胰岛素溶液间断冲洗联合封闭式负压持续引流治疗糖尿病下肢慢性溃疡创面的疗效观察  

EFFECTS OF INTERMITTENT IRRIGATION OF INSULIN SOLUTION COMBINED WITH CONTINUOUS DRAINAGE OF VACUUM SEALING DRAINAGE IN CHRONIC DIABETIC LOWER LIMB ULCERS

作　　者：孙勇[1] 范薇[2] 杨卫玺[1] 王光军[1] 於国军[1] 张大维[1] 王一兵[1] 

机构地区：[1]南京医科大学附属淮安第一医院整形烧伤科,江苏淮安223300 [2]南京医科大学附属淮安第一医院麻醉科,江苏淮安223300

出　　处：《中国修复重建外科杂志》2015年第7期812-817,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的观察胰岛素溶液间断冲洗联合持续封闭式负压引流（vacuunl sealing drainage，VSD）治疗糖尿病下肢慢性溃疡创面的疗效。方法选择2012年1月-2014年12月收治的45例糖尿病下肢慢性溃疡患者，按随机数字表法分为VSD组（A组）、生理盐水＋VSD组（B组）、胰岛素溶液＋VSD组（C组），每组15例。3组患者性别构成、年龄、溃疡病程、创面面积、创面深度、糖化血红蛋白、Wagner分级等一般资料比较，差异均无统计学意义（P〉0．05），具有可比性。清创后A组行VSD持续引流治疗，B组和C组分别行VSD持续引流加固等容量的生理盐水或胰岛素溶液间断冲洗治疗。治疗期间监测每日患者空腹血糖、餐后2h血糖及随机血糖；取每日引流组织行IGF-1、TNF-α、一氧化氮（nitricoxide，NO）含量检测；计算治疗6d后肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率；治疗6d后取创面肉芽组织行病理学观察；根据患者创面情况选择不同手术，记录各组患者创面达二期手术的时间、手术方式及移植皮片或皮瓣成活率。结果A组治疗后新生毛细血管及成纤维细胞较少；B组新生毛细血管较多，结构尚清，增生的成纤维细胞较多；C组大量新生毛细血管，结构清晰，周围有许多增生的成纤维细胞。3组患者治疗期间每日空腹血糖、餐后2h血糖及随机血糖比较，差异均无统计学意义（P〉0．05）。治疗6d后C组肉芽组织覆盖率、肉芽组织生长厚度及细菌清除率均明显高于A、B组（P〈0．05）。与A组相应时间点比较，C组IGF-1、NO含量明显增高，TNF-α含量明显下降（P〈0．05）；与B组比较，C组IGF-1、NO含量分别于治疗3—6d、2～6d明显升高，TNF—α于3—6d下降（P〈0．05）。C组达二期手术的时间明显少于A、B组，移植皮片和皮瓣成活率明显高于A、B组（P〈0．05）；3组患者二期手术方式差异无统计�Objective To investigate the effects of intermittent irrigation of insulin solution combined with continuous drainage of vacuum sealing drainage （VSD） in chronic diabetic lower limb ulcers. Methods Between January 2012 and December 2014, 45 patients with diabetic lower limb ulcer were treated with VSD （group A, n=15）, with VSD combining irrigation of normal saline （group B, n=15）, and with VSD combining irrigation of insulin solution （group C, n= 15） after debridement. There was no significant difference in gender, age, course of ulcers, area and depth of wound, glycosylated hemoglobin, and Wagner grade among 3 groups （P〉0.05）, and the data were comparable. The levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose were determined everyday during treatment. The contents of insulin growth factor 1 （IGF-1）, tumor growth factor α （TNF-α）, and nitric oxide （NO） in necrotic tissue after drainage were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated, the granulation tissue in the center of the wound was harvested for pathological observation with HE staining after 6 days of treatment. The second stage operation was performed according to the condition of wounds, and the time to the second stage operation and the method of the second stage operation were recorded and the survival rate of grafted skin or flap was calculated. Results The pathological staining showed that there were a few new microvessels and fibroblasts in group A after treatment; more new microvessels and fibroblasts were observed in group B; and many new microvessels and fibroblasts were found in group C. There was no significant difference in levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose among 3 groups during treatment （P〉0.05）. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than th

关 键 词：胰岛素 封闭式负压引流 冲洗治疗 糖尿病下肢慢性溃疡 

分 类 号：R632.1[医药卫生—外科学]