version demonstrated superior quality in external appraisals, particularly in "Scope and Purpose" (87.7%) and "Editorial Independence" (85.0%), providing a standardized, evidence-based tool for managing indications, dressing changes, and pressure settings in local wound care.

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