清法联合活扣减张缝合对糖尿病足急性创面炎症因子的影响  

Effect of Clearing Method plus Tesion-reducing Suture with Tying Slipknots on Inflammatory Cytokines in Acute Wounds of Diabetic Foot

作　　者：杨沁彤[1] 方豫东[1] 赵普庆[2] 曹烨民[1] 王伟灵[3] 尹凌峰[1] 徐洪涛[1] 杨建飞[1] 符伟国 Yang Qintong;Fang Yudong;Zhao Puqing;Cao Yemin;Wang Weiling;Yin Lingfeng;Xu Hongtao;Yang Jianfei;Fu Weiguo(Department of Angiopathy;Department of Internal Medicine;Clinical Lab,Shanghai TCM Integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200082;Department of Vascular Surgery,Zhongshan Hospital Affiliated to Fudan University,Shanghai,200032,P.R.China)

机构地区：[1]上海市中医药大学附属上海市中西医结合医院脉管病科,上海200082 [2]上海市中医药大学附属上海市中西医结合医院内科,上海200082 [3]上海市中医药大学附属上海市中西医结合医院检验科,上海200082 [4]复旦大学附属中山医院血管外科,上海200032

出　　处：《老年医学与保健》2018年第3期341-344,共4页Geriatrics & Health Care

基　　金：上海市科委中医引导类资助项目(13401905600)

摘　　要：目的探讨"清法"联合可吸收线活扣打结减张缝合术治疗中度感染糖尿病足湿热毒盛证急性创面的疗效及其对全身和创面局部炎症反应的影响。方法 96例中度感染、清创后创面宽度在3至5cm之间而无法一期缝合的糖尿病足湿热毒盛证患者,根据清创时间随机分为清法缝合组(n=32)、单纯缝合组(n=32)、清法换药组(n=32),3组均采用相同的基础治疗。清法缝合组运用"清法"联合可吸收线活扣打结减张缝合术治疗,单纯缝合组和清法换药组分别采用西医清创术后可吸收线活扣打结减张缝合和"清法"联合保守换药治疗。3组均观察清创前、后血清C-反应蛋白(CRP)、肿瘤坏死因子-(TNF-)、白介素-6(IL-6)及创面组织中TNF-、IL-6的含量变化,记录创面愈合时间,并随访1年。结果清法缝合组创面愈合时间最短(34.84±7.27)d,疗效优于对照组(<0.001);治疗组在清创前、清创术后第7天、第14天血清CRP的含量为(75.83±46.48,9.44±8.98,2.56±1.85)mg/L、IL-6的含量为(69.39±25.29,15.04±10.84,6.99±5.47)ng/m L和TNF-的含量为(50.66±16.40,30.00±7.58,25.11±6.90)ng/m L,及清创术后第1、7、14天创面组织中的TNF-的含量为(124.5±49.93,83.86±20.54,57.97±14.06,35.68±15.50)ng/m L和IL-6的含量为(57.24±20.19,48.87±17.02,39.86±16.59,29.46±13.88)ng/m L,治疗组各参数均较清创前和对照组下降;差异有统计学意义。治疗组患者创面随访1年无1例复发,但复发率较对照组无统计学差异(P>0.05)。结论采用"清法"联合可吸收线活扣打结减张缝合术的方法可有效治疗创面皮肤缺损较大而无法一期闭合创面的糖尿病足湿热毒盛证患者,减少全身及创面局部炎症因子的含量,从而减轻全身及足部炎症反应,并能利用原位皮肤快速缩小创面面积,加速创面愈合。Objective To investigate the effect of Clearing Method plus tension-reducing suture with tying slipknots with absorbable line on acute wounds of moderately infected diabetic foot with dampness heat toxic syndrome. Methods 96 cases of moderate infection of diabetic foot with Dampness Heat Toxic Syndrome（the width of each wound was between 3 to 5 cm）,whose wounds were too wide to be closed after the first debridement, were randomly divided into 3 groups： group A（Clearing Method plus tension-reducing suture with tying slipknots with absorbable line）, group B（tension-reducing suture with tying slipknots with absorbable line）, and group C（Clearing Method plus wound dressing） 32 cases in each; all the cases received the same basic treatment; the levels of serum C-reactive protein（CRP）, tumor necrosis factor-alpha（TNF--alpha） and interleukin-6（IL-6） in the serum and in the wound tissue were examined before and after debridement and the healing time of all the cases in the 3 groups were recorded; followed-up lasted for 1 years. Results The healing time in group A was shorter than those in group B and group C（ P0.001）; after debridement, the levels of serum CRP, IL-6 and TNF-in in group A were lower than those before debridement and lower than those in group B and group C（ P0.05）; 1-year follow-up showed thant no reccurrence was found in group A while the difference among the 3 groups was of no statistical significance（ P0.05）. Conclusions Clearing Method plus tension-reducing suture with tying slipknots with absorbable line can reduce systemic and local inflammatory responses by decreasing the contents of inflammatory cytokines in the serum and the wound tissue and can shorten the wound healing time by suture in situ..

关 键 词：糖尿病足 清法 减张缝合 炎症因子 

分 类 号：R587.2[医药卫生—内分泌]