活血生肌方创面灌注-负压治疗糖尿病足坏死性筋膜炎的疗效观察

The observation on curative efet of negative-pressure wound therapy with Huoxue Shengji Recipe insilation for necrotizing fascitis of diabetic

目的观察活血生肌方创面灌注-负压治疗糖尿病足坏死性筋膜炎的疗效。方法糖尿病足坏死性筋膜炎患者60例,随机分为观察组与对照组,各30例。在全身支持治疗的基础上,患者行手术扩创后,对照组应用0.9%氯化钠溶液进行创面灌注-负压治疗,观察组应用活血生肌方进行创面灌注-负压治疗。灌注冲洗2次/d,5 d为1个疗程,5 d后拆除敷料,如创面仍有坏死组织、肉芽灰暗或水肿、溃疡周围组织红肿皮温升高、出现脓性分泌物或恶臭,则继续行1个疗程的扩创及负压封闭引流治疗,直至上述症状消失后完成植皮或皮瓣移植。观察比较两组患者下肢肿胀程度、创周皮肤温度、炎症因子水平、创面细菌培养阳性率、治疗过程中手术扩创次数及创面愈合时间,分析活血生肌方创面灌注-负压治疗对糖尿病足坏死性筋膜炎的影响。结果治疗第1疗程后,观察组创面肿胀程度、皮肤温度优于对照组,观察组WBC、CRP、PCT指标及细菌培养阳性率低于对照组,差异有统计学意义(P<0.05)。两组患者扩创次数比较差异无统计学意义(P>0.05),两组患者愈合时间分别为(17.36±3.42)d、(23.21±6.37)d,观察组短于对照组(P<0.01)。结论活血生肌方创面灌注-负压治疗糖尿病足坏死性筋膜炎可进一步控制创面感染,改善创面炎症症状,降低炎症指标,促进创面愈合。

Objective To observe the curative effect of negative-pressure wound therapy(NPWT)with Huoxue Shengji Recipe instillation for necrotizing fasciitis of diabetic foot.Methods 60 patients with necrotizing fasciitis of diabetic foot were randomly divided into the observation group and the control group,with 30 cases in each group.On the basis of systemic support therapy,after the surgical expansion,the control group received NPWT with 0.9%sodium chloride solution instillation,and the observation group received NPWT with Huoxue Shengji Recipe instillation.After 5 days,the dressing was removed.If there were still necrotic tissue,gray granulation or edema on the wound surface,swelling and swelling of the tissue around the ulcer,and purulent secretions or stench,the wound expansion and NPWT instillation were continued for 1 course,until skin grafting or flap transplantation was completed after the above symptoms disappeared.Lower limb swelling degree,skin temperature around the wound,inflammatory factor level,positive rate of wound bacterial culture,number of surgical expansion and wound healing time of the two groups were observed and compared,and the influence of NPWT with Huoxue Shengji Recipe instillation for necrotizing fasciitis of diabetic foot was analyzed.Results After the first course of treatment,the wound swelling degree and skin temperature in the observation group were better than those in the control group,while the WBC,CRP,PCT indexes and the positive rate of bacterial culture in the observation group were lower than those in the control group,with statistical significance(P<0.05).There was no significant difference in the number of wound expansions between the two groups(P>0.05).The healing time of the two groups was(17.36±3.42)d and(23.21±6.37)d,respectively.The observation group was shorter than the control group(P<0.01).Conclusion The treatment of NPWT with Huoxue Shengji Recipe instillation for necrotizing fasciitis of diabetic foot can further control wound infection,improve inflammatory symptoms,reduce inflammatory indicators,promote wound healing and improve clinical efficacy.