负压封闭引流技术联合高压氧治疗糖尿病足的临床疗效分析

Analysis of clinical effects of vacuum sealing drainage combined with hyperbaric oxygen in the treatment of diabetic foot

目的评估负压封闭引流技术(VSD)联合高压氧治疗糖尿病足的临床疗效。方法选取2016年9月至2018年4月在青海大学附属医院烧伤整形科就诊的60例确诊为糖尿病足患者,按随机数字表法分为实验组30例和对照组30例,其中对照组予以控制饮食、控制血糖、抗感染等常规治疗的基础上以VSD技术对创面进行治疗;实验组在常规治疗的基础上以VSD技术联合高压氧进行治疗。对2组患者治疗7、14 d的综合疗效情况进行比较,观察治疗前及治疗7、14 d 2组患者血气分析、血液流变学各指标的变化,并观察2组患者治疗前及治疗7、14 d创面组织血管内皮生长因子(VEGF)、血小板衍生生长因子(PDGF)水平的变化以及创面面积大小变化。数据比较采用t检验和χ2检验。结果治疗7 d,实验组患者治疗总有效率93. 3%(28/30),明显高于对照组80. 0%(24/30),差异有统计学意义(χ2=7. 231,P <0. 05);治疗7 d,实验组患者血液中酸碱度(7. 42±0. 19)、PCO2(41. 76±1. 65) mm Hg、血氧分压(66. 10±2. 36) mm Hg、血氧饱和度(89. 50±1. 62)%、血氧含量(6. 60±1. 17) Vol%,明显高于对照组[(7. 40±0. 25)、(40. 32±2. 70) mm Hg、(62. 05±5. 05) mm Hg、(88. 10±3. 63)%、(6. 08±1. 17) Vol%],差异均有统计学意义(t=2. 221、2. 442、4. 023、2. 135、2. 073,P值均小于0. 05);治疗7 d,实验组患者全血低切黏度(11. 08±0. 81) m Pa. s、全血高切黏度(5. 17±0. 34) m Pa. s、血浆高切黏度(2. 09±0. 16) m Pa. s、红细胞变形指数(0. 76±0. 48),降低情况明显优于对照组[(12. 29±1. 81) m Pa. s、(5. 85±0. 34) m Pa. s、(2. 58±0. 21) m Pa. s、(0. 87±0. 11)],差异均有统计学意义(t=3. 265、7. 531、10. 366、4. 942,P值均小于0. 05);治疗7 d,实验组患者创面组织VEGF(35. 70±4. 84) pg/m L、PDGF(36. 60±2. 98) pg/m L,较对照组[(25. 36±3. 21) pg/m L、(27. 53±2. 94) pg/m L]升高更明显,差异均有统计学意义(t=9. 235、11. 134,P值均小于0. 05);治疗7 d,实验组患者创面面积(5. 13±0. 60) cm2,减小程度明显优于对照组(7. 03±0. 82) cm2,差异有统计学意义(t=10. 594,P=0. 015)。治疗14 d,实验组患者治疗总有效率96. 7%(29/30),明显强于对照组86. 7%(26/30),差异有统计学意义(χ2=7. 157,P=0. 028);治疗14 d,实验组患者血液中酸碱度(7. 42±0. 21)、PCO2(42. 46±1. 57) mm Hg、血氧分压(69. 26±1. 49) mm Hg、血氧饱和度(91. 05±1. 20)%、血氧含量(6. 74±0. 89) Vol%,高于对照组[(7. 40±0. 31)、(40. 23±2. 73) mm Hg、(62. 41±4. 86) mm Hg、(88. 23±2. 17)%、(6. 13±1. 22) Vol%],差异均有统计学意义(t=2. 790、3. 778、7. 455、6. 620、2. 185,P值均小于0. 05);治疗14 d,实验组患者全血低切黏度(8. 10±1. 07) m Pa. s、全血高切黏度(4. 26±0. 33) m Pa. s、血浆高切黏度(1. 64±0. 22) m Pa. s、红细胞变形指数(0. 64±0. 04),降低情况明显优于对照组[(11. 74±1. 54) m Pa. s、(5. 82±0. 41) m Pa. s、(2. 53±0. 23) m Pa. s、(0. 83±0. 10)],差异均有统计学意义(t=9. 905、16.609、16.358、9.617,P值均小于0. 05);治疗14 d,实验组患者创面组织VEGF(47. 72 3. 75)pg /mL、PDGF(49. 17 ± 2. 48)pg /mL,较对照组[(37. 04 ± 2. 90)pg /mL、(38. 18 ±2. 65)pg /mL]升高更明显,差异均有统计学意义(t= 13.062、17.276,P值均小于0. 05);治疗14 d,实验组患者创面面积(2. 88 ± 0. 52)cm2,减小程度明显优于对照组(5. 07 ± 0. 61)cm2,差异有统计学意义(t= 12.332,P= 0. 013)。结论VSD联合高压氧治疗对于糖尿病足患者的创面愈合有显著疗效,明显优于单纯使用VSD治疗的疗效,其二者结合的功效十分显著。16. 609、16. 358、9. 617,P值均小于0. 05);治疗14 d,实验组患者创面组织VEGF (47. 72±3. 75) pg/mL、PDGF (49. 17±2. 48) pg/mL,较对照组[(37. 04±2. 90) pg/mL、(38. 18±2. 65) pg/mL]升高更明显,差异均有统计学意义(t=13. 062、17. 276,P值均小于0. 05);治疗14 d,实验组患者创面面积(2. 88±0. 52) cm2,减小程度明显优于对照组(5. 07±0. 61) cm2,差异有统计学意义(t=12. 332,P=0. 013)。结论 VSD联合高压氧治疗对于糖尿病足患者的创面愈合有显著疗效,明显优于单纯使用VSD治疗的疗效,其二者结合的功效十分显著。

Objective To evaluate the clinical efficacy of vacuum sealing drainage( VSD)combined with hyperbaric oxygen in the treatment of diabetic foot. Methods From September 2016 to April2018,60 patients with diabetic foot diagnosed in the Department of Burns and Plastic Surgery,Affiliated Hospital of Qinghai University were enrolled. According to the random number table method,30 patients in the experimental group and 30 patients in the control group were included. On the basis of conventional treatments such as blood sugar control and anti-infection,VSD technology was used in control group;the experimental group was treated with VSD technology combined with hyperbaric oxygen on the basis of conventional treatment. The comprehensive curative effect of 2 groups after 7 and 14 days treatment was compared. The changes of blood rheology and blood gas analysis of 2 groups were observed before and after7 and 14 days treatment. The changes of vascular endothelial growth factor( VEGF) and platelet derived growth factor( PDGF) levels and wound area were observed before and after 7 and 14 days treatment. Data were compared with t test and χ2 test. Results After 7 days of treatment,the total effective rate of the experimental group was 93. 3%( 28/30),which was significantly stronger than that of the control group(80. 0%( 24/30))The difference was statistically significant( χ2= 7. 231, P < 0. 05). In the experimental group,after 7 days of treatment,the p H( 7. 42 ± 0. 19),PCO2( 41. 76 ± 1. 65) mm Hg,blood oxygen partial pressure( 66. 10 ± 2. 36) mm Hg,blood oxygen saturation( 89. 50 ± 1. 62) %,blood oxygen content( 6. 60 ± 1. 17) Vol%,significantly higher than the control group [( 7. 40 ± 0. 25),( 40. 32 ±2. 70) mm Hg,( 62. 05 ± 5. 05) mm Hg,( 88. 10 ± 3. 63) %,( 6. 08 ± 1. 17) Vol% ],the differences were statistically significant( t = 2. 221,2. 442,4. 023,2. 135,2. 073,with P values below 0. 05);7 days after treatment,the experimental group patients with low whole blood viscosity( 11. 08 ± 0. 81) m Pa. s,whole blood high shear viscosity( 5. 17 ± 0. 34) m Pa. s,plasma high shear viscosity( 2. 09 ± 0. 16) m Pa. s and the red blood cell deformation index( 0. 76 ± 0. 48),which was significantly better than the control group[( 12. 29 ± 1. 81) m Pa. s,( 5. 85 ± 0. 34) m Pa. s,( 2. 58 ± 0. 21) m Pa. s,( 0. 87 ± 0. 11) ],the differences were statistically significant( t = 3. 265,7. 531,10. 366,4. 942,with P values below 0. 05);after 7 days of treatment,in the experimental group,VEGF( 35. 70 ± 4. 84) pg/m L,PDGF( 36. 60 ±2. 98) pg/m L,which was more obvious than the control group [( 25. 36 ± 3. 21) pg/m L,( 27. 53 ± 2. 94)pg/m L],the differences were statistically significant( t = 9. 235,11. 134,with P values below 0. 05);7 days after treatment,the wound area of the experimental group was( 5. 13 ± 0. 60) cm2,the degree of reduction was significantly better than the control group( 7. 03 ± 0. 82) cm2,the difference was statistically significant( t = 10. 594,P = 0. 015). After 14 days of treatment,the total effective rate of the experimental group was 96. 7%( 29/30),which was significantly stronger than that of the control group [86. 7%( 26/30) ],the difference was statistically significant( χ2= 7. 157,P = 0. 028). In the experimental group,after 14 days treatment,the p H( 7. 42 ± 0. 21),partial pressure of carbon dioxide( PCO2)( 42. 46 ±1. 57) mm Hg,blood oxygen partial pressure( 69. 26 ± 1. 49) mm Hg,blood oxygen saturation( 91. 05 ±1. 20) %,blood oxygen content( 6. 74 ± 0. 89) Vol%,significantly higher than the control group [( 7. 40 ±0. 31),( 40. 23 ± 2. 73) mm Hg,( 62. 41 ± 4. 86) mm Hg,( 88. 23 ± 2. 17) %,( 6. 13 ± 1. 22) Vol% ],the differences were statistically significant( t = 2. 790,3. 778,7. 455,6. 620,2. 185,with P values below0. 05);after 1 4 days of treatment,the experimental group had low whole blood viscosity( 8. 10 ±1. 07) m Pa. s,whole blood high shear viscosity( 4. 26 ± 0. 33) m Pa. s,plasma high shear viscosity( 1. 64 ±0. 22) m Pa. s,the deformation index of red blood cells( 0. 64 ± 0. 04),which was significantly better than that of the control group [( 11. 74 ± 1. 54) m Pa. s,( 5. 82 ± 0. 41) m Pa. s,( 2. 53 ± 0. 23) m Pa. s,( 0. 83 ±0. 10) ],the differences were statistically significant( t = 9. 905,16. 609,16. 358,9. 617,with P values below 0. 05). In the experimental group,after 14 days treatment,VEGF level was( 47. 72 ± 3. 75) pg/m L and PDGF level was( 49. 17 ± 2. 48) pg/m L,compared with the control group [( 37. 04 ± 2. 90) pg/m L,( 38. 18 ± 2. 65) pg/m L],the difference was statistically significant( t = 13. 062,17. 276,with P values below 0. 05). The wound area of the experimental group after 14 days treatment was( 2. 88 ± 0. 52) cm2,which was significantly better than that of the control group( 5. 07 ± 0. 61) cm2. The difference was statistically significant( t = 12. 332,P = 0. 013). Conclusions VSD combined with hyperbaric oxygen therapy has a significant effect on the healing of diabetic foot patients,which is significantly better than the efficacy of VSD alone. The combined effect of the two is very significant.