负压创面疗法联合冲洗在糖尿病足溃疡治疗中的疗效研究

Drip irrigation with negative pressure wound therapy in the diabetic foot ulcers treatment

目的探讨负压创面疗法加用0.9%氯化钠溶液滴注冲洗治疗糖尿病足溃疡的疗效。方法收集2011年1月至2012年6月中山大学附属第一医院烧伤科收治的糖尿病足溃疡(Wagner分级为Ⅱ级)患者47例,随机分为实验组27例和对照组20例,常规进行手术清创后,对照组仅行封闭负压吸引疗法;实验组行封闭负压吸引联合0.9%氯化钠溶液滴注冲洗。比较两组创面细菌清除率、创面清洁时间和更换负压敷料次数。结果 47例患者溃疡创面均全部愈合,实验组与对照组的创面细菌清除率分别为88.9%和60.0%(P<0.05);创面清洁时间分别为(11.3±2.5)d和(17.1±3.1)d;更换负压敷料平均次数分别为2.4次和5.7次。实验组的创面细菌清除率、创面清洁时间、更换引流管次数明显优于对照组。结论在治疗糖尿病足溃疡时,0.9%氯化钠溶液滴注冲洗联合封闭负压疗法优于单纯的封闭负压疗法,能够提高细菌的清除率,缩短创面清洁时间,减少负压敷料更换次数,为创面治疗节约时间,减少患者费用,值得进一步推广应用于临床。

Objective To discuss the clinical effect of the drip irrigation with negative pressure wound therapy （NPWT） drip irrigation in treatment of the patients who had ulcer of diabetic foot. Methods Forty-seven cases who were in the First Affiliated Hospital of Sun Yat-Sen University from January 2011 to June 2012 with diabetic foot of grade Ⅱ of Wagner degree were enrolled. And they were randomly assigned to two groups： the study group with 27 cases and the control group with 20 cases. After the debridement operation, NPWT was used in the control group, while NPWT with the drip irrigation of 0.9% sodium chloride solution in the study group. The measurement indexes were the bacteria clearance rate of wound, wound cleaning time and the times to change dressing. Results Forty-seven cases of diabetic foot healed. The bacteria clearance rate of wound took up 88. 9% and 60.0%（P0.05） respectively in the study group and in the control group. The time of wound cleaning took up （11.3±2.5 ）days and （17.1±3.1） days respectively. The times to change dressing took up 2.4 times and 5.7 times respectively. Compared with the control group, the bacteria clearance rate of wound, the time of wound cleaning and the times to change dressing of the study group were better. Conclusions When treating diabetic foot ulcer, NPWT with the drip irrigation of 0.9% sodium chloride solution has obvious advantages over the simple way of NPWT. The former can improve the efficiency of getting rid of viruses, reduce the times to change the dressing, and time. Therefore, it can save the time for the treatment and the cost of the patients. It is worthy of being popularized in practice.