扶正解毒通络法治疗糖尿病足

Treatment of Diabetic Foot with the Method of Strengthening, Detoxifying and Removing Obstruction in Collaterals

目的观察扶正解毒通络法治疗糖尿病足(气血亏虚、湿毒内蕴证)患者的临床疗效。方法将90例糖尿病足(WagnerⅡ级或Ⅲ级),中医辨证属气血亏虚、湿毒内蕴证的患者随机均分成3组。其中治疗组A 30例,治疗组B 30例,对照组 30例。对照组予以西医内科常规治疗和蚕食清创,治疗组A在对照组基础上联用扶正解毒、通络生肌膏外用,治疗组B在治疗组A基础上内服中药汤剂。对比3组患者治疗前后中医证候积分、ABI、TcPO2、CRP、ALB、感觉阈值、创面面积等变化。4周为1个疗程,共治疗3个疗程。结果单纯西医内科常规治疗和蚕食清创的对照组临床总有效率为66.7%,加用中药膏外用的治疗组A临床总有效率83.3%;而内服汤药联合外用膏药治疗组B临床总有效率为90.0%,治疗组疗效明显优于对照组。3组治疗前后中医证候积分、ABI、CRP、ALB、感觉阈值、创面面积变化均有明显差异,治疗组明显优于对照组。治疗组均未出现不良反应。结论中药内外联用治疗糖尿病足(WagnerⅡ级或Ⅲ级)气血亏虚、湿毒内蕴证者疗效显著,在改善患者临床症状、创面面积及下肢循环、神经损伤等方面较单纯中医外治和单纯西医常规治疗疗效确切。

Objective To observe the clinical effect of FuzhengJieduTongluo method on diabetic foot (deficiencyof qi and blood,syndrome of dampness and toxin).Comprehensive evaluation of the effectiveness and safety ofFuzhengJieduTongluo method provides clinical basis for further improving the clinical efficacy of traditionalChinese medicine.Methods 90 cases of diabetic foot (Wagner grade II or III) were randomly divided into three groupsaccording to the syndrome differentiation of qi and blood deficiency and dampness toxin.There were 30 cases intreatment group A,30 cases in treatment group B and 30 cases in control group.The control group was treated withconventional western medicine and nibbling and debridement,treatment group A was treated with FuzhengJiedu andTongluoShengji ointment on the basis of control group,while treatment group B was treated with traditional Chinesemedicine decoction on the basis of treatment group A.The changes of TCM syndrome score,ABI,TcPO2,CRP,ALB,sensory threshold and wound area were compared before and after treatment.Four weeks is a course of treatment,atotal of three courses.Results The total clinical effective rate of the control group was 66.7%,and that of the treatmentgroup A was 83.3%.The total effective rate of the treatment group B was 90.0%,and the effect of the treatment groupwas better than that of the control group.There were significant differences in TCM syndrome score,ABI,CRP,ALB,sensory threshold and wound area before and after treatment in the three groups.The treatment group was significantlybetter than the control group.There were no adverse reactions in the treatment group.Conclusion The combinationof internal and external Chinese medicine is more effective in treating diabetic foot (Wagner class II or class III) withdeficiency of qi and blood and syndrome of dampness and toxin.It is more effective in improving patients’ clinicalsymptoms,wound area,circulation of lower limbs and nerve injury than the traditional Chinese medicine and Westernmedicine.