卧位非负重运动联合高压氧治疗糖尿病足溃疡的疗效观察

Effects of non-load exercise with lying position combined with hyperbaric oxygen on diabetic foot ulcer

目的 观察卧位非负重运动联合高压氧治疗糖尿病足溃疡（diabetic foot ulcer,DFU）的疗效.方法 将2010-2013年被确诊为DFU的131例患者分为常规治疗组（33例）、运动组（33例）、高压氧组（33例）和综合治疗组（32例）,观察治疗前后局部皮肤温度、踝肱指数（ankle/brachial index,ABI）、经皮氧分压、血管内皮生长因子（vascular endothelial growth factor,VEGF）等变化,同时进行疗效评价.结果 治疗后,综合治疗组总有效率93.8％,优于运动组（75.8％）、高压氧组（78.8％）和常规组（45.5％）,差异有统计学意义（P＜0.05）.运动组、高压氧组、综合组治疗后皮温、ABI、经皮氧分压、溃疡面积与治疗前比较,均有明显改善,差异有统计学意义（P＜0.05）.综合组治疗后上述各项指标与其他组治疗后比较,差异有统计学意义（P＜0.05）.综合治疗组治疗后血清VEGF水平较治疗前明显降低,与其他3组治疗后比较,差异有统计学意义（P＜0.05）.结论 非负重运动联合高压氧治疗对糖尿病足溃疡疗效显著,较单纯应用非负重运动和高压氧有更好的临床疗效,VEGF可作为DFU改善有效性的评价指标.

Objective To observe the effects of non-load exercise with lying position combined with hyperbaric oxygen（HBO） on diabetic foot ulcer （DFU）.Methods The patients with DFU were randomly divided into the routine treatment group,the exercise group,the HBO group and the comprehensive treatment group.Changes in local skin temperature,ankle brachial index （ABI）,transcutaneous oxygen pressure,and vascular endothelial growth factor （VEGF） were closely observed and therapeutic effects were evaluated before and after treatment.Results Following treatment,total efficacy for the comprehensive treatment group was 93.8%,which was superior to those of the exercise group （75.8%）,the HBO group （78.8%） and the routine treatment group （45.5%）（P 〈 0.05）,and statistical significance could be noticed when comparisons were made between them （P 〈 0.05）.One month after treatment,significant improvement could be seen in local skin temperature,ABI,transcutaneous oxygen pressure and ulcer size for the exercise group,the HBO group and the comprehensive treatment group （P 〈 0.05）,with statistical significance （P 〈 0.05）.Following treatment,the above indexes of the comprehensive treatment group were significantly improved,as compared with those of the other 3 groups,also with statistical significance（P 〈 0.05）.The level of serum VEGF for the comprehensive treatment group was decreased after treatment as compared with that before treatment,and there was also statistical significance as compared with those of the other 3 groups （P 〈 0.05）.Conclusions Non-load exercise with lying position combined with HBO could produce significant effects on DFU.This treatment method was obviously superior to those of simple non-load exercise and HBO therapy,and VEGF could be used as an effective index for the evaluation of treatment of diabetic foot ulcer.