NPWT促进糖尿病足溃疡面愈合的效果及作用机制

Effects and mechanism of negative pressure wound therapy in promoting wound healing of patients with diabetic foot ulcers

目的研究负压创面治疗技术(NPWT)促进糖尿病足溃疡面愈合的效果及作用机制。方法选取西安市北方医院消化内分泌科2014年5月至2016年5月收治的92例糖尿病足患者为研究对象,将纳入患者抽签随机分为NPWT组与对照组,每组46例。对照组在常规治疗基础上给予传统敷料处理,NPWT组在常规治疗基础上采用NPWT技术,均治疗7 d。比较两组患者治疗7 d后的血糖、血脂、血管生成因子、血流动力学、细菌清除率、创面愈合及预后情况。结果 NPWT组患者治疗7 d后转化生长因子-β1(TGF-β1)、血管内皮生长因子(VEGF)、左右侧血流量、细菌清除率分别为(35.22±10.68)ng/L、(98.08±18.72)ng/L、(53.46±7.31)m L/min、(54.97±6.34)m L/min、91.3%,明显高于对照组的(24.17±7.58)ng/L、(82.47±18.15)ng/L、(49.43±7.25)m L/min、(51.28±6.05)m L/min、76.1%,差异均有统计学意义(P<0.05);NPWT组患者治疗7 d后的溃疡面缩小率、肉芽覆盖率分别为(22.42±3.67)%、(65.18±10.64)%,明显高于对照组的(19.55±4.26)%、(53.14±12.78)%,差异均有统计学意义(P<0.05)。结论 NPWT可以通过刺激血管生成因子、增加创面血流量、抑制细菌繁殖等机制,促进溃疡面愈合与肉芽组织生长。

Objective To study the effects and mechanism of negative pressure wound therapy （NPWT） in pro-moting wound healing of patients with diabetic foot ulcers. Methods Ninety-two patients with diabetic foot ulcers whotreated in the Department of Digestive Endocrinology, the Northern Hospital of Xi＇an from May 2014 to May 2016 wereselected as the research objects. They were randomly divided into NPWT group and control group, with 46 patients ineach group. The control group was treated with conventional dressing, while the NPWT group was treated with NPWT,based on conventional treatment. The two groups were given 7 days of treatment. The blood glucose, blood lipids, angio-genic factors, hemodynamics, bacterial clearance rate, wound healing and prognosis were compared between the twogroups after 7 days of treatment. Results After 7 days of treatment, the transforming growth factor β1 （TGF-β1）, vascu-lar endothelial growth factor （VEGF）, left and right blood flow and the bacterial clearance rate in NPWT group were re-spectively （35.22±10.68） ng/L, （98.08±18.72） ng/L, （53.46±7.31） mL/min, （54.97±6.34） mL/min, 91.3%, which weresignificantly higher than （24.17±7.58） ng/L, （82.47±18.15） ng/L, （49.43±7.25） mL/min, （51.28±6.05） mL/min, 76.1% inthe control group （P〈0.05）. The reduction rate of ulcers, granulation coverage rate in NPWT group after 7 days of treat-ment were （22.42±3.67）%, （65.18±10.64）%, which were significantly higher than （19.55±4.26）%, （53.14±12.78）% in thecontrol group （P〈0.05）. Conclusion NPWT can promote the healing of ulcers and growth of granulation tissues bystimulating angiogenic factors, increasing the blood flow of wound surface and inhibiting bacterial reproduction.