除疽生肌膏联合介入动脉腔内治疗术治疗糖尿病足坏疽的疗效观察

Clinical Effect of Chuju Shengji Plaster Combined with Endovascular Intervention on Diabetic Foot Gangrene

目的观察除疽生肌膏联合介入动脉腔内治疗术治疗糖尿病足坏疽的临床疗效。方法选取2019年6月—2021年6月期间就诊于许昌市中心医院的热毒血瘀,气阴两伤证糖尿病足坏疽患者80例,采用随机数字表法分为对照组和治疗组,每组各40例。对照组采用常规西医治疗和动脉腔内治疗术治疗,治疗组在对照组的基础上联合外用除疽生肌膏治疗。治疗1个月以后,观察比较两组患者临床总疗效、中医临床症状积分、创面愈合相关指标(创面面积、创面氧分压、溃疡以及坏疽长径,创面pH值)、生长因子水平[血小板衍生生长因子(Platelet derived growth factor,PDGF)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)]、治疗后生活质量[简明健康调查量表(SF-36)]进行比较。结果治疗1个月后治疗组临床总有效率94.74%(32/39)明显高于对照组82.05%(36/38),差异有统计学意义(P<0.05)。治疗后两组患者中医临床症状积分与治疗前比较,均明显降低,差异有统计学意义(P<0.05)。且治疗组患者中医临床症状积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者创面氧分压较治疗前明显升高,创面面积、溃疡以及坏疽长径,创面pH值较治疗前明显降低,差异有统计学意义(P<0.05);且治疗组创面氧分压较对照组明显升高,创面面积、溃疡以及坏疽长径,创面pH值较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者VEGF、PDGF水平较治疗前明显升高,差异有统计学意义(P<0.05);且治疗组VEGF、PDGF水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后治疗组生活质量各项评分明显高于对照组,差异有统计学意义(P<0.05)。结论除疽生肌膏联合介入动脉腔内治疗术能够有效减轻糖尿病足坏疽患者中医临床症状,改善创面愈合指标,升高血清生长因子水平,明显提高生活质量。

Objective To investigate the clinical effect of Chuju Shengji Plaster combined with endovascular intervention on diabetic foot gangrene.Methods A total of 80 patients with diabetic foot gangrene of heattoxin,blood stasis,and qi-yin damage syndrome who were treated in Xuchang Central Hospital from June 2019 to June 2021 were included and randomized into the control group(n=40)and treatment group(n=40)according to a random number table.The control group was treated with conventional western medicine therapy and endovascula rintervention,and the treatment group with conventional western medicine therapy,endovascular intervention,and external application of Chuju Shengji Plaster.After one month of treatment,the clinical efficacy was evaluated,and the traditional Chinese medicine(TCM)symptom score,wound healing indexes(wound area,oxygen partial pressure of the wound,long diameter of ulcer and gangrene,pH of wound),and levels of growth factors[platelet-derived growth factor(PDGF),vascular endothelial growth factor(VEGF)]before and after treatment,and quality of life[short form-36(SF-36)]after treatment were compared between the two groups.Results After one month of treatment,the total clinical effective rate of the treatment group was 94.74%(32/39),higher than the 82.05%(36/38)of the control group(P<0.05).After treatment,the TCM symptom score was lower than that before treatment in the two groups(P<0.05),and the score in the treatment group was lower than that in the control group(P<0.05).After treatment,the oxygen partial pressure of the wound increased and the wound area,long diameter of ulcer and gangrene,and pH of wound decreased in the two groups as compared with those before treatment(P<0.05).In addition,the oxygen partial pressure of the wound in the treatment group was higher than that in the control group,and the wound area,long diameter of ulcer and gangrene,and pH of wound in the treatment group were lower than those in the control group(P<0.05).After treatment,the levels of PDGF and VEGF were higher than those before treatment in the two groups(P<0.05),and the levels in the treatment group were higher than those in the control group(P<0.05).After treatment,the score of each item in SF-36 in the treatment group was higher than that in the control group(P<0.05).Conclusion The combination of Chuju Shengji Plaster and endovascular intervention can alleviate the TCM symptoms,improve wound healing indexes,raise serum levels of growth factors,and improve quality of life of patients with diabetic foot gangrene.