糖尿病足溃疡患者局部封闭式负压治疗效果研究  

Therapeutic effect of local closed negative pressure on diabetic foot ulcer

作　　者：牛文芳[1] 姜玉峰[1] 朱平[1] 史琳涛[1] 石鸿雁[1] 王爱红[1] NIU Wenfang;JIANG Yufeng;ZHU Ping;SHI Lintao;SHI Hongyan;WANG Aihong(Department of Endocrinology,Strategic Support Force Characteristic Medical Center,Beijing 100101,China)

机构地区：[1]战略支援部队特色医学中心(原解放军第306医院)内分泌科

出　　处：《足踝外科电子杂志》2019年第2期26-29,共4页Electronic Journal of Foot and Ankle Surgery

基　　金：首都临床特色应用研究(Z181100001718027)

摘　　要：目的分析封闭式负压引流(vacuum assisted closure,VAC)治疗糖尿病足溃疡的临床效果。方法收集糖尿病足溃疡Wagner2-4级患者,以有无局部负压治疗分为负压治疗组(n=101)和对照组(n=48),均给予改善循环、营养神经、抗感染、改善全身状况等一般对症治疗,必要时行血管介入治疗。对照组创面正常清创换药,负压组清创或植皮后局部负压引流。结果负压组与对照组比较,住院时间、出院时好转率、小截肢率、大截肢率差异有显著统计学意义(P<0.05)。负压组患者以局部创面植皮与否分为植皮组与未植皮组,两组负压应用时间差异有显著统计学意义。将负压组患者以拭子培养结果分为无细菌生长组、单菌种感染组和混合菌感染组,三组患者年龄、住院总花费、小截肢率、大截肢率、好转率差异均有显著统计学意义(P<0.05)。多因素逐步Logistic回归分析显示,性别、足病病程、植皮、负压治疗是创面预后的独立相关因素。结论VAC治疗可减少大截肢率、有效提高愈合率,且总花费与传统治疗相当。Objective To analyze the clinical effect of vacuum assisted closure therapy on diabetic foot ulcer.Methods Patients with Wagner grade 2-4 diabetic foot ulcer were divided into negative pressure treatment group(n=101)and control group(n=48).They were treated with general symptomatic treatment such as improving circulation,nutritional nerve,anti-infection and improving general condition,and vascular interventional therapy was performed when necessary.The control group had conventional debridement and dressing change.The negative pressure group had local negative pressure drainage after debridement or skin grafting.Results There were significant differences in hospitalization time,improvement rate at discharge,small amputation rate and large amputation rate between negative pressure group and control group(P<0.05).Negative pressure group was divided into skin grafting group and non-skin grafting group according to local wound grafting or not.There was significant difference in the application time of negative pressure between the two groups(P<0.05).The negative pressure group was divided into bacteria-free growth group,single strain infection group and mixed bacteria infection group according to the results of swab culture.There were significant differences in age,total hospitalization expenses,small amputation rate,large amputation rate and improvement rate among the three groups(P<0.05).Multivariate stepwise logistic regression analysis showed that gender,course of foot disease,skin grafting and negative pressure treatment were independent related factors for wound prognosis.Conclusions VAC treatment can reduce the rate of amputation and improve the healing rate effectively,and the total cost is equivalent to that of traditional treatment.

关 键 词：封闭式负压治疗 糖尿病足 足溃疡 

分 类 号：R587.2[医药卫生—内分泌]