补阳还五汤加减治疗气虚血瘀型糖尿病足效果分析

目的分析补阳还五汤加减治疗气虚血瘀型糖尿病足的临床效果。方法选取2020年11月至2022年11月项城市中医院收治的82例气虚血瘀型糖尿病足患者作为研究对象,按照是否应用补阳还五汤加减将其分为观察组(41例)与对照组(41例),观察组患者在腰交感神经毁损术治疗基础上联合应用补阳还五汤加减,对照组患者单纯行腰交感神经毁损术治疗,对比观察两组患者中医证候积分、血液流变学状态、疼痛情况、下肢供血情况与生活质量。结果治疗6周后,观察组患者肢体症状、局部皮肤、精神神志、舌脉积分均明显低于对照组(t=4.111、5.122、4.339、4.913,P均<0.001),全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数以及疼痛评分亦均明显低于对照组(t=2.999、3.309、5.588、7.532、4.613,P=0.004、P=0.001、P<0.001、P<0.001、P<0.001),踝肱指数(ABI)、2型糖尿病患者生活质量评定量表(DMQLS)评分均明显高于对照组(t=2.316、5.248,P=0.023、P<0.001)。结论与单纯应用腰交感神经毁损术治疗相比,在腰交感神经毁损术基础上联合应用补阳还五汤加减治疗糖尿病足,更能显著改善患者血液流变学状态及下肢供血情况,减轻疼痛等症状,提高其生活质量。

负压引流联合前列地尔治疗糖尿病足溃疡临床研究

目的:评估2型糖尿病神经-缺血性足溃疡采用负压封闭引流联合前列地尔注射液治疗的效果。方法:选取2015-03~2017-01期间于内蒙古自治区人民医院内分泌科收治的42例住院2型糖尿病神经-缺血性足溃疡病人(Wagner分级2~3级)作为研究对象。所有病人均给予规范的控制血糖、血压、血脂、抗感染等全身基础治疗及创面清创前提下,通过计算机进行完全随机化分组将病人随机分为对照组和联合治疗组各21例。对照组给予创面负压封闭引流治疗、联合治疗组给予负压封闭引流联合前列地尔静滴治疗。观察2组病人治疗前后下肢血供与神经传导速度、治疗后创面愈合情况以及治疗后2组病人不良反应的情况,并进行对比分析。结果:两组病人治疗前足背动脉峰值流速、ABI及腓浅神经传导速度比较无明显差异(P>0.05),治疗后上述指标均有改善,联合治疗组上述指标改善程度均显著高于对照组(P<0.05)。对照组病人创面愈合率61%、治疗有效率80.8%,联合治疗组病人创面愈合率94%、治疗有效率100%,联合治疗组创面愈合率、治疗有效率均高于对照组(P<0.05)。所有糖尿病足溃疡病人治疗期间未出现严重不良事件。结论:负压封闭引流联合前列地尔治疗2型糖尿病神经-缺血性足溃疡疗效显著,可以明显改善糖尿病足溃疡病人下肢供血、提高下肢神经传导速度,加快创面愈合、改善临床治疗效果,而且治疗安全性高,值得临床推广。

Effect of acupoint injection with bone marrow mesenchymal stem cells on the blood flow in rats with hind limb ischemia

Objective To find out the best injection method of the bone marrow mesenchymal stem cells （BM-MSCs） transplantation in the treatment of a rat model with hind limb arterial ischemia. Methods Twenty-four SD rats were randomly divided into four groups： normal control group, model group, BM-MSCs acupoint injection group （Al group） and BM-MSCs muscular injection group （Ml group）. Acupoints of ＂Sanyinjiao＂（三阴交 SP 6） , ＂ Housanli＂ （后三里 ST 36）, ＂Zhaohai＂ （照海 Kl 6）, ＂Huantiao＂ （环跳 GB 30） and ＂Yanglingquan＂ （阳陵泉 GB 34） were selected for Al group, and five nonacupoints were selected on gastrocnemius and adductor of ischemic hind limbs in the Ml group. BMMSCs were injected to the latter two groups. The ischemic hind limb rat model was established using the method of blocking the femoral artery and its branches. The changes of blood flow （perfuse unit, PU） in the affected hind limb and the healthy hind limb were consecutively monitored with laser Doppler flowmetery. The PU index （PUI, the PU ratio of the affected hind limb to the healthy hind limb blood perfusion to describe the visual increment of the blood flow. Besides, the levels of vascular endothelial growth factor （VEGF） and basic fibroblast growth factor （bFGF） were detected, and the expressions of VEGF and bFGF were observed by immunohistochemical semiquantitative analysis. Results Compared with the model group and the Ml group, the PUI was significantly higher in the Al group on the 3^rd, 14^th and 21^st day after injection of BM-MSCs （P〈0.05, P〈0.01）. Compared with the model group, the serum VEGF, bFGF levels and the immunohistochemical expressions of VEGF and bFGF in the Al and Ml groups were significantly increased （all P〈0.01）. Conclusion After injection of BM-MSCs through the acupoint, the recovery speed of perfusion in the ischemic rat hind limbs was fast. Compared with the muscular injection, it can significantly improve the blood flow in the ischemic rat hind limbs.