顾步汤联合复方黄柏液治疗糖尿病足坏疽介入术后溃疡的研究

Study on Gubu Decoction combined with compound Huangbai liquid in the treatment of ulcers after interventional in diabetic foot gangrene

目的观察顾步汤联合复方黄柏液治疗糖尿病足坏疽介入术后溃疡的疗效及对炎症指标、足背动脉血流动力学的影响。方法将2020年1月—2021年7月在河北省中医院介入血管外科治疗的80例糖尿病足坏疽介入术后溃疡患者随机分为对照组40例、观察组40例。对照组给予前列地尔干乳剂治疗,观察组在对照组治疗基础上加用复方黄柏液涂剂局部外敷和顾步汤口服4周。观察2组患者治疗前及治疗4周后视觉模拟疼痛评分(VAS评分)、中医症状积分、足背动脉血流动力学[血流速度、血管内径、阻力指数(RI)、搏动指数(PI)]、炎症指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)、红细胞沉降率(ESR)]的变化,记录2组患者治疗4周后新鲜肉芽组织生长面积及创面愈合时间、住院时间,比较2组患者治疗效果。结果治疗4周后,2组患者VAS评分、中医症状积分、足背动脉RI及血清IL-6、CRP水平和ESR均明显低于治疗前(P均<0.05),足背动脉血流速度明显快于治疗前(P均<0.05),血管内径、足背动脉PI均明显高于治疗前(P均<0.05),观察组上述指标较对照组改善更明显(P均<0.05)。观察组治疗4周后新鲜肉芽组织生长面积明显大于对照组(P<0.05),创面愈合时间、住院时间均明显短于对照组(P均<0.05)。治疗4周后观察组、对照组总有效率分别为90.0%(36/40)、70.0%(28/40),观察组明显高于对照组(P<0.05)。结论顾步汤联合复方黄柏液治疗糖尿病性足坏疽介入术后溃疡临床疗效显著,可明显缓解症状,改善足背动脉血流,促进创面愈合,缩短住院时间,其机制可能与抑制炎症反应有关。

Objective It is to observe the curative effect of Gubu Decoction combined with compound Huangbai liquid in the treatment of ulcers after interventional in diabetic foot gangrene and its effect on inflammatory indexes and dorsal foot artery hemodynamics.Methods A total of 60 patients with postoperative ulcers of diabetic foot gangrene who were treated with interventional vascular surgery in Hebei Provincial Hospital of Traditional Chinese Medicine from January 2020 to July 2021 were randomly divided into a control group of 30 cases and an observation group of 30 cases.The control group was treated with alprostadil dry emulsion,and the observation group was additionally treated with topical application of compound Huangbai liquid paint and oral administration of Gubu Decoction for 4 weeks on the basis of the treatment of the control group.The changes in the Visual analog pain score(VAS score),TCM symptom score,dorsal foot artery hemodynamics[blood flow velocity,inner diameter of blood vessel,resistance index(RI),pulsatility index(PI)]and inflammatory indexes[interleukin-6(IL-6),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)]of the two groups before treatment and after 4 weeks of treatment were observed,and the growth area of fresh granulation tissue and wound healing time,hospitalization time of the patients in the two groups were recorded after 4 weeks of treatment,and the treatment effects of the two groups were compared.Results After 4 weeks of treatment,the VAS score,TCM symptom score,RI of dorsal foot artery,levels of serum IL-6,CRP and ESR were significantly lower than those before treatment(all P<0.05),and the blood flow velocity of dorsal foot artery was significantly faster than that before treatment(all P<0.05),blood vessel inner diameter and PI of dorsal foot artery were significantly higher than those before treatment in the two groups(all P<0.05),and the above indicators in the observation group were improved more significantly than those in the control group(all P<0.05).After 4 weeks of treatment,the growth area of fresh granulation tissue in the observation group was significantly larger than that in the control group(P<0.05),and the wound healing time and hospital stay were significantly shorter than those in the control group(all P<0.05).After 4 weeks of treatment,the total effective rates in the control group and the observation group were 63.3%(19/30)and 80.0%(24/30)respectively,and the observation group was significantly higher than the control group(P<0.05).Conclusion Gubu Decoction combined with compound Huangbai liquid has a significant clinical effect in the treatment of ulcers after interventional in diabetic foot gangrene,which can significantly relieve symptoms,improve the blood flow of the foot dorsal artery,promote wound healing,and shorten the hospital stay.The mechanism may be related to the inhibition of inflammatory response.