养血通络汤口服联合祛腐生肌药捻换药治疗重症糖尿病足疗效及其机制研究  

Clinical efficacy and mechanism of treatment of Yangxue Tongluo decoction combined with Qufu Shengji medicinal fuse for severe diabetic foot

作　　者：贺清珍 

机构地区：[1]西安高新医院,陕西西安710075

出　　处：《现代中西医结合杂志》2017年第5期471-473,484,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：陕西省科技统筹创新工程项目(XJYYHMS2013)

摘　　要：目的观察养血通络汤口服、祛腐生肌药捻换药治疗重症糖尿病足的临床疗效及其作用机制。方法 98例确诊为糖尿病足患者随机分为观察组和对照组各49例。2组均给予常规西医治疗。对照组在上述治疗基础上给予甲钴胺注射液静脉滴注联合足部创面常规清创换药。观察组在对照组治疗基础上给予自拟养血通络汤口服联合祛腐生肌药捻换药治疗。比较2组临床疗效及溃疡面积、脓性分泌物、创面肉芽及足背动脉搏动等改善情况、足背动脉管径和血流速度、腓总神经运动神经传导速度变化及局部组织肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血管内皮生长因子(VEGF)及碱性成纤维细胞生长因子(b FGF)水平变化。结果观察组临床疗效优于对照组(P<0.05)。经治疗,2组患者溃疡面积、脓性分泌物、创面肉芽及足背动脉搏动均较治疗前显著改善(P均<0.05)。2组足背动脉血流速度、血管内径及患肢腓总神经传导速度均较治疗前显著改善(P均<0.05)。观察组局部组织中TNF-α、IL-6较治疗前显著降低(P均<0.05),而b FGF和VEGF水平均较治疗前显著增高(P均<0.05)。且观察组各项指标改善程度均优于对照组(P均<0.05)。2组治疗期间未见明显肝肾功能损伤。结论自拟养血通脉汤加减联合祛腐生肌药捻换药治疗重症糖尿病足患者临床疗效确切,抑制了足部创面处的炎症反应,改善了局部的血液循环,增强了创面局部组织的修复能力,加速了创面愈合。Objective It is to observe the clinical efficacy and mechanism of treatment of Yangxue Tongluo decoction combined with Qufu Shengji medicinal fuse for severe diabetic foot. Methods Ninety-eight cases of patients diagnosed as diabetic foot were randomly divided into observation group and control group, 49 cases in each group. Both groups were given conven-tional western medicine. The control group was given mecobalamine by intravenous injection combined with foot wound conventional debridement and dressing. The observation groups was given Yangxue Tongluo decoction orally combined with Qufu Shengji medicinal fuse dressing on the basis of treatment in control group. The clinical efficacy, ulcer area, purulent discharge ,granulation and improvement of dorsalis pedis arterial pulse, the changes of dorsal artery diameter and blood flow velocity ,peroneal nerve motor nerve conduction velocity and changes of tumor necrosis factor-α （ TNF-α ） , interleukin-6 （ IL- 6）,vascular endothelial growth factor （ YEGF） and basic fibroblast growth factor （bFGF） in local tissue were compared. Re-sults The clinical efficacy in observation group was better than that in control group （P〈0. 05） . After treatment, ulcer area, purulent discharge, granulation and dorsalis pedis pulse, dorsal artery blood flow velocity,vessel diameter and limb peroneal nerve conduction velocity were significantly improved compared with that before treatment in both groups（P〈0. 05） . The levels of TNF-α, IL-6 in local tissue were significantly lower while that of bFGF and VEGF were higher after treatment than that before treatment in both groups （P〈0.05） , and the improvements in the observation group were all better than that in the control group （ P〈 0. 05 ） . No significant liver and kidney injury was found during therapy in the two groups. Conclusion Yangxue Tongmai decoction combined with Qufu Shengji medicinal fuse had good clinical effect on severe diabetic foot, which could inhibit the

关 键 词：养血通络汤 祛腐生肌 重症 糖尿病足 

分 类 号：R587.2[医药卫生—内分泌]