不同途径医用三氧联合负压封闭引流修复糖尿病足创面的临床研究

Clinical research on repairing the wound surface of diabetic foot by combined application of medical ozone and VSD in different ways

目的评估不同途径医用三氧联合VSD治疗糖尿病足创面的效果。方法将符合纳入标准的53例糖尿病足患者,随机分为对照组(25例)和观察组(28例),对照组给予VSD+医用三氧基本自血疗法+生理盐水冲洗,观察组给予VSD+医用三氧水冲洗。治疗前行创面大体观察、检测创面细菌菌属数,记录VSD应用第1个疗程中引流管堵塞率,治疗7天后拆除VSD装置,观察创面肉芽生长情况、检测肉芽组织覆盖率、创面局部组织液氧分压、创面细菌菌属数,后期行Ⅱ期手术,计算Ⅱ期创面修复的成活率。对数据进行统计学分析。结果 (1)创面大体观察示:两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,创缘炎症反应明显。治疗7天后,两组患者创面均出现新生肉芽组织,但观察组较对照组坏死组织及脓胎少,肉芽组织红润、生长好,创缘炎症反应轻。(2)对照组和观察组引流管堵塞率差异无统计学意义(c2=1.43,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(P<0.05)。结论将医用三氧直接作用于创面要比经血液循环作用于创面更加有效并最大程度的减少医用三氧的不良反应。

Objective To evaluate the effect of treating the wound surface of diabetic foot with medical ozone together with VSD in different ways.Methods53diabetic foot patients who met the inclusion criteria were randomly divided into the control group(25patients)and observation group(28patients).VSD+major autohemotherapy for medical ozone+saline flush were conducted for the control group;VSD+medical ozone flush were conducted for the observation group.Before treatment,their wound surfaces were generally observed to check the number of bacterial genuson wound surfaces and measure the ankle brachial pressure index of affected extremity.Then,the blocking rate of drainage tube after application of VSD for1course of treatment was recorded.After treatment for7days,the VSD devices were dismantled to observe the granulation growth on wound surfaces and detect the granulation tissue coverage rate,local tissue oxygen partial pressure on the wound surfaces,number of bacterial genus on wound surfaces.Later,Phase-Ⅱsurgeries were conducted and the rate of survival of Phase-Ⅱwound repair was calculated.Then,a statistical analysis on data was made.Results①As is shown in the general observation of wound surfaces:there were necrotic tissues,no or a few of granulation tissues on the wound surfaces of patients in both groups before debridement,and there were significant inflammatory responses in their wound edges.After treatment for7days,there were new granulation tissues on the wound surfaces of patients in both groups.However,compared with the control group,the observation group had fewer necrotic tissues and pus,ruddy well-growing granulation tissues and milder inflammatory responses in wound edges.②The difference in the blocking rates of drainage tube between control group and observation group is of no statistical significance(c2=1.43,P>0.05).However,the differences in their granulation tissue coverage rates,local tissue oxygen partial pressures on wound surfaces,bacterial clearance rates on wound surfaces and the survival rates of Phase-Ⅱwound repair are of statistical significance(P<0.05).Conclusion Direct application of medical ozone to a wound surface is more effective than the application through cyclic action on a wound surface and can minimize the adverse effect of medical ozone.