封闭式负压引流技术联合胰激肽原酶对糖尿病足患者创面愈合及抗凝血酶Ⅲ的影响

Effect of Vacuum Sealing Drainage Combined with Pancreatic Kininogenase on Wound Healing and Antithrombin Ⅲ in Diabetic Foot Patients

目的探讨封闭式负压引流技术(VSD)联合胰激肽原酶对糖尿病足患者创面愈合及抗凝血酶Ⅲ(AT-Ⅲ)的影响。方法回顾性分析2019年3月至2021年2月西安交通大学第一附属医院收治的68例糖尿病足患者的临床资料,依据治疗方式不同分为对照组(30例)和研究组(38例)。两组均予以常规糖尿病基础治疗,对照组在此基础上采取VSD治疗,研究组采用VSD联合胰激肽原酶治疗,两组均治疗6周。比较两组患者治疗前后创面情况(创面深度、创面面积、创面皮温、创面情况评分)、AT-Ⅲ水平,评估临床疗效,统计治疗期间不良反应发生情况。结果治疗前后创面深度、创面面积、创面皮温及创面情况评分的主效应差异有统计学意义(P<0.01),不考虑测量时间,各指标组间的主效应差异有统计学意义(P<0.05或P<0.01),组间和时点间存在交互作用(P<0.01),治疗后两组创面深度、创面面积及创面情况评分均低于治疗前,创面皮温高于治疗前(P<0.05),研究组各创面情况优于对照组(P<0.05)。治疗前后AT-Ⅲ水平的主效应差异有统计学意义(P<0.01),不考虑测量时间,AT-Ⅲ水平组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01);治疗后两组患者AT-Ⅲ水平较治疗前明显升高(P<0.05),且研究组高于对照组(P<0.05)。研究组患者总有效率高于对照组[92.11%(35/38)比70.00%(21/30)](χ^(2)=5.637,P=0.018)。研究组不良反应总发生率为15.79%(6/38),对照组为10.00%(3/30),两组间比较差异无统计学意义(P>0.05)。结论VSD联合胰激肽原酶治疗糖尿病足患者的临床疗效显著,可明显改善患者创面情况,促进创面愈合,升高AT-Ⅲ水平,且不增加不良反应发生率。

Objective To investigate the effects of vacuum sealing drainage(VSD)combined with pancreatic kininogenase on wound healing and antithrombinⅢ(AT-Ⅲ)in diabetic foot patients.Methods Clinical data of 68 diabetic foot patients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from Mar.2019 to Feb.2021 were retrospectively analyzed,and the cases were divided into a control group(30 cases)and a study group(38 cases)according to different treatment methods.Both groups were treated with conventional basic diabetes treatment,on the basis of which the control group was treated with VSD,and the study group was treated with pancreatic kininogenase combined with VSD,both for 6 weeks.The wound condition(wound depth,area,skin temperature,wound score)and AT-Ⅲlevel of the two groups were compared before and after treatment,the clinical efficacy of the two groups was evaluated,and the incidence of adverse reactions during treatment was statistically analyzed.Results The differences in the main effect of wound depth,wound area,skin temperature and wound score before and after treatment were statistically significant(P<0.01).Regardless of the measurement time,the differences in the main effect of each index between groups were statistically significant(P<0.05 or P<0.01),and there were interactions between groups and time points(P<0.01);after treatment,the wound depth,wound area and wound condition score of the two groups were lower than before treatment,and the wound skin temperature was higher than before treatment(P<0.05).The wound condition of the study group was better than that of the control group(P<0.05).The main effect difference of AT-Ⅲlevel before and after treatment was statistically significant(P<0.01),regardless of the measurement time,the main effect difference of AT-Ⅲlevel between groups was statistically significant(P<0.01),and there was interaction between groups and time points(P<0.01);after treatment the AT-Ⅲlevel of the two groups was significantly higher than that before treatment(P<0.05),and the study group was higher than the control group(P<0.05).The total effective rate of the study group was higher than that of the control group[92.11%(35/38)vs 70.00%(21/30)](χ^(2)=5.637,P=0.018).The total incidence of adverse reactions was 15.79%(6/38)in the study group and 10.00%(3/30)in the control group,and there was no statistical significance between the two groups(P>0.05).Conclusion The combination of VSD and pancreatic kininogenase in the treatment of diabetic foot patients has a good clinical effect,which can significantly improve the wound condition,promote wound healing,and increase AT-Ⅲlevel,without increasing the incidence of adverse reactions.