应用改良VSD等综合疗法治疗严重糖尿病足感染

Treatment of severe diabetic foot infections with combined therapies such as modified VSD

目的探索应用改良VSD等综合疗法治疗严重糖尿病足感染的临床效果。方法选取2010年1月-2017年12月唐山工人医院骨科收治的严重糖尿病足感染患者61例作为研究组,应用手术清创一期闭合创口、改良VSD系统负压引流、静脉及局部持续应用敏感抗菌药物、三维立体定向放射性治疗及应用中药制剂辅助治疗等综合治疗方法。选取2007年2月-2014年12月严重糖尿病足感染患者61例作为对照组,应用手术清创二期闭合创口、静脉持续应用抗感染等常规治疗。对患者病原学特点、血液指标和治疗效果进行分析。结果 122例严重糖尿病足感染患者穿刺液培养,共检出病原菌122株,其中革兰阳性菌36株占29.51%,革兰阴性菌81株占66.39%,真菌5株占4.10%;两组患者白细胞计数、C-反应蛋白、血沉水平治疗后均降低,且研究组优于对照组(P<0.05);研究组患者治愈率为80.33%(49/61)高于对照组患者的治愈率52.46%(32/61),两组比较差异有统计学意义(χ2=10.617,P<0.001)。结论应用改良VSD等综合方法治疗严重糖尿病足感染是一种临床疗效良好的治疗方法。

OBJECTIVE To explore the clinical effect of combined therapies such as modified VSD on treatment of severe diabetic foot infections.METHODS Totally 61 patients with severe diabetic foot infections who were treated in the orthopedics department of Tangshan Worker Hospital from Jan 2010 to Dec 2017 were chosen as the study group and given the combined therapies such as surgical debridement of phase I closed wound,modified vacuum sealing drainage（VSD）,sustained intravenous and local abminstration of sensitive antibiotics,three-dimensional stereotactic radiotherapy and adjuvant therapy with Traditional Chinese Medicine preparations.Totally 61 patients with severe diabetic foot infection who were treated from Feb 2007 to Dec 2014 were assigned as the control group and given the concentional therapies such as surgical debridement of phase II closed wound and sustained intravenous administration of antibiotics for treatment of infections.The etioligical characteristics,blood indexes and curative effects of the patients were observed.RESULTS A total of 122 strains of pathogens were isolated from the puncture fluid specimens of the 122 patients with severe diabetic foot infections,36（29.51%）of which were gram-positive bacteria,81（66.39%）were gram-negative bacteria,and 5（4.10%）were fungi.The white blood cells counts,C-reactive protein level and erythrocyte sedimentation rate were reduced in the two groups after the treatment and were significantly better in the study group than in the control group（P〈0.05）.The cure rate of the study group was 80.33%（49/61）,significantly higher than 52.46%（32/61）of the control group（χ^2=10.617,P〈0.001）.CONCLUSIONThe combined therapies such as the modified VSD can achieve favorable clinical effect on treatment of the patients with severe diabetid foot infections.