快速木乃伊化策略治疗糖尿病足临床研究

Prospective study of rapid mummification strategy in the treatment of diabetic foot

目的 对糖尿病足湿性坏疽采取快速木乃伊化策略,评价其临床疗效及安全性。方法 回顾性分析2012年7月至2013年7月天津中医药大学第二附属医院采用快速木乃伊化治疗的19例糖尿病足湿性坏疽病人的临床资料,以及2010年7月至2012年7月采用传统方法治疗的21例糖尿病足湿性坏疽病人资料,对比分析两组病人的疗效及并发症情况。结果 足跟部和第1跖趾关节处木乃伊化时间较短（3 d）,而足趾木乃伊化时间较长（5-9 d）。木乃伊化组和传统治疗组在治疗后第3天WBC差异无统计学意义[（9.5±1.8）×109/L vs.（10.2±2.0）×109/L,P〉0.05],而C反应蛋白（CRP）差异有统计学意义[（3.0±6.8）mg/L vs.（36.5±7.21）mg/L,P〈0.05];治疗后第6天,木乃伊化组病人WBC及CRP较传统治疗组改善明显,差异有统计学意义（P〈0.01）。木乃伊化组相较于传统治疗组感染扩散发生率（15.79%vs.47.62%,P〈0.05）及截肢发生率（21.05%vs.47.62%,P〈0.05）均明显降低,而愈合率（89.47%vs.71.43%）及病死率（10.53%vs.28.57%）差异无统计学意义（P〉0.05）。木乃伊化组病人在治疗过程中未出现疼痛或疼痛加重、过敏等并发症。结论 湿性坏疽组织快速脱水达到木乃伊化是一种有效控制感染的方法,可减少感染扩散并降低截肢发生率。

Objective To evaluate the clinical efficacy and safety of the rapid mummification strategy on wet gangreneof diabetes foot. Methods The clinical data of 19 cases of wet gangrene of diabetic foot used the self-designed 95%alcohol continuous perfusion technique from July 2012 to July 2013 in the Second Affiliated Hospital, Tianjin Universityof Traditional Chinese Medicine were compared with 21 cases of wet gangrene of diabetic foot performed the traditionaltreatment from July 2010 to July 2012. The therapeutic effect and complication between two groups were compared andanalyzed. Results The mummified time of heel and the first metatarsophalangeal joint was shortest about 3d, but that oftoes was the longest about 5-9d. WBC between two groups in 3d had no significant difference （P〉0.05） and there weresignificant difference in CRP between two groups （P〈0.01）. WBC and CRP in mummified group were improvedsignificantly in postoperative 6d （P〈0.01）. The infection spreading incidence （15.79% vs. 47.62%） and the majoramputation incidence （21.05% vs. 47.62%） decreased significantly （P〈0.05）. The wound healing rate （89.47% vs.71.43%） and mortality （10.53% vs. 28.57%） had no obvious difference （P〉0.05）. The mummified group does not appearpain or increased pain, allergy and other complications. Conclusion Wet gangrene tissue by rapid dehydration tomummification is an effective way to control infection, can reduce the infection spreading rate and the major amputationrate.