通脉活血汤联合降纤酶在老年糖尿病足治疗中的应用价值及治疗效果影响因素研究  

Study on Effect of Tongmai Huoxue Decoction and Defibrase in Treatment of Diabetic Foot in Elderly Patients and Analysis of Its Influencing Factors

作　　者：刘平[1] 崔公让[1] LIU Ping;CUI Gongrang(Perivascular Department,The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450003,Henan,China)

机构地区：[1]河南中医药大学第一附属医院周围血管科,河南郑州450003

出　　处：《中华中医药学刊》2020年第6期50-54,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家中医药管理局全国名中医崔公让传承工作室建设项目(国中医药办人教函[2018]119);河南省首批青苗人才培养项目(2100601-CZ0133-02);河南省中医管理局河南中医药大学第一附属医院中医外科诊疗中心培育项目(豫中医科教[2018]16)。

摘　　要：目的探讨全国名中医崔公让教授自拟通脉活血汤联合降纤酶治疗血脉瘀阻型老年糖尿病足的疗效及其疗效影响因素研究。方法2016年6月—2018年12月期间,100例老年糖尿病足患者在医院接受诊治,然后将其设定为研究对象,回顾性研究上述患者的临床病历资料。其中降纤酶对48例患者(对照组)治疗。观察组患者(52例)使用降纤酶外,同时使用通脉活血汤治疗。观察并比较两组患者的治疗效果。同时根据上述患者治疗疗效情况,将其分为有效组(64例)与无效组(36例),并通过cox回归模型分析影响妊娠结局的危险因素。结果(1)两组患者血清IL-6、IL-12、IGF-1水平治疗前差别不明显(P>0.05),观察组通过治疗后上述指标比对照组更优(P<0.05)。(2)两组患者血液流变学指标(全血低切黏度、全血高切黏度、血浆黏度、血小板聚集指数)水平治疗前差别不明显(P>0.05)。观察组通过治疗后上述指标比对照组更低(P<0.05)。(3)两组患者凝血功能指标(MMP-9、Hcy及TIMP-1)水平治疗前差别不明显(P>0.05)。观察组通过治疗后MMP-9、Hcy比对照组更低(P<0.05),而TIMP-1指标值明显高于对照组(P<0.05)。(4)两组患者动脉管径、血流速度及踝肱指数治疗前差别不明显(P>0.05)。观察组通过治疗后动脉管径、血流速度、踝肱指数指标比对照组更高(P<0.05)。(5)观察组总有效率相较对照组明显更高(P<0.05)。(6)cox回归分析结果表明,病程、年龄、细菌感染均为影响老年糖尿病足独立危险因素。结论通脉活血汤联合降纤酶治疗老年糖尿病足,能有效减少患者血管增生,降低炎性反应,改善患部血流量,治疗效果显著。另外,针对患者病程、年龄、细菌感染等独立危险因素,应及时采取预防措施,增加治疗效果。Objective To study on the effect of Tongmai Huoxue Decoction created by CUI Gongrang,a famous doctor of national traditional Chinese medicine and defibrase in the treatment of diabetic foot of blood stasis type in the elderly and the analysis of its influencing factors.Methods A hundred elderly patients in our hospital with diabetic foot were treated from 2016 June to 2018 December.Their clinical data was analyzed retrospectively.The patients were divided into the observation group(n=52)and the control group(n=48).The patients in the observation group were treated with Tongmai Huoxue Decoction and defibrase,while those in the control group were treated with defibrase.The treatment effects were observed and compared.At the same time,according to the treatment effect of these patients,they were divided into effective group(n=64)and non-effective group(n=36),and the risk factors were analyzed by cox regression model.Results(1)Before treatment,the difference was not significant for groups about IL-6,IL-12 or IGF-1(P>0.05).After treatment,the index stated above of the observation group was significantly better than that of the control group(P<0.05).(2)Before treatment,the difference was not significant for groups about hemorheological indexes(whole blood low shear viscosity,whole blood high shear viscosity,plasma viscosity,platelet aggregation index)(P>0.05).After treatment,the levels of adiponectin and Mg2+in the observation group were significantly lower than those in the control group(P<0.05),while the C reactive protein in the observation group was significantly lower than that of the control group(P<0.05).(3)Before treatment,there was no significant difference about MMP-9,Hcy or TIMP-1 for groups.The levels of MMP-9 and Hcy in the observation group after treatment were significantly lower than those in the control group(P<0.05),while the level of TIMP-1 in the observation group was significantly higher than that in the control group(P<0.05).(4)Before treatment,there was no significant difference about arterial di

关 键 词：通脉活血汤 降纤酶 老年糖尿病足 治疗效果 影响因素 

分 类 号：R259.872[医药卫生—中西医结合]