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中华损伤与修复杂志(电子版) ›› 2019, Vol. 14 ›› Issue (01) : 39 -45. doi: 10.3877/cma.j.issn.1673-9450.2019.01.008

所属专题： 文献；

论著

负压封闭引流技术联合高压氧治疗糖尿病足的临床疗效分析
唐才良1, 晁生武1,†(), 李毅1, 梁琰1   
  1. 1. 810001　西宁，青海大学附属医院烧伤整形外科
  • 收稿日期:2018-12-20 出版日期:2019-02-01
  • 通信作者: 晁生武
  • 基金资助:
    青海省科技厅项目(2016-ZJ-732)

Analysis of clinical effects of vacuum sealing drainage combined with hyperbaric oxygen in the treatment of diabetic foot

Cailiang Tang1, Shengwu Chao1,†(), Yi Li1, Yan Liang1   

  1. 1. Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
  • Received:2018-12-20 Published:2019-02-01
  • Corresponding author: Shengwu Chao
  • About author:
    Corresponding author: Chao Shengwu, Email:
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引用本文：

唐才良, 晁生武, 李毅, 梁琰. 负压封闭引流技术联合高压氧治疗糖尿病足的临床疗效分析[J]. 中华损伤与修复杂志(电子版), 2019, 14(01): 39-45.

Cailiang Tang, Shengwu Chao, Yi Li, Yan Liang. Analysis of clinical effects of vacuum sealing drainage combined with hyperbaric oxygen in the treatment of diabetic foot[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2019, 14(01): 39-45.

目的

评估负压封闭引流技术(VSD)联合高压氧治疗糖尿病足的临床疗效。

方法

选取2016年9月至2018年4月在青海大学附属医院烧伤整形科就诊的60例确诊为糖尿病足患者，按随机数字表法分为实验组30例和对照组30例，其中对照组予以控制饮食、控制血糖、抗感染等常规治疗的基础上以VSD技术对创面进行治疗；实验组在常规治疗的基础上以VSD技术联合高压氧进行治疗。对2组患者治疗7、14 d的综合疗效情况进行比较，观察治疗前及治疗7、14 d 2组患者血气分析、血液流变学各指标的变化，并观察2组患者治疗前及治疗7、14 d创面组织血管内皮生长因子(VEGF)、血小板衍生生长因子(PDGF)水平的变化以及创面面积大小变化。数据比较采用t检验和χ2检验。

结果

治疗7 d，实验组患者治疗总有效率93.3%(28/30)，明显高于对照组80.0%(24/30)，差异有统计学意义(χ2＝7.231，P<0.05)；治疗7 d，实验组患者血液中酸碱度(7.42±0.19)、PCO2(41.76±1.65) mmHg、血氧分压(66.10±2.36) mmHg、血氧饱和度(89.50±1.62)%、血氧含量(6.60±1.17) Vol%，明显高于对照组[(7.40±0.25)、(40.32±2.70) mmHg、(62.05±5.05) mmHg、(88.10±3.63)%、(6.08±1.17) Vol%]，差异均有统计学意义(t＝2.221、2.442、4.023、2.135、2.073，P值均小于0.05)；治疗7 d，实验组患者全血低切黏度(11.08±0.81) mPa.s、全血高切黏度(5.17±0.34) mPa.s、血浆高切黏度(2.09±0.16) mPa.s、红细胞变形指数(0.76±0.48)，降低情况明显优于对照组[(12.29±1.81) mPa.s、(5.85±0.34) mPa.s、(2.58±0.21) mPa.s、(0.87±0.11)]，差异均有统计学意义(t＝3.265、7.531、10.366、4.942，P值均小于0.05)；治疗7 d，实验组患者创面组织VEGF(35.70±4.84) pg/mL、PDGF(36.60±2.98) pg/mL，较对照组[(25.36±3.21) pg/mL、(27.53±2.94) pg/mL]升高更明显，差异均有统计学意义(t＝9.235、11.134，P值均小于0.05)；治疗7 d，实验组患者创面面积(5.13±0.60) cm2，减小程度明显优于对照组(7.03±0.82) cm2，差异有统计学意义(t＝10.594，P＝0.015)。治疗14 d，实验组患者治疗总有效率96.7%(29/30)，明显强于对照组86.7%(26/30)，差异有统计学意义(χ2＝7.157，P＝0.028)；治疗14 d，实验组患者血液中酸碱度(7.42±0.21)、PCO2(42.46±1.57) mmHg、血氧分压(69.26±1.49) mmHg、血氧饱和度(91.05±1.20)%、血氧含量(6.74±0.89) Vol%，高于对照组[(7.40±0.31)、(40.23±2.73) mmHg、(62.41±4.86) mmHg、(88.23±2.17)%、(6.13±1.22) Vol%]，差异均有统计学意义(t＝2.790、3.778、7.455、6.620、2.185，P值均小于0.05)；治疗14 d，实验组患者全血低切黏度(8.10±1.07) mPa.s、全血高切黏度(4.26±0.33) mPa.s、血浆高切黏度(1.64±0.22) mPa.s、红细胞变形指数(0.64±0.04)，降低情况明显优于对照组[(11.74±1.54) mPa.s、(5.82±0.41) mPa.s、(2.53±0.23) mPa.s、(0.83±0.10)]，差异均有统计学意义(t＝9.905、16.609、16.358、9.617，P值均小于0.05)；治疗14 d，实验组患者创面组织VEGF(47.72±3.75) pg/mL、PDGF(49.17±2.48) pg/mL，较对照组[(37.04±2.90) pg/mL、(38.18±2.65) pg/mL]升高更明显，差异均有统计学意义(t＝13.062、17.276，P值均小于0.05)；治疗14 d，实验组患者创面面积(2.88±0.52) cm2，减小程度明显优于对照组(5.07±0.61) cm2，差异有统计学意义(t＝12.332，P＝0.013)。

结论

VSD联合高压氧治疗对于糖尿病足患者的创面愈合有显著疗效，明显优于单纯使用VSD治疗的疗效，其二者结合的功效十分显著。

关键词: 糖尿病足, 高压氧, 血气分析, 负压封闭引流
Objective

To evaluate the clinical efficacy of vacuum sealing drainage (VSD) combined with hyperbaric oxygen in the treatment of diabetic foot.

Methods

From September 2016 to April 2018, 60 patients with diabetic foot diagnosed in the Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University were enrolled. According to the random number table method, 30 patients in the experimental group and 30 patients in the control group were included. On the basis of conventional treatments such as blood sugar control and anti-infection, VSD technology was used in control group; the experimental group was treated with VSD technology combined with hyperbaric oxygen on the basis of conventional treatment. The comprehensive curative effect of 2 groups after 7 and 14 days treatment was compared. The changes of blood rheology and blood gas analysis of 2 groups were observed before and after 7 and 14 days treatment. The changes of vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) levels and wound area were observed before and after 7 and 14 days treatment. Data were compared with t test and χ2 test.

Results

After 7 days of treatment, the total effective rate of the experimental group was 93.3%(28/30), which was significantly stronger than that of the control group [80.0%(24/30)]. The difference was statistically significant (χ2=7.231, P<0.05). In the experimental group, after 7 days of treatment, the pH (7.42±0.19), PCO2 (41.76±1.65) mmHg, blood oxygen partial pressure (66.10±2.36) mmHg, blood oxygen saturation (89.50±1.62)%, blood oxygen content (6.60±1.17) Vol%, significantly higher than the control group [(7.40±0.25), (40.32±2.70) mmHg, (62.05±5.05) mmHg, (88.10±3.63)%, (6.08±1.17) Vol%], the differences were statistically significant (t=2.221, 2.442 , 4.023, 2.135, 2.073, with P values below 0.05); 7 days after treatment, the experimental group patients with low whole blood viscosity (11.08 ± 0.81) mPa.s, whole blood high shear viscosity (5.17 ± 0.34) mPa.s, plasma high shear viscosity (2.09±0.16) mPa.s and the red blood cell deformation index (0.76±0.48), which was significantly better than the control group [(12.29±1.81) mPa.s, (5.85±0.34) mPa.s, (2.58± 0.21) mPa.s, (0.87±0.11)], the differences were statistically significant (t=3.265, 7.531, 10.366, 4.942, with P values below 0.05); after 7 days of treatment, in the experimental group, VEGF (35.70±4.84) pg/mL, PDGF (36.60±2.98) pg/mL, which was more obvious than the control group [(25.36±3.21) pg/mL, (27.53±2.94) pg/mL], the differences were statistically significant (t=9.235, 11.134, with P values below 0.05); 7 days after treatment, the wound area of the experimental group was (5.13±0.60) cm2, the degree of reduction was significantly better than the control group (7.03±0.82) cm2, the difference was statistically significant (t=10.594, P=0.015). After 14 days of treatment, the total effective rate of the experimental group was 96.7%(29/30), which was significantly stronger than that of the control group [86.7%(26/30)], the difference was statistically significant (χ2=7.157, P=0.028). In the experimental group, after 14 days treatment, the pH (7.42± 0.21), partial pressure of carbon dioxide (PCO2) (42.46±1.57) mmHg, blood oxygen partial pressure (69.26±1.49) mmHg, blood oxygen saturation (91.05±1.20)%, blood oxygen content (6.74±0.89) Vol%, significantly higher than the control group [(7.40±0.31), (40.23±2.73) mmHg, (62.41±4.86) mmHg, (88.23±2.17)%, (6.13±1.22) Vol%], the differences were statistically significant (t=2.790, 3.778, 7.455, 6.620, 2.185, with P values below 0.05); after 14 days of treatment, the experimental group had low whole blood viscosity (8.10±1.07) mPa.s, whole blood high shear viscosity (4.26±0.33) mPa.s, plasma high shear viscosity (1.64±0.22) mPa.s, the deformation index of red blood cells (0.64±0.04), which was significantly better than that of the control group [(11.74±1.54) mPa.s, (5.82±0.41) mPa.s, (2.53±0.23) mPa.s, (0.83±0.10)], the differences were statistically significant (t=9.905, 16.609, 16.358, 9.617, with P values below 0.05). In the experimental group, after 14 days treatment, VEGF level was (47.72±3.75) pg/mL and PDGF level was (49.17±2.48) pg/mL, compared with the control group [(37.04±2.90) pg/mL, (38.18±2.65) pg/mL], the difference was statistically significant (t=13.062, 17.276, with P values below 0.05). The wound area of the experimental group after 14 days treatment was (2.88±0.52) cm2, which was significantly better than that of the control group (5.07±0.61) cm2. The difference was statistically significant (t=12.332, P=0.013).

Conclusions

VSD combined with hyperbaric oxygen therapy has a significant effect on the healing of diabetic foot patients, which is significantly better than the efficacy of VSD alone. The combined effect of the two is very significant.

Key words: Diabetic foot, Hyperbaric oxygenation, Blood gas analysis, Vacuum sealing drainage
表1 2组糖尿病足患者一般资料比较(±s)
组别 例数 性别(例) 年龄(岁) 糖尿病病程(年) 空腹血糖(mmol/L) 溃疡面积(cm2) 溃疡时间(d)
男 女
实验组 30 13 17 62.70±5.82 13.74±2.08 11.32±1.80 11.33±0.62 14.04±2.10
对照组 30 15 15 62.13±6.00 13.89±2.06 11.22±1.87 11.03±0.81 13.97±1.94
t值 ? ? ? 0.405 0.260 0.205 1.680 0.113
P值 ? ? ? 0.689 0.797 0.839 0.104 0.911
表2 2组糖尿病足患者综合疗效比较[例(%)]
组别 例数 治疗7 d 治疗14 d
显效 有效 无效 总有效率 显效 有效 无效 总有效率
实验组 30 18(60.0) 10(33.3) 2(6.7) 28(93.3) 23(76.7) 6(20.0) 1(3.3) 29(96.7)
对照组 30 8(26.7) 16(53.3) 6(20.0) 24(80.0) 13(43.3) 13(43.3) 4(13.3) 26(86.7)
χ2值 ? ? ? ? 7.231 ? ? ? 7.157
P值 ? ? ? ? <0.05 ? ? ? 0.028
表3 2组糖尿病足患者治疗前后血气分析(±s)
组别 例数 酸碱度 PCO2(mmHg) 血氧分压(mmHg)
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
实验组 30 7.41±0.28 7.42±0.19 7.42±0.21 40.76±2.55 41.76±1.65 42.46±1.57 62.78±3.32 66.10±2.36 69.26±1.49
对照组 30 7.40±0.29 7.40±0.25 7.40±0.31 39.85±2.08 40.32±2.70 40.23±2.73 62.22±5.21 62.05±5.05 62.41±4.86
t值 ? 0.449 2.221 2.790 1.607 2.442 3.778 0.500 4.023 7.455
P值 ? 0.657 0.034 0.009 0.119 0.021 0.001 0.621 0.030 0.021
组别 例数 血氧饱和度(%) 血氧含量(Vol%)
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
实验组 30 88.45±1.76 89.50±1.62 91.05±1.20 6.31±0.93 6.60±1.17 6.74±0.89
对照组 30 87.56±3.29 88.10±3.63 88.23±2.17 6.15±1.23 6.08±1.17 6.13±1.22
t值 ? 1.254 2.135 6.620 0.587 2.073 2.185
P值 ? 0.220 0.041 0.011 0.565 0.047 0.037
表4 2组糖尿病足患者治疗前后血液流变学参数(±s)
组别 例数 全血低切黏度(mPa.s) 全血高切黏度(mPa.s)
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
实验组 30 12.74±1.07 11.08±0.81 8.10±1.07 5.89±0.36 5.17±0.34 4.26±0.33
对照组 30 12.85±1.14 12.29±1.81 11.74±1.54 5.97±0.32 5.85±0.34 5.82±0.41
t值 ? 0.378 3.265 9.905 1.414 7.531 16.609
P值 ? 0.709 0.015 0.008 0.168 0.009 0.004
组别 例数 血浆高切黏度(mPa.s) 红细胞变形指数
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
实验组 30 2.61±0.60 2.09±0.16 1.64±0.22 0.89±0.76 0.76±0.48 0.64±0.04
对照组 30 2.62±0.18 2.58±0.21 2.53±0.23 0.90±0.85 0.87±0.11 0.83±0.10
t值 ? 0.101 10.366 16.358 1.292 4.942 9.617
P值 ? 0.918 0.007 0.004 0.206 0.011 0.008
表5 2组糖尿病足患者治疗前后组织VEGF、PDGF水平变化(pg/mL, ±s)
组别 例数 VEGF PDGF
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
实验组 30 2.13±0.41 35.70±4.84 47.72±3.75 2.08±0.28 36.60±2.98 49.17±2.48
对照组 30 2.12±0.43 25.36±3.21 37.04±2.90 2.12±0.26 27.53±2.94 38.18±2.65
t值 ? 0.205 9.235 13.062 0.539 11.134 17.276
P值 ? 0.839 0.012 0.009 0.594 0.013 0.008
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