封闭负压冲洗引流在严重糖尿病足修复中的应用

Negative pressure wound therapy in the wound repair of diabetic foot

目的改善糖尿病足修复手术治疗效果,减少大截肢,缩短治疗时间。尽可能保留糖尿病足患者足部功能,提高生活质量。方法将2006年1月至2008年10月解放军306医院治疗的82例糖尿病足坏疽患者(Wagner4,5级)设为单纯手术组。该组患者进行清创修复或小截肢手术,术后给予常规换药14d后拆线。将2008年11月至2011年6月解放军306医院治疗的91例糖尿病足坏疽患者(Wagner4,5级)设为联合负压组,该组患者手术联合封闭负压冲洗引流。持续负压引流6～7d,拆除负压引流后换药7d后拆线。比较两组患者保足率(修复或小截肢手术成功率)和治疗时间。结果单纯手术组57例术后伤口愈合,25例术后伤口愈合不良,再次行截肢手术治疗,保足率为69.5%,平均治疗时间为43.1d。联合负压组80例伤口愈合,11例愈合不良二次手术,保足率为87.9%,平均治疗时间为33.7d。联合负压组保足率高于单纯手术组且平均治疗时间低于单纯手术组(P<0.05)。结论封闭负压引流技术可以提高严重糖尿病足修复或小截肢修复治疗的成功率,促进术后伤口愈合,防止感染并缩短治疗时间。

Objective To improve the effects of wound repair in diabetic foot treatment, reduce tissue damage and decrease the time for treatment, and to keep patients ＇ ability to stand and walk. Methods From January 2006 to October 2008, 82 cases of diabetic foot gangrene （ Wagner 4, 5 ） treated with plastic surgery or minor amputation were set to the group of surgery only. From November 2008 to June 2011, 91 cases of diabetic foot gangrene （ Wagner 4, 5 ） treated with negative pressure wound therapy served as the group of co-negative. Continuous negative pressure drainage was used about 6 to 7 days after operation, and then sutures were taken out 7 days after removing the negative pressure dressing. The rate of limbs preserving and time for treatment in two groups were compared. Results In the group of surgery only, 57 cases got wound healing, and 25 cases got delayed wound healing. The average time of hospitalization was 43.1 days. The rate of limbs preserving was 69.5%. In the group of co-negative, 80 cases got wound healing, and 11 patients got delayed wound healing. The average time of hospitalization was 33.7 days. The rate of limbs preserving was 87.9%. The limbs preserving rate of co-negative group was higher than that of the surgery only group and the average treatment time of co-negative group was less than that of the surgery only group （ P 〈 0.05 ）. Conclusion Negative pressure wound therapy can improve the success rate of wound repair in diabetic foot, promote wound healing and reduce tissue damage, and decrease the time for treatment.