下肢动脉病变和组织微循环状况对伤口负压治疗糖尿病足溃疡的疗效影响  

Effects of different lower extremity arterial disease and tissue microcirculation on negative pressure therapy for diabetic foot ulcer

作　　者：莫嘉敏 颜晓东[1] 黄秀禄[1] 玉颜庆[1] Mo Jiamin;Yan Xiaodong;Huang Xiulu;Yu Yanqing(Department of Endocrinology,Diabetic Foot Treatment Center,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院内分泌代谢科糖尿病足病治疗中心,南宁530021

出　　处：《中华糖尿病杂志》2021年第3期209-214,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：广西壮族自治区卫生厅科技研究计划 (桂重卫200811)。

摘　　要：目的分析不同程度下肢动脉病变和组织微循环状况对伤口负压治疗糖尿病足溃疡疗效的影响。方法该研究为观察性研究。选取2015年11月至2019年11月在广西壮族自治区人民医院内分泌代谢科糖尿病足治疗中心住院的糖尿病足溃疡患者(Wagner分级2~3级)共75例,根据下肢血管彩色超声、踝肱指数(ABI)、经皮氧分压(TcPO2)检查结果分为血管病变A、B、C三组,每组进行为期2周的负压辅助闭合技术治疗。于负压前、负压2周末测定溃疡面积、肉芽面积的变化。组间比较采用了Wilcoxon秩和检验及Kruskal-Wallis检验,相关因素及影响因素采用Spearman相关分析和多重线性回归分析,评价负压治疗2周末三组溃疡面积减少值、肉芽面积增加值的差异和影响因素。结果血管病变A、B、C三组患者(分别为27、29、19例)的溃疡面积、肉芽面积在负压前与负压2周末组内比较差异均有统计学意义(P<0.05),其中三组患者的负压2周末溃疡面积缩小值及缩小率、肉芽面积增加值和增加率在组间比较中,C组与A、B组差异有统计学意义(P<0.05),A组与B组差异无统计学意义(P>0.05)。负压2周末溃疡面积缩小值与糖尿病病程(r=-0.311)、ABI(r=0.394)、TcPO2(r=0.301)、下肢血管彩色超声(r=-0.292)具有相关性(均P<0.05)。负压2周末肉芽面积增加值与TcPO2(r=0.239)、下肢血管彩色超声(r=-0.207)具有相关性(P<0.05)。负压2周末溃疡面积缩小值的影响因素是ABI、糖尿病病程(P<0.05);负压2周末肉芽面积增加值的影响因素是TcPO2(P<0.05)。结论糖尿病下肢动脉病变程度和组织微循环状况对负压辅助闭合技术治疗糖尿病足溃疡的疗效具有重要影响,下肢血管病变及组织微循环障碍程度越严重,伤口负压治疗效果越差。Objective To analyze the effects of different lower extremity arterial disease and tissue microcirculation on negative pressure therapy for diabetic foot ulcer,and to explore the peripheral vascular and tissue microcirculation conditions suitable for the treatment of diabetic foot ulcer with negative pressure wound therapy.Methods A total of 75 patients with diabetic foot ulcer(Wagner grade 2 to 3)who were hospitalized in the Diabetic Foot Treatment Center of Endocrinology and Metabolism Department of Guangxi Zhuang Autonomous Region People′s Hospital from November 2015 to November 2019 were selected.According to the results of lower extremity vascular ultrasound,ankle-brachial index(ABI)and percutaneous oxygen partial pressure(TcPO2),the patients were divided into three groups(Group A,Group B and Group C)based on the condition of lower extremity arterial lesions and tissue microcirculation.Each group underwent negative pressure therapy for 2 weeks.Image J graphic analysis software was used to measure the ulcer area and granulation area.Wilcoxon rank sum test and Kruskal-Wallis test were used for comparison between groups.Spearman correlation analysis and multiple linear regression analysis were used to study the correlation and influencing factors of ulcer area reduction value and granulation area increase value at the end of 2 weeks negative pressure therapy.Results The decrease of ulcer area,and the increase of granulation area in three groups(27,29 and 19 cases respectively)with different lower extremity arterial lesions and tissue microcirculation at the end of 2 weeks treatment were significantly different compared with those before treatment(P<0.05).In the comparison between the three groups,there were statistically significant differences between Group C and Group A,Group B in the value and rate of ulcer area reduction over the end of 2 weeks negative pressure therapy(P<0.05).However,there was no statistical difference between Group A and Group B(P>0.05).Besides,in the comparison between the three group

关 键 词：下肢动脉病变 组织微循环 糖尿病足溃疡 伤口负压疗法 

分 类 号：R587.2[医药卫生—内分泌]