小切口对口引流换药技术对糖尿病足肌筋膜间隙感染患者患足功能康复的影响

Effect of small incision counterpart drainage and dressing change technique on rehabilitation of foot function in patients with diabetic foot fascial space infection

目的探讨小切口对口引流换药技术对糖尿病足肌筋膜间隙感染患者患足功能康复的效果。方法选择2018年1月至2018年7月首都医科大学宣武医院伤口护理中心收治的60例糖尿病足肌筋膜间隙感染患者,按随机数字表法将患者随机分为2组,观察组和对照组,每组30例。观察组行多个小切口相互贯通至正常组织,蚕食样逐渐清除坏死组织,清创后用脂质水胶体敷料进行对口引流,若炎症蔓延则继续扩创,患足红肿消退开始考虑逐步撤除对口引流条,最后撤出足底与足背贯穿的对口,采用湿性及密闭敷料覆盖。对照组采取大切口彻底清创,后期多次使用无菌剪或手术刀片清创去除坏死组织控制感染,用0.9%氯化钠溶液冲洗患足并沾干,使用银离子敷料等功能敷料覆盖。统计2组患者疼痛评分、切口愈合时间、患者满意度,并对患者进行健康状况调查,包括生理领域(生理机能、生理职能、躯体疼痛和一般健康状况)和心理领域(精力、社会功能、情感职能和精神健康)。数据比较采用t检验。结果观察组患者疼痛评分、切口愈合时间和患者满意度分别为(3.76±1.94)分、(39.09±10.55)d和(94.21±6.77)分,与对照组[(5.31±2.48)分、(47.11±7.13)d和(82.09±7.26)分]比较,差异均有统计学意义(t=2.70,3.45,6.69,P值均小于0.05)。观察组患者生理领域各指标(生理功能、生理职能、躯体疼痛、一般健康状况)评分分别为(79.99±14.12)、(71.33±10.21)、(77.47±12.78)、(81.15±12.77)分,与对照组[(72.54±12.01)、(63.03±11.67)、(67.19±11.12)、(73.08±10.54)分]比较差异均有统计学意义(t=2.20、2.93、3.32、2.67,P值均小于0.05);观察组患者心理领域各指标(精力、社会功能、情感职能、精神健康)评分分别为(83.64±10.88)、(92.55±11.32)、(92.67±25.55)和(86.34±9.77)分,与对照组[(76.11±15.02)、(70.31±16.23)、(73.34±21.21)、(78.98±11.01)分]比较差异均有统计学意义(t=2.22、6.16、3.19、2.74,P值均小于0.05)。结论小切口对口引流换药技术创伤小,出血量少,安全可靠,相比常规方法优势明显。而且保全患足外形及功能,患者生活质量明显提高,健康状态明显改善。

Objective To investigate the effect of small incision counterpart drainage and dressing change technique on foot function in patients with diabetic foot muscle fascial space infection.Methods From January 2018 to July 2018,60 patients with diabetic foot fascial space infectioniabetic foot were treated in the Wound Care Center of Xuanwu Hospital Capital Medical University.The patients were randomly divided into two groups according to the random number table method,observation group and control group,30 cases in each group.The observation group underwent counterpart drainage and dressing with small incision to normal tissues.Necrotic tissue was gradually cleared away and the lipid hydrocolloid dressing was used for drainage after debridement.If inflammation spread,debridement continued.When the redness and swelling of the affected foot began to recede,the removal of the drainage strip was taken into consideration.Finally,the incision between sole and back of the foot was closed and covered with wet and closed dressing.The control group underwent thorough debridement through a large incision.In the later stage,sterile scissors or surgical blades were repeatedly used to debridement the necrotic tissue to control the infection.The affected foot was rinsed with 0.9%sodium chloride solution and dried with sterile gauze.Functional dressings such as silver ion dressings were used to cover it.The pain score,incision healing time,patient satisfaction,and the health status of the patients in the two groups,including the physiological field(physical functions,physiological functions,physical pain and general health)and the psychological field(energy,social function,emotion functional and mental health)were calculated and surveyed.Data were compared by t test.Results The observation group’s pain score,incision healing time,and patient satisfaction were(3.76±1.94)points,(39.09±10.55)d and(94.21±6.77)points,and the control group were[(5.31±2.48)points,(47.11±7.13)d and(82.09±7.26)points],the differences were statistically significant(t=2.70,3.45,6.69;with P values below 0.05).In addition,the scores of the physiological field(physical functions,physiological functions,physical pain and general health)scores of the observation group were(79.99±14.12),(71.33±10.21),(77.47±12.78)and(81.15±12.77)points,respectively and those in the control group were[(72.54±12.01),(63.03±11.67),(67.19±11.12),(73.08±10.54)points],the differences were statistically significant(t=2.20,2.93,3.32,2.67;with P values below 0.05);the scores of various indicators in the psychological field(energy,social function,emotion functional and mental health)of the observation group were(83.64±10.88),(92.55±11.32),(92.67±25.55)and(86.34±9.77)points,and those in the control group were[(76.11±15.02),(70.31±16.23),(73.34±21.21)and(78.98±11.01)points],the differences were statistically significant(t=2.22,6.16,3.19,2.74;with P values below 0.05).Conclusions Counterpart drainage and dressing change with small incision is of less damage and bleeding,safer,more reliable,and much better than conventional dressing change.Moreover,the appearance and function of the diabetic foot can be preserved,and the quality of life and health of the patients can be significantly improved.