富含血小板血浆联合异种脱细胞真皮基质修复糖尿病足缺血性创面的临床效果

Effect of platelet-rich plasma combined with xenogeneic acellular dermal matrix in the repair of ischemic wound of diabetic foot

目的观察富含血小板血浆(PRP)联合异种脱细胞真皮基质在糖尿病足缺血性创面修复中的临床效果。方法选择2020年10月至2022年10月新疆维吾尔自治区人民医院烧伤创面修复科收治的糖尿病足缺血性创面患者69例,采用简单随机化分组将患者分为PRP联合异种脱细胞真皮基质覆盖组(P+X组)、单纯PRP覆盖组(P组)、单纯异种脱细胞真皮基质覆盖组(X组),每组23例。对比3组患者肉芽完整覆盖创面所需时间、首次换药疼痛程度(VAS评分)、创面细菌培养阳性率。结果P+X组肉芽完整覆盖创面所需时间[(13.70±2.39)d]短于P组[(18.17±4.12)d]和X组[(17.89±3.86)d],差异有统计学意义(t=4.283、4.014,P<0.05);P组与X组肉芽完整覆盖创面所需时间比较,差异无统计学意义(t=0.268,P>0.05)。P+X组首次换药VAS评分为(2.68±1.26),低于P组(5.72±1.86)和X组(3.04±1.37),差异有统计学意义(t=6.786、2.366,P<0.05);X组与P组首次换药VAS疼痛评分比较,差异有统计学意义(t=4.420,P<0.05)。P+X组创面细菌培养阳性率(4.35%)低于P组(13.04%)和X组(21.74),差异无统计学意义(P=0.272)。结论PRP联合异种脱细胞真皮基质在糖尿病足缺血性创面修复中可缩短创面愈合时间,减轻换药疼痛程度。

Objective To explore the effect of platelet-rich plasma combined with xenogeneic acellular dermal matrix in the repair of ischemic wound of diabetic foot.Methods A total of 69 patients with ischemic wound of diabetic foot in Department of Burns and Wound Repair Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region from October 2020 to October 2022 were selected.The patients were divided into platelet-rich plasma combined with xenogeneic acellular dermal matrix group,platelet-rich plasma group and xenogeneic acellular dermal matrix group by simple randomization,with 23 cases in each group.The time for the granulation to cover the wound completely,the degree of pain(VAS score)on the first time of changing the dressing,positive rate of bacterial culture on the wound were compared among the three groups.Results The time for the granulation to cover the wound completely in platelet-rich plasma combined with xenogeneic acellular dermal matrix group[(13.70±2.39)d]was shorter than that of platelet-rich plasma group[(18.17±4.12)d]and xenogeneic acellular dermal matrix group[(17.89±3.86)d],and the difference was statistically significant(t=4.283,4.014;P<0.05).The time for the granulation to cover the wound completely in platelet-rich plasma group and xenogeneic acellular dermal matrix group was not statistically different(t=0.268,P>0.05).The VAS pain score on the first time of changing the dressing in platelet-rich plasma combined with xenogeneic acellular dermal matrix group was(2.68±1.26),which was lower than that in platelet-rich plasma group(5.72±1.86)and xenogeneic acellular dermal matrix group(3.04±1.37),with statistically significant difference(t=6.786,2.366;P<0.05),and the difference was statistically significant between xenogeneic acellular dermal matrix group and platelet-rich plasma group(t=4.420,P<0.05).The positive rate of bacterial culture on the wound in platelet-rich plasma combined with xenogeneic acellular dermal matrix group(4.35%)was lower than that of platelet-rich plasma group(13.04%)and xenogeneic acellular dermal matrix group(21.74%),the difference was not statistically significant(P=0.272).Conclusion Platelet-rich plasma combined with xenogeneic acellular dermal matrix in the repair of ischemic wound of diabetic foot can shorten the wound healing time,reduce the pain of dressing change.