胰岛素外用在糖尿病患者烧伤创面治疗中的效果评价

Evaluation of the effectiveness of topical insulin in the treatment of burn wounds in diabetic patients

目的 探讨胰岛素外用在糖尿病烧伤患者治疗中的应用价值,为糖尿病烧伤患者的治疗提供新思路。方法 选取医院糖尿病烧伤患者104例。按照随机数字表法将患者分为2组,每组52例。对照组常规烧伤换药治疗,治疗组于对照组基础上给予0.01 U/L普通胰岛素溶液均匀喷于创面,每日换药1次,直至创面愈合。观察2组创面愈合、感染控制情况,比较2组伤后1、3、6个月创面愈合后瘢痕增生情况,入院时及伤后14、28 d创面血流灌注流量(perfusion value, PU)、炎症因子[超敏C反应蛋白(high sensitivity C-reactive protein, hs-CRP)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素1(interleukin-1,IL-1)]水平、促愈合指标[血管内皮生长因子(vascular epithelial growth factor, VEGF)、表皮生长因子(epidermal growth factor, EGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor, bFGF)、血小板衍生生长因子(platelet derived growth factor, PDGF)]水平及不良反应情况。结果 治疗组伤后28 d内创面愈合率明显高于对照组(P<0.05);2组创面感染控制情况比较,治疗组创面感染后10 d内控制率明显高于对照组(P<0.05);治疗组伤后1个月、3个月及6个月创面愈合后瘢痕增生程度均较对照组轻(P<0.05);2组PU值均随着时间呈现增高趋势,且治疗组增高趋势更明显,2组组间、时点间以及组间·时点间交互作用比较差异有统计学意义(P<0.05);2组血清hs-CRP、IL-6、TNF-α及IL-1水平均随着时间呈现先增高后降低的趋势,且治疗组变化趋势较为平缓,2组组间、时点间以及组间·时点间交互作用比较差异有统计学意义(P<0.05);2组血清VEGF、EGF、bFGF及PDGF水平均随着时间呈现增高趋势,且治疗组增高趋势更明显,2组组间、时点间以及组间·时点间交互作用比较差异有统计学意义(P<0.05);2组均未出现过敏反应及低血糖状况。结论 胰岛素外用治疗糖尿病烧伤患者可以促进新生血管形成,改善血液循环,抑制炎性因子表达,并可有效促进创面愈合,减少瘢痕形成,提高创面修复效果,且具有较高安全性。

Objective To investigate the application value of topical insulin in the treatment of burn wounds in diabetic patients,and to provide a new idea for the treatment of burn wounds in diabetic patients.Methods One hundred and four diabetic patients with burn wounds treated in our hospital were selected and divided into two groups by random number table method,with 52 patients in each group.The control group was treated with conventional burn dressing change,and the treatment group was given 0.01 U/L normal insulin solution evenly sprayed on the wound surface on the basis of the control group,and the dressing was changed once a day until the burn wounds healed.The wound healing and infection control of the two groups were observed,and the scar growth after the wound healing at 1,3 and 6 months after the injury,the blood perfusion value(PV)of the wound surface at the time of admission and at 14 and 28 d after the injury,the inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)],pro-healing factors[vascular epithelial growth factor(VEGF),epidermal growth factor(EGF),basic fibroblast growth factor(bFGF),platelet derived growth factor(PDGF)]levels and adverse effects were compared between the two groups.Results The wound healing rate within 28 d after injury in the treatment group was significantly higher than that in the control group(P<0.05).Comparison of wound infection control between two groups showed that the control rate within 10 d after wound infection in the treatment group was significantly higher than that in the control group(P<0.05).At 1 month,3 months,and 6 months after injury,the degree of scar hyperplasia following wound healing in the treatment group was milder than that in the control group(P<0.05).The PI values of wound surface in both groups showed an increasing trend over time,and the treatment group showed a more significant increasing trend.There was a significant difference in the interaction between groups,time points,and time points between groups(P<0.05).The levels of serum hs-CRP,IL-6,TNF-α,and IL-1 in both groups all showed a trend of first increasing and then decreasing over time,and the trend of change in the treatment group was relatively gentle;there was a significant difference in the interaction between groups,time points and time points between groups(P<0.05).The levels of serum VEGF,EGF,bFGF,and PDGF all showed an increasing trend over time,and the treatment group showed a more significant increasing trend;there was a significant difference in the interaction between groups,time points and time points between groups(P<0.05).Both groups did not experience any allergic reactions or hypoglycemia.Conclusion Topical insulin in the treatment of burn wounds in diabetic patients can promote neovascularization,improve blood circulation,inhibit the expression of inflammatory factors,effectively promote wound healing,reduce scar formation,and improve wound repair effect,with high safety.