rhGM-CSF联合藻酸盐敷料治疗中老年体表慢性难愈性创面的临床观察

发布时间：2018-11-20 04:06

【摘要】：目的观察评价联合应用rhGM-CSF(重组人粒细胞巨噬细胞刺激因子)凝胶与藻酸盐敷料治疗中老年体表慢性难愈性创面的临床疗效及安全性,探讨其有关作用机制,评估将其作为一种治疗中老年体表慢性难愈性创面的非手术疗法的临床可行性。方法采用非盲法随机对照设计,选择于2011-05至2013-05在山东大学附属济南市中心医院烧伤科住院治疗的中老年体表慢性难愈性创面患者60例,采用分层随机分组的方法将其分为4组,每组各15例。分组如下：rhGM-CSF凝胶+藻酸盐敷料+凡士林纱布治疗组(A组)；rhGM-CSF凝胶+凡士林纱布治疗组(B组)；藻酸盐敷料+凡士林纱布治疗组(C组)；凡士林纱布常规治疗组(D组)。试验周期设为8周。观察记录各组用药后的不良反应发生情况,评估治疗前、治疗后1,2,3,4,5,6,7,8周各时相点的创面渗液量、创面色泽及肉芽组织和上皮生长情况、创面疼痛程度、创面愈合率,以及治疗后8周各组的创面痊愈率、有效率。结果 1.创面渗液量：入组治疗前各组创面渗液量比较差异无统计学意义(P0.05)；开始治疗后,各组创面渗液量均呈减少的趋势,各时相点组间创面渗液量比较差异有统计学意义(P0.05)；治疗后1-4周,A组和C组创面渗液量均少于B组和D组,差异有统计学意义(P0.05)；治疗后5-8周,A组、B组和C组创面渗液量均少于D组,差异有统计学意义(P0.05)。 2.大体观察：入组治疗前各组创面色泽及肉芽组织和上皮生长情况比较差异无统计学意义(P0.05)；开始治疗后,各组创面基底均呈现出由黄白色苍老肉芽向鲜红色新鲜肉芽转变的趋势,治疗后3-8周,各组间创面色泽及肉芽组织和上皮生长情况比较差异有统计学意义(P0.05)；治疗后3-4周,A组和B组在创面色泽、肉芽组织和上皮生长情况方面均好于C组和D组,差异有统计学意义(P0.05)；治疗后5-8周,A组、B组和C组在创面色泽、肉芽组织和上皮生长情况方面均好于D组,差异有统计学意义(P0.05)。 3.创面疼痛程度：入组治疗前各组间创面疼痛程度比较差异无统计学意义(P0.05)；开始治疗后,各组创面疼痛程度总体呈现逐渐降低的趋势,各时相点组间疼痛程度比较差异有统计学意义(P0.05)；治疗后1-4周,A组和C组创面疼痛程度均低于B组和D组,差异有统计学意义(P0.05)；在治疗后5-8周,A组、B组和C组创面疼痛程度均低于D组,差异有统计学意义(P0.05)。 4.创面愈合率：治疗后1周,各组间创面愈合率比较差异无统计学意义(P0.05)；治疗后2周-8周,各组间创面愈合率比较差异有统计学意义(P0.05)；A组、B组和C组的创面愈合率均高于D组,其中A组创面愈合率最高,其后依次为B组,C组,差异有统计学意义(P0.05)。 5.治疗后8周各组的创面痊愈率及有效率：治疗后8周,各组间创面痊愈率及有效率比较差异有统计学意义(P0.05)；A组、B组和C组的创面痊愈率及有效率均高于D组,其中A组创面痊愈率及有效率高于B组和C组,差异有统计学意义(P0.05)。 6.不良反应：试验过程中各组均未见明显不良反应。结论 rhGM-CSF联合藻酸盐敷料治疗中老年体表慢性难愈性创面有协同互补作用,不仅能刺激肉芽组织增生,加速再上皮化,促进创面愈合；还能明显减少创面渗液量,减轻换药时创面疼痛,提高了患者治疗依从性和日常生活护理质量；且未发现明显不良反应。将其作为一种治疗中老年体表慢性难愈性创面的的非手术疗法既安全又有效,具有临床可行性。
[Abstract]:Purpose To evaluate the clinical efficacy and safety of rhGM-CSF (recombinant human granulocyte-macrophage stimulating factor) gel and alginate dressing in the treatment of chronic refractory wound in the middle-aged and the elderly, and to explore its related effects Mechanism and evaluation as a non-operative treatment for the treatment of chronic refractory wound on the surface of the middle-aged and the elderly line property Methods The non-blind randomized controlled design was used to select 60 cases of chronic refractory wound in the middle-aged and old-aged and middle-aged and middle-aged and old-aged patients who were hospitalized in the Central Hospital of Jinan, Shandong University, from 2011 to 05 to 2013-05. The method of stratified random grouping was divided into 4 groups. Group, 15 in each group. The group was as follows: rhGM-CSF gel + alginate dressing + Vaseline gauze treatment group (group A); rhGM-CSF gel + Vaseline gauze treatment group (group B); alginate dressing + Vaseline gauze treatment group (group C); Vaseline gauze often Gauge treatment group (group D). The test period was set to 8 weeks. The occurrence of the adverse reaction after the treatment was recorded. The amount of the wound exudate, the color of the wound, the tissue of the wound and the growth of the epithelium, the degree of wound pain, the rate of wound healing, and the 8-week post-treatment were evaluated before and after the treatment. the creation of each group face-to-face Results 1. The recovery rate and the effective rate. Results 1. The amount of the wound exudate in each group was not statistically significant (P0.05). After the treatment, the amount of the wound exudate in each group was decreased, and the difference of the amount of wound exudate between the groups at the time of treatment was statistically significant (P <0.05). There was no difference between group A and group D in group A and group C after treatment for 1-4 weeks after treatment (P <0.05), and the amount of wound liquid in group A, group B and group C was less than that of group D and poor in group A, group B and group C. There was no significant difference in the difference between the color of the wound and the tissue of the granulation and the growth of the epithelium (P0.05). There was a significant difference in the color of the wound, the tissue of the wound and the growth of the epithelium in the 3-8 weeks after the treatment (P0.05). The difference was statistically significant between the group C and the D group in the group A and group B after 3-4 weeks of treatment. significance (P0.05); 5-8 weeks after treatment, group A, group B and group C were good in the color of the wound, the tissue of granulation and the growth of the epithelium. There was no significant difference in the degree of wound pain in the group (P0.05). The degree of pain in group A, group B and group C was significantly lower than that in group B and D (P0.05). The degree of pain in group A, group B and group C were all lower than that of group B and group D after 1-4 weeks after treatment (P0.05). There was no significant difference in the rate of wound healing in group D (P0.05). 4. The rate of wound healing was not significant (P0.05). The rate of wound healing in group A, group B and group C was higher than that of group D, and the rate of wound healing in group A was the highest. In group B and group C, the difference was significant (P0.05). The recovery rate and the effective rate of the wound in each group at 8 weeks after treatment were statistically significant (P0.05). 5) The recovery rate and effective rate of wound surface in group A, group B and group C were higher than that of group D. The effective rate was higher than that of group B and group C (P0.05). 5). 6. Adverse reaction: no obvious adverse reaction was found in each group during the test. Conclusion The combination of rhGM-CSF and alginate dressing in the treatment of chronic refractory wound surface in the middle-aged and the elderly has a synergistic effect, not only can stimulate the proliferation of granulation tissue, accelerating and re-epithelialization, and promoting wound healing; and also can obviously reduce the amount of the wound exudate and reduce the drug change, The wound pain is improved, the patient's treatment compliance and daily life care quality are improved, and no obvious adverse reaction is found.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R644

【相似文献】