负压封闭引流技术治疗糖尿病足溃疡（Wagner2-3级）的回顾性分析

发布时间：2018-03-16 12:31

本文选题：糖尿病　切入点：糖尿病足溃疡　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的回顾性分析负压封闭引流技术(Vacuum sealing drainage)在治疗糖尿病足溃疡(Wagner 2-3级)中的临床疗效。方法1.研究对象回顾分析2012年1月~2014年12月,天津市第一中心医院烧伤科住院部收治的糖尿病足患者。2.纳入标准(1)临床确诊,经住院手术治疗,病情稳定的出院患者;(2)未合并其它类型血管性病变、皮肤性病变;(3)住院期间糖尿病病情趋于稳定,非终末期肾脏病患者,以糖尿病足溃疡为主症就诊;(4)患者住院期间依从性良好,未出现放弃治疗或自动出院;(5)糖尿病足溃疡Wagner分级2-3级。3.研究对象分组共纳入糖尿病足患者120例,男42例,女78例,年龄55~78岁、平均(64.4±5.1)岁,糖尿病病程1~16年、平均(7.4±2.2)年,糖尿病足溃疡病程8~194d、平均(81±40)d,溃疡面积3cm×4cm~10cm×10cm。根据是否应用负压封闭引流将患者分为试验组和对照组。试验组60例,男18例,女42例,年龄(55~74)岁,平均(65.1±5.5)岁,平均糖尿病病史(7.5±2.2)年,平均糖尿病足溃疡史(83±40)天。对照组60例,男24例,女36例,年龄(60~78)岁,平均(63.8±4.6)岁,平均糖尿病病史(7.4±2.3)年,平均糖尿病足溃疡史(80±40)天。4.治疗方法试验组:手术清创后应用负压封闭引流治疗,负压维持在80mm Hg~125mm Hg,术后当天开始给予0.9%生理盐水500ml冲洗引流,冲洗3-5天,VSD连续应用7-10天,视肉芽生长及创面感染情况更换新的VSD敷料或行手术植皮治疗。对照组:手术清创后给予传统换药处理,无菌纱布覆盖,每日换药1次,根据肉芽生长情况行手术植皮治疗。其他治疗:两组患者均给予控制血糖、控制合并症、抗感染、改善微循环、手术清创等常规基础治疗。5.观察指标根据出院及随访记录,统计两组患者换药平均次数、创面平均愈合时间及患者换药时疼痛峰值;根据问卷调查表,统计患者满意度。6.统计方法以SPSS19.0软件包处理所获数据资料,计量资料采用(x±s)表示,组间比较采用t检验,计数资料用x2检验,P㩳0.05表示差异具有统计学意义。结果(1)试验组负压封闭引流治疗后,肉芽组织创面达到植皮条件后行创面植皮治疗,平均换药次数(5.8±0.9)次,与对照组平均换药次数(31.6±3.3)比较,差异具有统计学意义(P0.05)。(2)试验组糖尿病足创面平均愈合时间(28.9±5.6),与对照组(50.6±5.4)天创面平均愈合时间比较,差异具有统计学意义(P0.05)。(3)试验组与对照组相比,治疗期间患者痛苦程度明显减轻,通过视觉模拟评分法评分得出疼痛峰值分别为(4.3±2.0)和(6.8±1.7),差异具有统计学意义(P0.05)。(4)试验组患者满意度评分为(88.6±6.5),对照组为(69.2±10.6),两组均数差异具有统计学意义(P0.05)。结论负压封闭引流技术用于治疗糖尿病足溃疡Wagner2-3级患者,临床疗效较好,与传统换药和手术治疗方法比较,降低换药频次、节省人力、促进创面愈合、减轻患者痛苦、患者满意度好,值得临床推广应用。缺点是价格较贵限制了它在临床上的广泛应用。
[Abstract]:Objective to retrospectively analyze the clinical efficacy of vacuum sealing drainage in the treatment of diabetic foot ulcers (Wagner 2-3 grade). Diabetic foot patients admitted in the Department of Burn and Trauma of the first Central Hospital of Tianjin. Patients with non-end-stage kidney disease, with diabetic foot ulcer as the main treatment, had good compliance during hospitalization. There were 120 diabetic foot ulcers (male 42, female 78, mean 64.4 卤5.1) years old (mean 64.4 卤5.1) years. The course of diabetes was 1 ~ 16 years (mean 7.4 卤2.2) years. The course of diabetic foot ulcerative ulcer was 8194d, with an average ulcer area of 3cm 脳 4cm / 10cm 脳 10cm 脳 10cm 路cm. The patients were divided into experimental group (n = 60) and control group (n = 60, male 18, female 42, mean age: 65.1 卤5.5) years, mean diabetes history (7.5 卤2.2) years. The average history of diabetic foot ulcers was 83 卤40 days in the control group (n = 60, male 24, female 36, age: 6078) years, mean age was 63.8 卤4.6 years, mean diabetes history was 7.4 卤2.3 years. The average history of diabetic foot ulcer was 80 卤40 days. 4. Treatment group: after debridement, the treatment group was treated with negative pressure sealing drainage, the negative pressure was maintained at 80mm Hg~125mm Hg, 0.9% normal saline 500ml wash and drainage was given on the day of operation, and 3 to 5 days after operation, Hg~125mm was continuously used for 7-10 days. Visual granulation growth and wound infection were treated with new VSD dressing or skin grafting. Control group was treated with traditional dressing after debridement, covered with sterile gauze, and changed once a day. According to the growth of granulation, the patients in both groups were treated with conventional basic treatment, such as controlling blood sugar, controlling complications, anti-infection, improving microcirculation, debridement, and so on. The average number of times of dressing change, the average healing time of wound and the peak value of pain in the two groups were counted, according to the questionnaire, the patients' satisfaction degree was .6.The statistical method was used to process the data obtained by SPSS19.0 software package, and the measurement data were expressed as "x 卤s". T test was used for comparison among groups, and X2 test was used for counting data. Results after the treatment of negative pressure sealing drainage, the granulation tissue wound was treated with skin grafting, the average times of dressing change was 5.8 卤0.9 times, compared with that of the control group (31.6 卤3.3). The average healing time of diabetic foot wound in the experimental group was 28.9 卤5.6g, and that in the control group was 50.6 卤5.4 days. The difference was statistically significant. During the treatment, the pain degree of the patients was obviously alleviated. The results of visual analogue score showed that the peak value of pain was 4.3 卤2.0 and 6.8 卤1.7, respectively. The difference was statistically significant (P 0.05. 05). The score of patient satisfaction was 88.6 卤6.5 in the trial group and 69.2 卤10.6 in the control group. The difference between the two groups was statistically significant (P0.050.Conclusion negative pressure sealing is a significant difference between the two groups. Drainage technique is used to treat Wagner2-3 grade diabetic foot ulcer patients. Compared with the traditional methods of dressing change and surgical treatment, it can reduce the frequency of dressing change, save manpower, promote wound healing, alleviate the pain of patients, and improve the patients' satisfaction. It is worthy of clinical application. The disadvantage is that the high price limits its wide application in clinic.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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