应用羧甲基纤维素钠银敷料联合封闭负压吸引治疗糖尿病足溃疡的疗效

doi:10.3877/cma.j.issn.1673-9450.2023.04.010

目的

探讨羧甲基纤维素钠银敷料(CMC-Na)联合封闭负压吸引(VSD)技术治疗糖尿病足溃疡的疗效。

方法

选择2020年10月1日至2021年12月31日潍坊医学院附属医院内分泌代谢病科收治的糖尿病足患者120例，根据治疗方案不同分为对照组、CMC-Na组、CMC-Na联合VSD组，每组40例。在常规降糖和抗感染治疗基础上，对照组给予黄柏液冲洗及生理盐水纱布敷贴治疗，CMC-Na组在对照组基础上给予CMC-Na治疗，CMC-Na联合VSD组在对照组基础上给予CMC-Na联合VSD治疗。比较3组患者治疗1、2、4周后糖尿病足溃疡创面缩小率、窦道深度变化情况、疗效及患者满意度。

结果

(1)创面缩小率：3组创面缩小率均随治疗时间的延长呈增加趋势(F＝203.588、582.072、606.211，P<0.05)；治疗1、2周，CMC-Na联合VSD组均优于对照组，差异有统计学意义(t＝6.920、23.086，P<0.05)，与CMC-Na组比较差异均无统计学意义(t＝3.064、14.305，P>0.05)；治疗4周，CMC-Na联合VSD组显著优于对照组和CMC-Na组，差异有统计学意义(t＝－7.038、－4.999，P<0.05)。(2)窦道深度变化情况：3组窦道深度均随治疗时间的延长呈递减趋势(F＝7.888、4.197、12.388，P<0.05)；CMC-Na联合VSD组显著优于对照组，差异有统计学意义(t＝－2.293、－2.958、－3.289，P<0.05)；与CMC-Na组比较，CMC-Na联合VSD组窦道深度更小，但差异无统计学意义(t＝－0.241、－1.166，－1.162，P>0.05)。(3)总有效率：3组总有效率分别为75.0%、92.5%、97.5%，差异有统计学意义(χ²＝10.836，P<0.05)。(4)患者满意度：3组患者满意度分别为45.0%、82.5%、95.0%，差异有统计学意义(χ²＝8.683，P<0.05)。

结论

羧甲基纤维素钠银敷料联合封闭负压吸引治疗糖尿病足溃疡可显著促进创面愈合，提高患者满意度。

关键词: 糖尿病足溃疡, 羧甲基纤维素钠, 封闭负压吸引

Objective

To discuss the clinical efficacy of sodium carboxyl-methyl-cellulose dressings (CMC-Na) combined with vacuum sealing drainage (VSD) in the treatment of diabetic foot ulcer.

Methods

A total of 120 patients with diabetic foot admitted to Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University from October 1, 2020 to December 31, 2021 were selected. The patients were divided into control group, CMC-Na group, and CMC-Na combined with VSD group according to different treatment plans, with 40 cases in each group. On the basis of conventional hypoglycemia and anti-infection, the control group was treated with Huangbai liquid rinsing and saline gauze dressing, the CMC-Na group was treated with CMC-Na on the basis of the control group, and the CMC-Na combined with VSD group was treated with CMC-Na combined with VSD on the basis of the control group. At 1 week, 2 weeks and 4 weeks of treatment, the reduction rate of diabetes foot ulcer wound, changes in sinus depth, curative effect and patient satisfaction were compared among the three groups.

Results

(1)Ulcer wound reduction rate: all three groups showed an increasing trend of ulcer wound reduction rate with the extension of the treatment time (F=203.588, 582.072, 606.211; P<0.05). At 1 week and 2 weeks of treatment, the CMC-Na combined with VSD group was superior to the control group, and the difference was statistically significant (t=6.920, 23.086; P<0.05), but there was no difference between the CMC-Na combined with VSD group and the CMC-Na group (t=3.064, 14.305; P>0.05). At 4 weeks of treatment, the CMC-Na combined with VSD group was significantly better than the control group and the CMC-Na group, and the difference was statistically significant (t=-7.038, -4.999; P<0.05). (2)Changes in sinus depth: all three groups showed a decreasing trend in sinus depth with the extension of treatment time (F=7.888, 4.197, 12.388; P<0.05). The CMC-Na combined with VSD group was significantly better than the control group, and the difference was statistically significant (t=-2.293, -2.958, -3.289; P<0.05). Compared with the CMC-Na group, the sinus depth was smaller in the CMC-Na combined with VSD group, but the difference was not statistically significant (t=-0.241, -1.166, -1.162, P>0.05). (3)Total effective rate: total effective rate of the three groups were 75.0%, 92.5% and 97.5% respectively, the difference was statistically significant (χ²=10.836, P<0.05). (4)Satisfaction: The satisfaction in the three groups was 45.0%, 82.5%, 95.0% respectively, the difference was statistically significant (χ²=8.683, P<0.05).

Conclusion

Treatment of diabetes foot ulcer with combination of CMC-Na and VSD can significantly promote wound healing, improve patient satisfaction.

Key words: Diabetic foot ulcer, Sodium carboxyl-methyl-cellulose, Vacuum sealing drainage

表1 3组创面缩小率比较(%，±s)

组别	例数	治疗1周	治疗2周	治疗4周	F值	P值
对照组	40	13.01±1.20	34.85±1.18^a	58.91±2.22^ab	203.588	0.000
CMC-Na组	40	20.81±1.45	50.44±0.93^a	81.09±1.31^ab	582.072	0.000
CMC-Na联合VSD组	40	27.83±1.78^c	68.30±0.84^ac	90.33±1.06ab^cd	606.211	0.000
F值		24.633	284.132	75.314
P值		0.000	0.000	0.000

表1 3组创面缩小率比较(%，±s)

组别	例数	治疗1周	治疗2周	治疗4周	F值	P值
对照组	40	13.01±1.20	34.85±1.18^a	58.91±2.22^ab	203.588	0.000
CMC-Na组	40	20.81±1.45	50.44±0.93^a	81.09±1.31^ab	582.072	0.000
CMC-Na联合VSD组	40	27.83±1.78^c	68.30±0.84^ac	90.33±1.06ab^cd	606.211	0.000
F值		24.633	284.132	75.314
P值		0.000	0.000	0.000

表2 3组窦道深度比较(cm，±s)

组别	例数	治疗1周	治疗2周	治疗4周	F值	P值
对照组	40	1.91±0.26	1.17±0.22^a	0.68±0.18^ab	7.888	0.000
CMC-Na组	40	1.34±0.22	0.74±0.16^a	0.26±0.08^ab	4.197	0.000
CMC-Na联合VSD组	40	1.25±0.23^c	0.51±0.14^ac	0.14±0.07^abc	12.388	0.000
F值		2.287	3.659	5.783
P值		0.04	0.01	0.003

表2 3组窦道深度比较(cm，±s)

组别	例数	治疗1周	治疗2周	治疗4周	F值	P值
对照组	40	1.91±0.26	1.17±0.22^a	0.68±0.18^ab	7.888	0.000
CMC-Na组	40	1.34±0.22	0.74±0.16^a	0.26±0.08^ab	4.197	0.000
CMC-Na联合VSD组	40	1.25±0.23^c	0.51±0.14^ac	0.14±0.07^abc	12.388	0.000
F值		2.287	3.659	5.783
P值		0.04	0.01	0.003

表3 3组临床疗效比较(例)

组别	例数	治愈	显效	有效	无效	总有效率(%)
对照组	40	2	0	28	10	75.0
CMC-Na组	40	4	18	15	3	92.5^a
CMC-Na联合VSD组	40	10	26	3	1	97.5^a
χ²值						10.836
P值						0.004

表3 3组临床疗效比较(例)

组别	例数	治愈	显效	有效	无效	总有效率(%)
对照组	40	2	0	28	10	75.0
CMC-Na组	40	4	18	15	3	92.5^a
CMC-Na联合VSD组	40	10	26	3	1	97.5^a
χ²值						10.836
P值						0.004

表4 3组患者满意度比较(例)

组别	例数	非常满意	比较满意	不满意	总满意度(%)
对照组	40	2	16	22	45.0
CMC-Na组	40	15	18	7	82.5
CMC-Na联合VSD组	40	33	5	2	95.0^a
χ²值					8.683
P值					0.013

表4 3组患者满意度比较(例)

组别	例数	非常满意	比较满意	不满意	总满意度(%)
对照组	40	2	16	22	45.0
CMC-Na组	40	15	18	7	82.5
CMC-Na联合VSD组	40	33	5	2	95.0^a
χ²值					8.683
P值					0.013

图1 应用CMC-Na联合VSD治疗糖尿病足溃疡。A示患者入院时创面；B示CMC-Na联合VSD治疗前创面；C示CMC-Na联合VSD治疗后创面；D示治疗一个半月创面；E示治疗两个月创面

[1]	罗怡欣，杨川，刘兴州，等. 基于循证指南的糖尿病足敷料选择和应用建议[J]. 中国全科医学，2022, 25(32): 3990-3998.
[2]	李永洁，冯绮玲，麦梨芳，等. 胶原蛋白敷料联合负压封闭引流技术在糖尿病足窦道型创面中的应用[J]. 岭南急诊医学杂志，2019, 24(5): 501-503.
[3]	龙一军，叶健波，张芸，等. 负压吸引同步联合其他方案治疗糖尿病足的现状[J]. 内科，2022, 17(2): 187-190.
[4]	Lipsky BA, Senneville E, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)[J]. Diabetes Metab Res Rev, 2020, 36 Suppl 1: e3280.
[5]	地里夏提·库尔班，陈召，刘小龙. 供氧条件下负压封闭引流联合自体皮移植治疗难愈性糖尿病足溃疡的临床研究[J]. 中华损伤与修复杂志(电子版), 2022, 17(1): 25-31.
[6]	任妮，刘朝东. 银离子敷料联合COX健康行为互动模式在糖尿病足患者中的应用效果探讨[J]. 现代医学与健康研究电子杂志，2022, 6(8): 120-123.
[7]	Graca PM, Vilaca M, Pedras S, et al. Wound healing and healing process in patients with diabetic foot ulcers: a survival analysis study[J]. Diabetes Res Clin Pract, 2023: 110623.
[8]	Walsh JW, Hoffstad OJ, Sullivan MO, et al. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom[J]. Diabet Med, 2016, 33(11): 1493-1498.
[9]	Everett E, Mathioudakis N. Update on management of diabetic foot ulcers[J]. Ann N Y Acad Sci, 2018, 1411(1): 153-165.
[10]	Naves CC. The diabetic foot: a historical overview and gaps in current treatment[J]. Adv Wound Care (New Rochelle), 2016, 5(5): 191-197.
[11]	张鹤，耿树军. 糖尿病足中医外治法分期分层论治策略[J]. 北京中医药，2022, 41(7): 769-772.
[12]	邵蕊，何庆. 老年糖尿病足的中西医认识及治疗进展[J]. 天津医科大学学报，2022, 28(4): 452-455.
[13]	Piaggesi A, Baccetti F, Rizzo L, et al. Sodium carboxyl-methyl-cellulose dressings in the management of deep ulcerations of diabetic foot[J]. Diabet Med, 2001, 18(4): 320-324.
[14]	Ruffo M, Parisi OI, Dattilo M, et al. Synthesis and evaluation of wound healing properties of hydro-diab hydrogel loaded with green-synthetized AGNPS: in vitro and in ex vivo studies[J]. Drug Deliv Transl Res, 2022, 12(8): 1881-1894.
[15]	何浩韫. 糖尿病足溃疡影响因素与治疗的研究进展[J]. 中国城乡企业卫生，2022, 37(6): 30-32.
[16]	Liu Z, Dumville JC, Hinchliffe RJ, et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus[J]. Cochrane Database Syst Rev, 2018, 10: D10318.
[17]	Stanley BJ. Negative pressure wound therapy[J]. Vet Clin North Am Small Anim Pract, 2017, 47(6): 1203-1220.

[1]	赵雅玫, 谢斌, 陈艳, 吴健. 抗生素骨水泥联合负压封闭引流对糖尿病足溃疡临床疗效的荟萃分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 427-433.
[2]	雷霞, 李炳辉, 王晓蓉, 张丽娟, 刘慧真, 王卉, 李恭驰. 对糖尿病足溃疡诱因与发生部位的临床观察[J]. 中华损伤与修复杂志(电子版), 2023, 18(02): 104-108.
[3]	郭光华, 朱峰, 闵定宏, 黄跃生, 吴军. 糖尿病足合并难愈性创面外科治疗全国专家共识（2020版）[J]. 中华损伤与修复杂志(电子版), 2020, 15(04): 256-263.
[4]	李红, 李雯. 银离子敷料在老年糖尿病足溃疡合并感染治疗中的应用[J]. 中华老年病研究电子杂志, 2022, 09(01): 20-23.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Analysis on the clinical efficacy of sodium carboxyl-methyl-cellulose dressings combined with vacuum sealing drainage in the treatment of diabetic foot ulcer

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Analysis on the clinical efficacy of sodium carboxyl-methyl-cellulose dressings combined with vacuum sealing drainage in the treatment of diabetic foot ulcer