改良促血管再生方案辅助高压氧对老年糖尿病足溃疡患者创面修复影响的研究

Influence of modified vascular regeneration program assisted with HBO on wound healing and laboratory parameters of elderly patients with diabetic foot ulcers

目的探讨改良促血管再生方案辅助高压氧(HBO)对老年糖尿病足溃疡(DFU)患者创面修复及生化指标的影响。方法选取2014年8月至2017年12月于我院内分泌科收治的老年DFU住院患者116例,根据患者意愿分为试验组(BVR)及对照组(Con),每组各58例。BVR组予改良促血管再生方案+HBO治疗,Con组在对症干预基础上予HBO治疗。比较两组临床疗效、治疗前后足部症状评分、密歇根神经病变筛查评分系统(MNSI)、足背动脉血流速度、踝臂指数(ABI)、腓总神经神经传导速度(NCV)、溃疡直径、TNF-α、IL-6、AGEs及随访6个月复发率。结果BVR组治疗后足部症状评分、MNSI评分、溃疡直径、TNF-α、IL-6及AGEs水平均低于治疗前及Con组(P<0.05),治疗后足背动脉血流速度、ABI、腓总神经NCV均高于治疗前及Con组(P<0.05);BVR组治疗总有效率高于Con组(94.83%vs 75.86%,P<0.05),随访6个月复发率低于Con组(0.00%vs 13.64%,P<0.05)。结论改良促血管再生方案辅助HBO治疗老年DFU可有效减轻足部症状体征,改善足部微循环状态和神经传导速率,促进创面缩小,降低TNF-α、IL-6及AGEs水平,有助于预防远期复发。

Objective To investigate the influence of modified vascular regeneration program assisted with hyperbaric oxygen(HBO)on wound healing and laboratory parameters of elderly patients with diabetic foot ulcer(DFU).Methods 116 DFU inpatients from August 2014 to December 2017 were divided into control group(Con,n=58)treated with HBO and experiment group(BVR,n=58)treated with modified vascular regeneration program+HBO.The clinical efficacy,the foot symptom score,MNSI score,the blood flow velocity of foot dorsum,ABI,SNCV of peroneal nerve,the ulcer diameter,the levels of TNF-α,IL-6 and AGEs before and after treatment and the recurrence rate in 6 months between two groups were compared.Results Compared with Con group,the clinical symptom score and MNSI score in BVR group decreased significantly after treatment(P<0.05).The improvements of blood flow velocity of foot dorsum,ABI,SNCV of peroneal nerve and the ulcer diameter after treatment in BVR group were significantly better than Con group(P<0.05).The levels of TNF-α,IL-6 and AGEs in BVR group decreased significantly after treatment(P<0.05).The overall rate of effective treatment in BVR group was higher than that in Con group(94.83%vs 75.86%,P<0.05).The recurrence rate within 6 months in BVR group was significantly lower than Con group(0.00%vs 13.64%,P<0.05).Conclusion Modified vascular regeneration program assisted with HBO in the treatment of elderly patients with diabetic foot ulcers can efficiently relieve the symptoms and signs of foot,improve the microcirculation state and nerve conduction of foot,reduce the wound surface and the levels of TNF-α,IL-6 and AGEs,which helps to prevent the recurrence of DFU the long-term recurrence.