含氧生理盐水间断冲洗联合负压封闭引流治疗糖尿病肢体慢性溃疡的效果观察

Clinical effect of intermittent irrigation with oxygenated saline combined with vacuum sealing drainage on limb ulcer in diabetic patients

目的探讨含氧生理盐水间断冲洗联合负压封闭引流(VSD)治疗糖尿病肢体慢性溃疡的效果。方法以2016年1~12月遵义医学院第五附属(珠海)医院整形烧伤手外科收治的60例糖尿病肢体慢性溃疡患者为研究对象,采用随机数表法分为单纯VSD组(A组)和VSD+含氧生理盐水组(B组),每组30例。入院后清创处理,A组清创后仅行VSD治疗,B组清创后行含氧生理盐水间断冲洗联合VSD治疗。治疗7 d后撤掉VSD装置,观察创面大体情况,测定创面组织液氧分压,计算细菌清除率和创面肉芽组织覆盖率,检测肉芽组织琥珀酸脱氢酶(SDH)和乳酸脱氢酶(LDH)水平。结果治疗后,B组患者的引流管堵塞率低于A组[(2.4±0.8)%vs(13.2±2.7)%],细菌清除率高于A组[(90.5±10.4)%vs(71.3±8.9)%],肉芽组织覆盖率高于A组[(93.4±7.2)%vs(77.6±9.3)%],差异均有统计学意义(P<0.05);B组患者的创面组织液氧分压[(85.3±5.6)mmHg vs(67.8±4.3)mmHg]和肉芽组织SHD水平[(2.75±0.38)U/L vs(1.93±0.41)U/L]均高于A组,LDH水平低于A组[(90.8±14.5)U/L vs(125.4±19.3)U/L],差异均有统计学意义(P<0.05)。结论含氧生理盐水间断冲洗联合负压封闭引流可有效清除创面细菌,改善创面组织缺氧,促进肉芽组织生长,从而提高对糖尿病肢体慢性溃疡的治疗效果。

Objective To investigate the clinical effect of intermittent irrigation with oxygenated saline combined with vacuum sealing drainage（VSD） on limb ulcer in diabetic patients. Methods Sixty diabetic patients with limb ulcer treated in Department of Plastic Surgery, Burns, and Hand Surgery, the Fifth Affiliated（Zhuhai） Hospital of Zunyi Medical College from January 2016 to December 2016 were selected as research objects. All the patients were randomly divided into VSD group（group A, n=30）, oxygenated saline combined with VSD（group B, n=30） by random number table. Group A was treated with VSD after debridement, while group B was treated with intermittent irrigation with oxygenated saline combined with VSD after debridement. 7 d after treatment, VSD device was removed. The wound general situation was observed, and the partial pressure of oxygen in the wound tissue was determined. The clearance rate of bacteria and the granulation tissue coverage rate were calculated, and the succinate dehydrogenase（SDH） and lactate dehydrogenase（LDH） levels were detected. Results The blocking rate, bacterial clearance rate, granulation tissue coverage rate of group B were（2.4±0.8）%,（90.5±10.4）%,（93.4±7.2）%, respectively, versus（13.2±2.7）%,（71.3±8.9）%,（77.6±9.3）% in group A（P0.05）. The partial pressure of oxygen in wound tissue, and the level of SHD in granulation tissue of group B were（85.3±5.6） mmHg,（2.75±0.38） U/L, significantly higher than（67.8±4.3） mmHg,（1.93±0.41） U/L in group A（P0.05）. The level of LDH of group B was significantly lower than that of group A,（90.8±14.5） U/L vs（125.4±19.3） U/L, P0.05. Conclusion Intermittent irrigation with oxygenated saline combined with vacuum sealing drainage can effectively remove the wound bacteria, improve wound tissue hypoxia, and promote granulation tissue growth, thereby improving the treatment of limb ulcer in diabetic patients.