压力疗法在下肢静脉性溃疡治疗中的应用研究

Study on the application of pressure therapy in the treatment of venous ulcer of lower limbs

目的评估不同压力疗法应用于下肢静脉性溃疡患者的疗效。方法本研究为前瞻性随机对照研究。选取2021年1月至2021年12月山西医科大学第二医院血管外科行大隐静脉高位结扎+曲张浅静脉勾剥+穿静脉结扎术的81例下肢静脉性溃疡患者,用随机数字表法分为三组(对照组、观察一组、观察二组),每组27例。对照组溃疡伤口接受常规创面处理和踝泵运动,观察一组在对照组治疗基础上使用短延展绷带压力治疗,观察二组在观察一组的基础上采用间歇式空气波压力治疗仪治疗。采用Bates-Jensen伤口评价量表评估伤口愈合情况,采用疼痛数字评定量表(NRS)评估疼痛强度。分析三组Bates-Jense和NRS评分的变化趋势并比较组间差异。结果随着时间的延长,三组患者伤口Bates-Jensen评分和NRS评分均下降。治疗前,三组Bates-Jensen评分和NRS评分差异均无统计学意义(均P>0.050);治疗2周和4周,对照组、观察一组和观察二组患者Bates-Jensen评分[2周:(43.11±1.01)分比(28.44±3.66)分比(27.67±3.15)分,F=251.748,P<0.001;4周:(22.89±2.90)分比(19.44±4.66)分比(15.00±4.10)分,F=26.972,P<0.001]和NRS评分[2周:(4.00±0.69)分比(3.44±0.51)分比(2.33±0.48)分,F=61.486,P<0.001;4周:(2.11±0.68)分比(1.22±0.80)分比(1.11±0.75)分,F=15.817,P<0.001]相比,差异均有统计学意义。Bates-Jensen评分两两比较,治疗2周和4周,观察一组和观察二组均低于对照组,差异均有统计学意义(均P<0.001);治疗2周,观察一组和观察二组差异无统计学意义(P=0.957);治疗4周,观察二组低于观察一组,差异有统计学意义(P<0.001)。NRS评分两两比较,治疗2周和4周,观察一组和观察二组均低于对照组,差异均有统计学意义(均P<0.001);治疗2周,观察二组低于观察一组,差异有统计学意义(P<0.001);治疗4周,观察一组和观察二组差异无统计学意义(P=1.000)。结论对于下肢静脉性溃疡患者,在传统治疗的基础上使用短延展绷带压力治疗和(或)间歇式空气波压力治疗仪治疗可促进静脉溃疡的愈合,减轻患者疼痛。

ObjectiveTo evaluate the therapeutic effect of different pressure therapies on patients with venous ulcers of lower limbs.MethodsThis study was a prospective randomized controlled study.Clinical data of 81 patients admitted by the Vascular Surgery Department of Second Hospital of Shanxi Medical University who met the diagnostic criteria of venous ulcer of lower limbs and underwent high ligation of great saphenous vein,superficial varicose vein stripping and vein ligation from January 2021 to December 2021 were collected and analyzed.The patients were randomly divided into three groups:control group,observation group 1 and observation group 2,with 27 cases in each group.Patients in the control group received traditional treatment;observation group 1 used short-stretch compression bandages on the basis of traditional treatment;observation group 2 was treated with intermittent pneumatic compression therapy on the basis of therapies used in observation group 1.Bates-Jensen Wound Assessment Scale was used to compare the wound healing and Numeric Rating Scale(NRS)was applied to assess the pain intensity of the three groups of patients.The trend of score changes over time was analyzed and differences between groups were compared.ResultsWith the passage of time,the Bates-Jensen scores and NRS scores of the three groups of patients decreased.Before treatment,there was no statistically significant difference in Bates-Jensen scores and NRS scores among the three groups(all P>0.050).After 2 weeks and 4 weeks of treatment,the differences in Bates-Jensen scores(2 weeks:43.11±1.01 vs.28.44±3.66 vs.27.67±3.15 F=251.748,P<0.001;4 weeks:22.89±2.90 vs.19.44±4.66 vs.15.00±4.10,F=26.972,P<0.001)and NRS scores(2 weeks:4.00±0.69 vs.3.44±0.51 vs.2.33±0.48,F=61.486,P<0.001;4 weeks:2.11±0.68 vs.1.22±0.80 vs.1.11±0.75,F=15.817,P<0.001)between the control group,observation group 1,and observation group 2 were statistically significant.After 2 weeks and 4 weeks of treatment,the Bates-Jensen scores and NRS scores were compared in pairs,and both the scores of observation group 1 and observation group 2 were lower than those of the control group,with statistically significant differences(all P<0.001).The pairwise comparison revealed no statistically significant difference in Bates-Jensen scores between observation group 1 and observation group 2 at 2 weeks after treatment(P=0.957),while statistically significant difference in Bates-Jensen scores at 4 weeks after treatment(P<0.001).However,there was a statistically significant difference in NRS scores between the two observation groups at 2 weeks after treatment(P<0.001),while no statistically significant difference in NRS scores at 4 weeks after treatment(P=1.000).ConclusionOn the basis of traditional treatment,the use of short-stretch compression bandages and/or intermittent pneumatic compression therapy can effectively promote the healing of venous ulcers and relieve the pain of patients,and the treatment effect is remarkable,which is worthy of wide application in clinical practice.