NPWT联合灌洗系统治疗Wagner 3~5级糖尿病足合并感染的临床疗效对比分析

Comparative Analysis of Clinical Efficacy of Negative Pressure Wound Therapy Plus Lavage System in the Treatment of Wagner Grade 3-5 Diabetic Foot Ulcers Combined with Infection

目的对比分析应用创面负压治疗(negative pressure wound therapy,NPWT)联合灌洗系统治疗Wagner 3~5级糖尿病足合并感染的临床效果。方法回顾分析2016年1月–2020年1月,我科收治的100例Wagner分级为3~5级糖尿病足伴感染患者的临床资料,按照治疗方式分为联合治疗组(NPWT联合灌洗系统)和单一治疗组(仅使用NPWT)。观察患者创面感染细菌类型、创面细菌培养转阴的时间、血中炎症指标的情况(包括白细胞计数和C反应蛋白)。收集住院期间首次手术术前等待时间、住院期间手术次数、住院时间、NPWT使用时间、创面愈合时间,以及出院后患者在院外抗生素使用时间、最终创面愈合比率、创面最终愈合时间以及创面远期并发症(包括伤口裂开、新溃疡产生、感染复发、再入院、再手术,截肢)。结果两组病例在年龄、性别、病程、损伤侧别、病损大小、合并疾病方面差异无统计学意义,同样在创面细菌种属及比率方面差异亦无统计学意义。但在创面细菌培养转阴时间方面,联合治疗组优于单一治疗组(P<0.05)。在血中炎症指标中,除了联合组的C反应蛋白在术后一周时间点较单一组下降更明显外(P<0.05),余指标中两组无明显差异。尽管在住院期间手术次数、住院时间、NPWT使用时间、创面闭合时间方面,联合治疗组的指标均低于单一治疗组(P<0.05),但在远期创面并发症方面,两组患者差异无统计学意义。结论采用NPWT联合灌洗系统治疗Wagner 3~5级糖尿病足合并感染,可以有效早期控制创面感染,减少创面细菌培养转阴的时间。同时刺激创面肉芽生长,早期有效覆盖创面。

Objective To compare and analyze the clinical efficacy of negative pressure wound therapy(NPWT)combined with lavage system in the treatment of Wagner grade 3-5 diabetic foot ulcers combined with infections.Methods The clinical data of 100 patients with Wagner grade 3-5 diabetic foot ulcers combined with infections admitted to our department between January 2016 and January 2020 were retrospectively analyzed.According to the methods of surgical wound management,they were divided into two groups,a combination treatment group treated by NPWT plus a lavage system and a single treatment group receiving NPWT only.Patients were studied for the types of bacterial infection found in the wounds,the amount of time it took for the wound bacterial culture to turn negative,and the status of blood inflammatory indicators,including white blood cell count and C-reactive protein(CRP).Data concerning hospitalization were collected,including the waiting time before the first operation,the number of operations,length of hospital stay,NPWT usage time,and wound closure time.In addition,data concerning patient condition after discharge were also collected,including the duration of out-of-hospital antibiotic use,the final wound healing rate,the final wound healing time,and long-term wound complications,which include wound dehiscence,new ulcer,infection recurrence,readmission,reoperation,and amputation.Results There were no statistically significant differences in age,sex,course of disease,lesion side,lesion size and combined diseases between the two groups.Likewise,there was no significant difference in the species and genus,or the composition of bacteria found in the wounds(P>0.05).However,the combination treatment group showed better results than the single treatment group did in the amount of time it took for wound bacterial culture to turn negative(P<0.05).As for the blood inflammatory indicators,there was no significant difference between the two groups except that the CRP of the combination group decreased more significantly than that of the single treatment group did at one week postop.The number of surgeries,length of hospital stay,NPWT use time,and wound closure time were lower in the combination treatment group than those in the single treatment group(P<0.05).However,there was no significant difference in long-term wound complications between the two groups.Conclusion When applying NPWT plus lavage system in the treatment of Wagner grade 3-5 diabetic foot ulcers combined with infection,wound infection can be controlled effectively at an early stage and the amount of time needed for wound bacterial culture to turn negative can also be reduced.In addition,the combination treatment stimulates granulation growth of the wounds to effectively cover the wound at an early stage.