经皮超声电导透入前列地尔在糖尿病足溃疡治疗中的应用  

Application of percutaneous ultrasound penetration of alprostadil in the treatment of diabetic foot ulcers

作　　者：李健[1] 余兰[2] 王珩[1] 王明才[1] LI Jian;YU Lan;WANG Heng;WANG Mingcai(Department of Endocrinology,the First People's Hospital of Zigong City,Zigong,Sichuan 643000,China;Department of Ultrasound Medicine,the First People's Hospital of Zigong City,Zigong,Sichuan 643000,China)

机构地区：[1]四川省自贡市第一人民医院内分泌科,643000 [2]四川省自贡市第一人民医院超声医学科,643000

出　　处：《重庆医学》2021年第6期982-986,共5页Chongqing medicine

基　　金：2017年自贡市重点科技计划项目(自筹)(2017ZC49);四川省卫计委课题(16JP599)。

摘　　要：目的观察经皮超声电导透入前列地尔治疗糖尿病足溃疡的临床疗效及安全性。方法89例糖尿病足溃疡患者分为静脉组、外用组和联合组3组。3组患者均给予积极的代谢调节、抗感染、局部创面清创换药、营养支持等基础治疗。静脉组给予前列地尔注射液10μg静脉注射,每天1次,外用组溃疡局部区域给予前列地尔5μg经皮超声电导透入,每天2次,联合组给予每天1次前列地尔注射液10μg静脉注射+每天2次溃疡局部区域5μg前列地尔经皮超声电导透入,疗程4周,观察各组溃疡的愈合情况。结果静脉组患者TcPo2、ABI较治疗前有升高趋势,但差异无统计学意义[(37.11±9.21)mm Hg vs.(35.14±10.4)mm Hg,P>0.05],[(0.54±0.10)vs.(0.53±0.07),P>0.05];外用组TcPo2较治疗前明显升高[(41.52±12.5)mm Hg vs.(34.33±13.1)mm Hg,P<0.05],但ABI治疗前后差异无统计学意义[(0.55±0.08)vs.(0.52±0.11),P>0.05];联合组TcPo2、ABI较治疗前明显升高[(46.35±11.2)mm Hg vs.(33.94±10.5)mm Hg,P<0.01],[(0.60±0.12)vs.(0.54±0.10),P<0.05]。治疗结束后,外用组、联合组TcPo2较静脉组升高,其中联合组最高(F=6.273,P=0.012);联合组ABI较其余2组明显升高,静脉组和外用组差异无统计学意义(F=4.800,P=0.032)。治疗1个月,3组83例患者组间愈合率比较差异有统计学意义(F=5.520,P=0.006),其中外用组愈合率较静脉组升高[(71.4±10.6)%vs.(68.5±10.5)%,P>0.05],但差异无统计学意义,联合组愈合率明显高于静脉组和外用组[(77.7±11.9)%vs.(68.5±10.5)%,P<0.05;(77.7±11.9)%vs.(71.4±10.6)%,P<0.05],差异有统计学意义。随访3个月,3组患者创面愈合时间组间比较差异有统计学意义(F=11.738,P=0.000),外用组创面愈合时间较静脉组缩短[(70.3±10.4)d vs.(78.2±15.3)d,P<0.05],联合组创面愈合时间明显短于静脉组和外用组[(62.6±11.6)d vs.(78.2±15.3)d,P<0.01;(62.6±11.6)d vs.(70.3±10.4)d,P<0.05]。3组患者总截肢率差异无统计学意义(χ^(2)=0.279,P=0.870)�Objective To observe the clinical efficacy and safety of percutaneous ultrasound penetration of alprostadil in the treatment of diabetic foot ulcers.Methods A total of 89 diabetic foot ulcer patients were randomly divided into the 3 groups:the intravenous group,the external application group and the combination group.Patients in the three groups were given basic treatments such as metabolic regulation,anti-infection,local wound debridement and dressing,and nutritional support.Meanwhile,the intravenous group was given 10μg of alprostadil injection intravenously once a day,the external application group was given 5μg of alprostadil percutaneous ultrasound penetration in the local area of the ulcer,twice a day,the combination group was given both therapies above.The healing of ulcers in each group was observed.Results After 4 weeks of treatment,TcPo2 and ABI of the foot in the intravenous group had a tendency to increase when compared with before treatment,but the difference was not statistically significant[(37.11±9.21)mm Hg vs.(35.14±10.4)mm Hg,P>0.05],[(0.54±0.10)vs.(0.53±0.07),P>0.05].TcPo2 in the external application group was significantly higher than that before treatment[(41.52±12.5)mm Hg vs.(34.33±13.1)mm Hg,P<0.05],but there was no significant difference in ABI[(0.55±0.08)vs.(0.52±0.11),P>0.05].TcPo2 and ABI in the combination group were significantly higher than those before treatment[(46.35±11.2)mm Hg vs.(33.94±10.5)mm Hg,P<0.01;(0.60±0.12)vs.(0.54±0.10),P<0.05].After treatment finished,the TcPo2 of the external application group and the combination group was higher than that of the intravenous group,and the combination group was the highest(F=6.273,P=0.012);the ABI of the combination group increased more significantly than the other two groups,there was no statistical significant difference between the intravenous group and the external application group(F=4.800,P=0.032).After 1 month of treatment,there was a statistically significant difference in the healing rate of 83 patients in the 3

关 键 词：糖尿病足 溃疡 前列腺素E1 超声药物电导透入 治疗结果 

分 类 号：R473.5[医药卫生—护理学]