湿性疗法对糖尿病足溃疡创面血管化影响的相关研究

Effects of moist wound therapy on vascularization of wound surface in diabetic patients with foot ulcers

目的探讨湿润烧伤膏联合美宝疮疡贴对糖尿病足溃疡创面血管形成的影响。方法将我科2010年6月～2011年6月收治的64例糖尿病足溃疡患者按数字随机法分为2组,A组32例设为实验组,溃疡创面使用美宝湿润烧伤膏联合疮疡贴换药,2次/d;B组32例为对照组,溃疡创面使用凡士林油纱布换药,2次/d。两组患者于创面处理后0、7、12、21 d分别采取创面组织标本行免疫组织化学检测CD34,并行创面微血管密度(MVD)计数,同时观察各组创面肉芽组织的生长情况。结果两组患者治疗后0、7 d时,创面肉芽组织生长、CD34无统计学差异(P>0.05);治疗后12 d,A组创面肉芽组织生长(24.87±0.24)%较B组(18.66±0.45)%增快,CD34表达增强的微血管为(8.34±0.48)个/HP,与对照组(4.42±0.14)个/HP相比有统计学差异(P<0.05);换药后21 d,两组各项观察指标统计学差异性更为显著(P<0.01)。结论糖尿病足溃疡创面局部联合应用美宝湿润烧伤膏和疮疡贴可促进创面血管形成,加速肉芽组织生长,其机理可能与激活创面内源性干细胞等因素有关。

Objective To discuss the effects of Moist Burn Cream combined with Meibao Paste for Pyocutaneous Disease on vascularization of wound surface in diabetic patients with foot ulcers. Methods Sixty four diabetic patients with foot ulcers,who were hospitalized in our department from June 2010 to June 2011, were randomly divided into two groups. Group A （32 cases）was the experimental group treated by Moist Burn Cream combined with Meibao Paste for Pyocutancous Disease twice per day. Group B （32 cases ）was the control group treated by vaseline gauze twice per day. Respectively 0 d ,7 d, 12 d and 21 d after the treatment, the wound surface tissue samples of both groups were taken to detect the CD34 by immunohistochemistry. And microvessel density in the wound surface was calculated. The growth condition of granulation tissues in the wound surface was observed. Results There were no significant differences in the growth of wound surface granulation tissues and CD34 between the two groups 0 d and 7 d after the treatment（P 〉 0.05 ）. In 12 d after the treatment, the growth of granulation tissues in group A became faster than that in group B [ （ 24.87 ± 0.24 ） % versus （ 18.66 ± 0.45 ） % ] and CD34 expression increased in group A [ （ 8.34 ± 0.48 ） vessels/HP ], which was significantly higher than that in group B [ （4.42 ± 0. 14） vessels/HP] （P 〈 0.05）. In 21 d after the change of dressing, above differences between the two groups were more significant（ P 〈0.01 ）. Conclusion Moist Bum Cream combined with Meibao Paste for Pyocutaneous Disease in the treatment of diabetic patients with foot ulcers can accelerate the vascularization of the wound surface and the growth of granulation tissues. Its mechanism may have correlation with the activation of wound surface endogenous stem cells.