负压封闭引流联合输氧治疗糖尿病足Wagner3级创面的疗效观察

发布时间：2018-05-29 02:44

本文选题：负压封闭引流技术 + 输氧　；参考：《兰州大学》2015年硕士论文

【摘要】：目的：观察负压封闭引流联合输氧治疗Wagner3级糖尿病足溃疡的临床疗效,以探讨糖尿病足的有效治疗方法。方法：本研究自2011年3月至2014年3月在本院内分泌科及骨科住院的糖尿病足患者66例。其中治疗组患者36例,男24例,女12例,年龄48-70岁,平均(59.6±2.8)岁。创面面积从1.Ocm × 1.6cm-5.1cm×8.6cm不等。对照组患者30例,男17例,女13例,年龄46-75岁,平均57.2±3.1岁。创面面积从1.2cmx0.8cm-4.0cm×8.1cm不等。所入选对象均符合1999年WHO的糖尿病诊断标准,糖尿病病程5-12年(平均7年),平均HbAic8.3%,足溃疡创面按照《糖尿病足国际临床指南》Wagner分级：符合Wagner3级。2组均给予常规治疗,采取有效措施积极控制血糖,在糖尿病饮食的基础上,适度增强膳食营养,采取气圈、棉垫等工具支撑,减轻创面周围的局部压迫；若创面伤口出现感染,则取分泌物或脓液进行细菌培养并常规做药敏试验,选择敏感抗菌素积极进行抗感染治疗,对照组在常规处理的基础上,采用传统敷料进行包扎,并可根据创面周围渗出情况和局部的血液循环状态酌情调整换药频次,一般的换药间隔时间为前7天每天换药1次,第八天以后可以每隔1-3天换1次药,一直换到创面愈合为止。治疗组在常规治疗的基础上,给予负压封闭引流联合输氧,根据创面大小裁剪或拼接负压封闭引流装置,运用生物半透薄膜封闭被引流区同时使创面与外界隔绝。连接负压源及氧气源,形成一个单向、封闭、高效引流及创面给养系统。两组均观察30天,治疗30天前后均观察血流变和足背动脉流体力学指标,并保持跟踪随访6个月到一年。结果：全体患者血糖均得到有效控制,体温、血常规检查正常,局部无窦道、无疼痛,感染均得到有效控制。术后随访4个月到一年,无感染复发。2组患者经负压引流联合输氧治疗或者传统治疗后均获得满意疗效。其中,负压引流联合输氧治疗组疗效(总有效率94%)明显优于传统治疗法组(总有效率83%)。且治疗组患者的治愈、显效、好转时间均明显短于于对照组,差异有统计学意义(P0.05)。与对照组比较,治疗组患者在植皮或皮瓣转移的时间、换药次数、总体治疗费用等方面均有显著差异(P0.05)。治疗前后两组血液流变学指标和足背动脉血流动力学指标均有所改善,治疗组明显优于对照组。结论：VSD联合输氧对糖尿病足溃疡Wagner3级创面修复具有良好的作用,可以有效促进创面愈合,其作用明显优于传统方法,且能够为植皮或皮瓣转移成功奠定良好基础。此外,本方法还具有技术操作简便,易于掌握的优势。因此,适合在临床治疗糖尿病足时进行推广应用。
[Abstract]:Objective: to observe the clinical effect of negative pressure sealing drainage combined with oxygen infusion in the treatment of Wagner3 grade diabetic foot ulcer. Methods: from March 2011 to March 2014, 66 patients with diabetic foot were hospitalized in Department of Endocrinology and Orthopaedics. There were 36 patients in the treatment group, 24 males and 12 females, aged from 48 to 70 years, with an average age of 59.6 卤2.8 years. The wound area ranged from 1.Ocm 脳 1.6cm-5.1cm 脳 8.6cm. There were 30 patients in the control group, 17 males and 13 females, aged 46 to 75 years (mean 57.2 卤3.1 years). The wound area ranged from 1.2cmx0.8cm-4.0cm 脳 8.1cm. The subjects were all in accordance with the diagnostic criteria of WHO in 1999. The course of diabetes was 5-12 years (mean 7 years, average HbAic8.3a). The wound of foot ulcer was treated with routine therapy according to the Wagner grading of Diabetic foot International Clinical guidelines: according to Wagner3 grade .2 group. Take effective measures to actively control blood sugar, on the basis of diabetes diet, moderately enhance dietary nutrition, take air rings, cotton pads and other tools support, reduce the local pressure around the wound; if the wound infection, Then take the secretion or pus for bacteria culture and routine drug sensitivity test, select sensitive antibiotics for active anti-infection treatment, the control group on the basis of conventional treatment, using traditional dressing for dressing, The frequency of dressing change can be adjusted according to the condition of exudation around the wound and local blood circulation. The general interval time of dressing change is 1 time per day for the first 7 days, and once every 1-3 days after the eighth day. Until the wound is healed. On the basis of routine treatment, the treatment group was given negative pressure sealing drainage combined with oxygen, cutting or splicing the negative pressure sealing drainage device according to the size of the wound, using biological semi-permeable membrane to seal the drainage area and make the wound cut off from the outside world at the same time. Connect negative pressure source and oxygen source to form a unidirectional, closed, efficient drainage and wound feeding system. The hemorheology and hydrodynamics of dorsal foot artery were observed before and after treatment for 30 days in both groups, and follow-up was maintained for 6 months to 1 year. Results: blood sugar was effectively controlled, body temperature, blood routine examination were normal, no sinus tract, no pain, infection were effectively controlled. After 4 months to 1 year follow-up, the patients in group 2 were treated with negative pressure drainage combined with oxygen therapy or conventional therapy. Among them, the effect of negative pressure drainage combined with oxygen therapy group (total effective rate 94) was significantly better than that of traditional therapy group (total effective rate 83%). The cure, effect and improvement time of the patients in the treatment group were significantly shorter than those in the control group, and the difference was statistically significant (P 0.05). Compared with the control group, there were significant differences in the time of skin graft or flap transfer, the times of dressing change and the total treatment cost in the treatment group. Before and after treatment, the hemorheology index and the hemodynamic index of dorsal foot artery were improved in both groups, and the treatment group was better than the control group. ConclusionVSD combined with oxygen infusion has a good effect on the repair of Wagner3 grade wound of diabetic foot ulcer and can effectively promote wound healing. The effect is obviously superior to the traditional method and can lay a good foundation for successful skin grafting or flap transfer. In addition, this method also has the technical operation simple, easy to grasp the superiority. Therefore, it is suitable for popularizing and applying in clinical treatment of diabetic foot.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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