不同负压创面治疗技术对糖尿病足的修复效果比较

Comparison of Different Negative Pressure Wound Therapyin the Repair of Diabetes Foot

目的:分析比较负压辅助闭合(Vacuum-assisted closure,VAC)、负压封闭引流(Vacuum sealing drainage,VSD)两种负压创面治疗(Negative pressure wound therapy,NPWT)对糖尿病足(Diabetic foot,DF)的修复效果。方法:纳入2018年1月-2020年7月收治的80例DF患者作为研究对象,采用随机数表法进行简单随机抽样,将患者分为VAC组和VSD组,每组40例。两组均对创面进行NPWT,VAC组采用VAC法,VSD组采用VSD法。比较两组患者疗效,评估患者恢复情况,比较两组治疗前、治疗2周后血清细胞因子水平[内皮素-1(Endothelin-1,ET-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)]、氧化应激标志物[超氧化物歧化酶(Superoxide dismutase,SOD)、一氧化氮(Nitric oxide,NO)、脂质过氧化物丙二醛(Lipid peroxidemalondialdehyde,MDA)],随访记录患者预后情况。结果:两组临床疗效比较,差异无统计学意义(P>0.05)。VAC组创基准备时间、创面治愈时间和住院时间均短于VSD组(P<0.05)。治疗2周后,两组ET-1、TNF-α、MDA水平均低于治疗前,VEGF、SOD、NO水平均高于治疗前,差异有统计学意义(P<0.05);且VAC组ET-1、MDA、VEGF、SOD、NO变化幅度大于VSD组,差异有统计学意义(P<0.05)。两组复发率比较,差异无统计学意义(P>0.05)。结论:VAC、VSD治疗DF均能促进创面修复,但VAC较VSD在缩短恢复时间上更有优势。

Objective To analyze and compare the repair effects of two negative pressure wound treatment therapy(NPWT)of vacuum-assisted closure(VAC)and vacuum sealing drainage(VSD)on diabetic foot(DF).Methods A total of 80 patients with DF who were admitted between January 2018 and July 2020 were included as the research subjects.The patients were divided into the VAC group and the VSD group by simple random sampling of the random number table method,with 40 cases in each group.The two groups underwent NPWT for wound,and VAC group was treated with VAC method,and VSD group was treated with VSD method.The efficacy was compared between the two groups,and the recovery status of patients were evaluated.The levels of serum cytokines(ET-1,VEGF and TNF-α)and oxidative stress markers(SOD,NO and MDA)were compared between the two groups before treatment and after 2 weeks of treatment,and the prognosis was followed up and recorded.Results There was no statistical significance in clinical efficacy between the two groups(P>0.05).The preparation time of wound base,wound healing time and hospital stay in the VAC group were shorter than those in the VSD group,the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of ET-1,TNF-αand MDA in the two groups were lower than those before treatment,while the levels of VEGF,SOD and NO were higher than those before treatment(P<0.05).And the changes of ET-1、MDA、VEGF、SOD and NO in the VAC group were greater than those in the VSD group(P<0.05).There was no statistical difference in the recurrence rate between the two groups(P>0.05).Conclusion Both VAC and VSD in the treatment of DF can promote wound repair,but VAC has an advantage over VSD in shortening the recovery time.