急性感染性糖尿病足湿性坏疽不同创面处理方式的临床比较

Clinical cpmparision of different treatment methods for wounds of acute infectious diabetic foot moist gangrene

目的针对急性感染性糖尿病足湿性坏疽创面临床上常采用的手术治疗和非手术治疗方式的临床疗效进行分析探讨,为急性感染性糖尿病足湿性坏疽创面的临床处理提供指导意见。方法回顾性地分析广州市第一人民医院烧伤科2014年1月至2017年3月收治的急性感染性糖尿病足湿性坏疽创面患者共63例,根据临床实际情况对糖尿病足湿性坏疽创面分别采用手术治疗方式[包括清创手术和清创手术+负压创面治疗(NPWT),设为手术治疗组,共44例]和非手术治疗方式(包括超声清创和常规换药),设为非手术治疗组,共19例。通过分析创面处理前后血糖值变化、创周炎症反应情况、肉芽组织生长情况以及总体截肢率,评价糖尿病足湿性坏疽创面不同临床处理方式的临床疗效。数据比较采用配对资料t检验、Radit分析法和χ~2检验。结果手术治疗组和非手术治疗组在治疗前后均有明显的血糖值降低,差异均有统计学意义(P值均小于0.05)。在创周炎症反应和肉芽组织生成方面,手术治疗组在炎症反应控制方面95%CI为0.808~1.149,在肉芽组织生成方面95%CI为0.792~1.133,均明显好于非手术治疗组,差异均有统计学意义(P值均小于0.05)。同时对手术治疗组内的清创手术和清创手术+NPWT两种治疗方式行进一步Radit分析,结果提示两种治疗方式在肉芽组织生成方面,95%CI为0.2466~0.6466,差异无统计学意义(P>0.05)。手术治疗组截肢率为9%,非手术治疗组截肢率为37%,提示手术治疗可以明显降低截肢率,差异有统计学意义(χ~2=5.30,P<0.05)。结论对于急性感染性糖尿病足湿性坏疽创面,应积极行清创手术治疗或辅以NPWT,尽量清除坏死组织,积极控制感染,促进肉芽组织生长,这对糖尿病足湿性坏疽保肢治疗有重要意义。

Objective To explore clinical effects about surgical operation treatment and nonsurgical operation treatment methods for acute infectious diabetic foot moist gangrene wounds,and to provide guidance for treatment of acute infectious diabetic foot moist gangrene wounds. Methods To retrospectively analyze 63 cases of acute infectious diabetic foot moist gangrene patients treated by the Department of Burns,Guangzhou First People＇s Hospital from January 2014 to March 2017. According to the clinical situation of acute infectious diabetic foot moist gangrene wounds,the surgical treatment[including debridement surgery and debridement surgery plus negative pressure wound therapy（ NPWT） ] and non-surgical treatment（ including ultrasonic debridement and routine dressing） was performed respectively. The 63 cases were divided into surgical treatment group（ 44 cases） and non-surgical treatment group（ 19 cases） on the basis of the differences of treatments. By analyzing the changes of blood glucose before and after wound treatment,the inflammation around the wound,the growth of granulation tissue and the total amputation rate,the clinical effect of different clinical treatment on diabetic foot moist gangrene wound was evaluated. The data were compared by t test,Radit analytical method and chi-square test. Results Both the surgical treatment group and the non-surgical treatment group had obvious blood glucose reduction before and after operation,the difference were statistically significant（ with P values below 0. 05）. In the field of inflammatory reaction and granulation tissue formation,the surgical treatment group had 95% CI in the control of inflammatory reaction（ 0. 808-1. 149）,and in granulation generation,the following 95% CI was 0. 792-1. 133,obviously better than non-surgical treatment group,the difference was statistically significant. At the same time,Radit analysis was performed on the debridement surgery and debridement plus NPWT in the surgical treatment group. The results suggested that there was no significant difference in granulation between the two treatment methods. The 95% CI was 0. 2466-0. 6466. The amputation rate was 9% in the surgical treatment group,and 37% in the non-surgical treatment group,it was suggesting that surgical treatment can significantly reduce the amputation rate,the difference was statistically significant（ χ~2= 5. 30,P〈0. 05）. Conclusions For acute infectious diabetic foot moist gangrene wounds,debridement surgery or plus NPWT should be actively performed to remove necrotic tissue as much as possible,actively control infection,and promote granulation growth. That is of great significance for limb salvage treatment of diabetic foot moist gangrene.