创面负压治疗联合骨膜牵张术治疗糖尿病足的临床研究

目的探讨创面负压治疗(NPWT)联合骨膜牵张术治疗糖尿病足的临床疗效。方法2022年6月~2023年4月我院收治的糖尿病足病人129例,采用随机数字1∶1列表法,随机分为联合组(43例)、负压组(43例)和对照组(43例),对照组采用常规治疗,负压组采用NPWT,联合组采用NPWT联合骨膜牵张技术,比较三组治疗有效率、炎性指标水平、外周血象水平、视觉疼痛(VAS)评分、足部相关指标水平。结果治疗4周后联合组VAS评分、白细胞计数、降钙素原、白细胞介素-6、超敏C-反应蛋白均低于其他两组(P均<0.05);联合组治疗有效率、足温、趾端血氧、踝肱指数、血管内径、血流流速、灌注指数水平高于其他两组(P<0.05)。结论NPWT联合骨膜牵张术能有效缓解疼痛,改善足部血液供应,缓解机体炎性反应。

Effect of limited access dressing on surface pH of chronic wounds

Aim:Changes in the pH of chronic wounds can inhibit the optimal activity of various enzymes in the wound environment,thereby delaying wound healing.The aim of the present study is to monitor the effect of limited access dressing(LAD)on the pH on the surface of chronic wounds.Methods:A total of 140 patients with chronic wounds of more than 4 weeks duration were divided into two groups by simple randomization:a LAD group(n=64)and a conventional dressing group(n=76).Fifty-six participants(22 in the LAD group and 34 in the conventional dressing group)were lost to follow-up or withdrawn from the study.Results:In the LAD group(n=42),the mean age was 38.3±10.56 years(range:12-60 years),and the mean wound size at the time of admission was 28 cm^(2)(range:19-40 cm^(2)).In the conventional dressing group(n=42),the mean age was 35.3±14.0 years(range:17-65 years),and the mean wound size at the time of admission was 26 cm^(2)(range:18-39 cm^(2)).Patients treated with LAD showed a significant decrease in the mean±standard deviation pH when compared with the conventional dressing group(0.83±0.52 vs.0.41±0.26,P=0.048).Conclusion:LAD reduces the chronic wound surface pH to a level required for the optimal function of various enzymes.This could be a factor that exerts a beneficial effect on wound healing.

Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic:A case report

BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.

简易机械间断负压引流联合湿润烧伤膏序贯治疗糖尿病足窦道疗效分析

目的 探讨简易机械间断负压引流联合湿润烧伤膏序贯治疗糖尿病足窦道的临床效果。方法 选取2020年2月至2020年10月牡丹江心血管病医院糖尿病分院收治的59例伴有窦道的糖尿病足患者作为研究对象,按照随机数表法将其随机分为观察组(30例)与对照组(29例),观察组患者采用简易机械间断负压引流联合湿润烧伤膏序贯治疗,对照组患者采用藻酸盐敷料联合湿润烧伤膏序贯治疗,对比观察两组患者材料费、处置费、窦道长度以及临床疗效。结果 治疗第7、 28天,观察组患者材料费、处置费均明显低于对照组(治疗第7天:t=15.111、 23.209,P均<0.001;治疗第28天:t=15.219、 26.374,P均<0.001)。治疗第7天,观察组患者窦道长度与对照组无明显差异(t=0.703,P=0.484);治疗第28天,观察组患者窦道长度明显短于对照组(t=3.024,P=0.004)。治疗第7天,观察组患者中显效4例、有效15例、无效11例,明显优于对照组患者的显效1例、有效9例、无效19例(Z=-2.304,P=0.021);治疗第28天,观察组患者中痊愈8例、显效8例、有效7例、无效7例,明显优于对照组患者的痊愈3例、显效4例、有效8例、无效14例(Z=-2.398,P=0.016)。结论 简易机械间断负压引流联合湿润烧伤膏序贯治疗糖尿病足窦道,可有效促进创面愈合,临床疗效较好,且治疗费用较低,值得基层医疗机构推广应用。