负压封闭吸引对糖尿病溃疡愈合的促进作用

Promotion of diabetic ulcer healing by vacuum-assisted closure therapy

目的在“创面床准备（WBP）”理论指导下，观察负压封闭吸引局部处理糖尿病溃疡的疗效。方法收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组，2005年1月至2007年6月的8例糖尿病溃疡患者为试验组。两组患者均经常规系统的治疗，试验组在创面的黑、黄期采用清创后负压吸引治疗。观察两组创面各分期间的演进情况。比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果。观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸一天狼猩红染色结果及对其含量进行图像分析。结果试验组患者创面各分期的演进速度、手术Ⅰ期修复率均优于对照组（100％比46％，P〈0．05）。治疗2周后试验组创面未检出致病菌，对照组检出率为66．7％（P〈0．05）。HE染色显示试验组各期间的演进类似于急性创面愈合过程，且试验组黄期Ⅰ、Ⅲ型胶原总含量为12．28％，对照组为24．77％（P〈0．01）。结论基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程。

Objective To observe the efficacy of local treatment on diabetic ulcer by using vacuumassisted closure （VAC） way based on ＂wound bed preparation （WBP）＂ theory. Methods Twenty-seven patients admitted to our hospital from Jan 2000 to Jan 2005, 8 patients from Jan 2005 to June 2007, were respectively divided into control group and trial group. All the 35 patients were suffered from diabetic skin ulcer. Conventional and systematic therapy was adopted for both two groups. And vacuum-assisted closure was applied in trial group when debridement was practiced in black or/and yellow stage. The time consuming of wounds evolving from inferior stage to superior one, one-step operation healing rate, wounds bacterial detection at admission and 1, 2, 3 weeks post vacuum-assisted closure treatment were observed. Biopsies of different stages were harvested to make histology observations by HE stain and Ⅰ and Ⅲ type collagen analysis at yellow and red stage by picrosirius-polarization technique and image analysis. Results Speed of wounds evolving to other stages and one-step operation healing rate were superior in trial group than those in control group （ 100% vs 46% , P 〈 0.05 ）. No bacteria was detected in trial group but the rate still persisted at 66.7% in control group at the time of 2 weeks post-treatment（ P 〈 O. 05 ）. HE stain showed that healing process at each stage in trial group was like an acute wound process. Total Ⅰ and Ⅲ type collagen in trial group was 12.28% and 24. 77% in control group（P 〈 0.01 ）. Conclusions Vacuum -assisted closure based on WBP theory is a good treatment to promote diabetic ulcer healing.