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

doi:10.3877/cma.j.issn.1673-9450.2019.01.008

Abstract

Abstract:

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) cm^2, the degree of reduction was significantly better than the control group (7.03±0.82) cm^2, 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) cm^2, 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

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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhssyxfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9450.2019.01.008

https://zhssyxfzz.cma-cmc.com.cn/EN/Y2019/V14/I01/39

Figures/Tables 5

References 25

[1]	Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot.lnternational Working Group on the Diabetic Foot[J]. Diabetes Metab Res Rev, 2000, 16 Suppl 1: 84-92.
[2]	Basha B, Samuel SM, Triggle CR, et al. Endothelial dysfunction in diabetes mellitus: possible involvement of endoplasmic reticulum stress？[J]. Exp Diabetes Res, 2012, 2012: 481840.
[3]	Schneider AM, Morykwas MJ, Argenta LC, et al. A new and reliable method of securing skin grafts to the difficult recipient bed[J]. Plast Reconstr Surg, 1998, 102(4): 1195-1198.
[4]	张旭艳, 王中京, 丁胜, 等. 封闭负压引流治疗糖尿病足溃疡的疗效及对VEGF、MMP-2及TIMP-1的影响[J]. 中国老年学杂志, 2018, 38(6): 1289-1291.
[5]	胡承诺, 李东宇, 庞宗超, 等. 封闭式负压引流技术治疗糖尿病足对创面组织中TGF-β1及其受体表达的影响研究[J]. 中国修复重建外科杂志, 2018, 32(8): 1061-1065.
[6]	吴汉妮, 孙晖. 高压氧治疗糖尿病足的临床疗效[J]. 中华物理医学与康复杂志, 2003, 25(6): 371-373.
[7]	Yuan J, Handy RD, Moody AJ, et al. Response of blood vessels in vitro to hyperbaric oxygen (HBO): modulation of VEGF and NO(x) release by external lactate or arginine[J]. Biochim Biophys Acta, 2009, 1787(7): 828-834.
[8]	Hopf HW, Gibson JJ, Angeles AP, et al. Hyperoxia and angiogenesis[J]. Wound Repair Regen, 2005, 13(6): 558-564.
[9]	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med, 1998, 15(7): 539-553.
[10]	Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment[J]. Foot Ankle, 1981, 2(2): 64-122.
[11]	吴钟琪. 高压氧临床医学[M]. 长沙：中南大学出版社, 2003: 192-193, 230-231.
[12]	Mauricio D, Jude E, Piaggesi A, et al. Diabetic foot: current status and future prospects[J]. J Diabetes Res, 2016, 2016: 5691305.
[13]	Leone S, Pascale R, Vitale M, et al. Epidemiology of diabetic foot[J]. Infez Med, 2012, 20 Suppl: 8-13.
[14]	Bortoletto MS, de Andrade SM, Matsuo T, et al. Risk factors for foot ulcers-A cross sectional survey from a primary care setting in Brazil[J]. Prim Care Diabetes, 2014, 8(1): 71-76.
[15]	Waaijman R, de Haart M, Arts ML, et al. Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients[J]. Diabetes Care, 2014, 37(6): 1697-1705.
[16]	Monteiro-Soares M, Boyko EJ, Ribeiro J, et al. Predictive factors for diabetic foot ulceration: a systematic review[J]. Diabetes metab Res Rev, 2012, 28(7): 574-600.
[17]	Moues CM, Heule F, Hovius SE. A review of topical negative pressure therapy in wound healing: sufficient evidence？[J]. Am J Surg, 2011, 201(4): 544-556.
[18]	Kamoh LP, Andel H, Haslik W, et al. Use of subatmospherie pressure therapy to prevent burn wound progression in human: first experiences[J]. Burns, 2004, 30(3): 253-258.
[19]	Seherer SS, Pietramaggiori G, Mathews JC, et al. The meeha-nism of action of the vacuum-assisted closure devicer[J]. Plast Reconstr Surg, 2008, 122(3): 786-797.
[20]	Fabian TS, Kaufman HJ, Lett ED, et al. The evaluation of sub. atmospheric pressure and hyperbaric oxygen in ischemic fullthickness wound healing[J]. Am Surg, 2000, 66(12): 1136-1143.
[21]	Labler L, Rancan M, Mica L, et al. Vacuum-assisted closure therapy increases local interleukin-8 and vascular endothelial growth factor levels in traumatic wounds[J]. J Trauma, 2009, 66(3): 749-757.
[22]	Meara GJ, Guo L, Smith JD, et al. Vacuum Assisted Closure in the treatment of degloving injuries[J]. Am Plast Surg, 1999, 42(6): 589-594.
[23]	Shon YS, Lee YN, Jeong SH, et al. Influence of negative-pressure wound therapy on tissue oxygenation of the foot[J]. Arch Plast Surg, 2014, 41(6): 668-672.
[24]	Barata P, Cervaens M, Resende R, et al. Hyperbaric oxygen effects on sports injuries[J]. Ther Adv Musculoskelet Dis, 2011, 3(2): 111-121.
[25]	曾宪忠, 刘氜, 李毅. 高压氧治疗糖尿病足的疗效评价及对患者血清VEGF、bFGF水平的影响[J]. 中国现代医学杂志, 2016, 26(19): 110-113.

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)
组别	例数	男	女	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)
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

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)
组别	例数	男	女	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)
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

组别	例数	治疗7 d				治疗14 d
组别	例数	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

组别	例数	治疗7 d				治疗14 d
组别	例数	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

组别	例数	酸碱度			PCO₂(mmHg)			血氧分压(mmHg)
组别	例数	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%)
组别	例数	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	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

Please choose a citation manager

Content to export