超声水刀清创系统联合封闭式负压引流(VSD)冲洗在慢性糖尿病足创面治疗中的应用效果

Application Effect of Ultrasonic Water Knife Debridement System Combined with Closed Negative Pressure Drainage(VSD) Irrigation in the Treatment of Chronic Diabetic Foot Wounds

目的分析超声水刀清创系统+封闭式负压引流(VSD)冲洗在慢性糖尿病足(DF)创面治疗中的应用效果,以及对足背部动脉血流动力指数的影响及安全性。方法选取2019年8月—2021年8月该院住院的92例慢性DF患者为研究对象,对患者进行随机分组,每组46例,对比组接受VSD冲洗治疗,观察组接受超声水刀清创系统+VSD冲洗治疗,两组均在治疗6周后评价治疗效果,对比两组临床疗效、换药次数、创面愈合时间、足背部动脉血流动力指数,创面渗液TIMP-1、MMP-2、VEGF含量,并发症总发生率。结果观察组临床总有效率(95.65%)高于对比组(69.57%),观察组换药次数低于对比组,观察组创面愈合时间短于对比组,两组比较差异有统计学意义(P<0.05)。观察组治疗后足背部动脉最慢流速、最快流速均高于对比组,观察组治疗后足背部动脉阻力指数低于对比组,两组比较差异有统计学意义(P<0.05)。观察组治疗后创面渗液TIMP-1、VEGF含量均高于对比组,观察组治疗后创面渗液MMP-2低于对比组,观察组并发症总发生率(2.17%)低于对比组(15.22%),两组比较差异有统计学意义(P<0.05)。结论超声水刀清创系统+VSD冲洗可促进慢性DF患者创面愈合,减少创面分泌物,抑制创面渗液因子表达,改善足背部动脉血液循环,降低并发症发生率,效果显著,具有更高的临床应用及推广价值。

Objective To analyze the effect of ultrasonic water knife debridement system + closed negative pressure drainage(VSD) irrigation in the treatment of chronic diabetic foot(DF) wounds, its influence on the arterial hemodynamic index of the back of the foot and its safety. Methods A total of 92 patients with chronic DF who were hospitalized in this hospital from August 2019 to August 2021 were selected as the research objects, and the patients were randomly divided into 46 cases in each group. The comparison group received VSD irrigation treatment, and the observation group received ultrasonic water knife debridement system + VSD Irrigation treatment, both groups were evaluated after 6 weeks of treatment, and the clinical efficacy, number of dressing changes, wound healing time, dorsal arterial blood flow index, wound exudate TIMP-1, MMP-2, VEGF content and total incidence of complications were compared between the two groups. Results The total clinical effective rate(95.65%) of the observation group was higher than that of the comparison group(69.57%), the number of dressing changes in the observation group was lower than that of the comparison group, and the wound healing time of the observation group was shorter than that of the comparison group, the difference between the two groups was statistically significant(P<0.05). The slowest and fastest flow velocity of the dorsal foot arteries in the observation group were higher than those in the control group, the resistance index of the dorsal foot arteries in the observation group was lower than that in the comparison group, the difference between the two groups was statistically significant(P <0.05). The contents of TIMP-1 and VEGF in the wound exudate of the observation group were higher than those of the control group, the MMP-2 of the wound exudate of the observation group was lower than that of the control group, the total incidence of complications(2.17%) in the observation group was lower than that of the control group(15.22%), the difference between the two groups was statistically significant(P<0.05). Conclusion Ultrasonic water knife debridement system+ VSD flushing can promote wound healing in chronic DF patients, reduce wound secretions, inhibit the expression of wound exudate factors, improve blood circulation in the arteries of the back of the foot, reduce the incidence of complications, and have significant effects and higher clinical application and promotion value.