负压封闭引流联合医用三氧水修复糖尿病足创面的临床观察

Clinical observation of vacuum sealing drainage combined with medical three oxygen water repairing the wound surface of diabetic foot

目的评估负压封闭引流(VSD)联合医用三氧水治疗糖尿病足创面的效果。方法收集内蒙古自治区乌海市人民医院内分泌科在2013年7月~2016年7月住院的符合纳入标准的56例糖尿病足患者,随机分为常规组(20例)、对照组(17例)和观察组(19例),常规组给予常规VSD联合生理盐水冲洗,对照组给予常规VSD联合含氧冲洗液冲洗,观察组给予常规VSD联合医用三氧水冲洗。观察或检测创面大体情况、创面细菌菌属数、引流管堵塞率、肉芽组织覆盖率、创面局部组织液氧分压和Ⅱ期创面修复的成活率。结果创面大体观察示,三组患者的创面在清创前均有坏死组织存在,无或少量肉芽组织。治疗7 d后,三组创面坏死组织均明显减少,肉芽组织显著增多,但好转程度以观察组为明显,对照组次之,常规组略差些。三组的引流管堵塞率差异无统计学意义(F=2.21,P>0.05),肉芽组织覆盖率、创面局部组织液氧分压、创面细菌清除率和Ⅱ期创面修复的成活率差异有统计学意义(F=19.58、86.52、30.47、10.34,P<0.01)。结论 VSD联合医用三氧水能加快糖尿病创面愈合的速度、减少创面感染、提高Ⅱ期手术的质量。

Objective To evaluate the effect of vacuum sealing drainage （VSD） combined with medical three oxygen water treating the wound surface of diabetic foot.Methods 56 hospitalized patients diabetic foot meeting the inclusion criteria in Department of Endocrinology of Wuhai People＇s Hospital in Inner Monggol Autonomous Region from July 2013 to July 2016 were collected.Patients were randomly divided into the routine group （20 patients）,the control group （17 patients） and the observation group （19 patients）.The routine group was given the routine VSD combined with normal saline flushing,the control group was given the routine VSD combined with oxygen-containing fluid flushing,while the observation group was given the routine VSD combined with medical three oxygen water flushing.The general situation of the wound,the number of bacteria in the wound,the blocking rate of the drainage tube,the coverage rate of granulation tissue,the partial pressure of oxygen in the local tissue of the wound and the survival rate of the second stage wound healing were observed and measured.Results The general situation of the wound showed that necrotic tissues were found on the wound surface of patients in three groups before debridement having no or a few of granulation tissues.Af- ter treatment for 7 days,necrotic tissue were significantly reduced and granulation tissue were significantly increased in three groups,but the degree of improvement in the observation group,the control group and the conventional group was slightly worse.Drainage tube blockage rate among three groups was not statistically significant （F=2.21,PM）.OS）,wound coverage rate of granulation tissue,local tissue oxygen pressure of wound,wound bacterial clearance rate and the survival rate of wound repairing at phase-II was statistically significant （F=19.58,86.52,30.47,10.34,P〈0.01）.Conclusion VSD com- bined with medical three oxygen water can accelerate the wound healing of diabetic foot,reduce wound infection and improve the quality of phase-II surgery.