橡皮生肌膏治疗精准血运重建术后糖尿病足溃疡的随机对照研究  

Effect of Rubber Myogenic Ointment on Diabetic Foot Ulcer after Precise Revascularization:A Randomized Controlled Trial

作　　者：万春 左敬雅 张欣 史丽娜 楚信强 孙云朝 苏坤 张雅 马云龙 WAN Chun;ZUO Jing-ya;ZHANG Xin;SHI Li-na;CHU Xin-qiang;SUN Yun-chao;SU Kun;ZHANG Ya;MA Yun-long(Graduate School,Hebei University of Traditional Chinese Medicine,Shijiazhuang 050091;Office of Medical Insurance,The First Affiliated Hospital of Hebei Medical University,Shijiazhuang 050031;Surgical WardⅡ,The First Affiliated Hospital of Hebei University of Traditional Chinese Medicine,Hebei Hospital of Traditional Chinese Medicine,Shijiazhuang 050011)

机构地区：[1]河北中医学院研究生学院,石家庄050091 [2]河北医科大学附属第一医院医保办,石家庄050031 [3]河北中医学院附属第一医院/河北省中医院外二科,石家庄050011

出　　处：《中国中西医结合杂志》2023年第7期801-807,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：河北省中医药管理局科研计划项目(No.2020060)。

摘　　要：目的 观察自制橡皮生肌膏对Angiosome理念指导下的精准血运重建术后的糖尿病足溃疡的疗效。方法 选取2020年11月—2022年4月在河北省中医院周围血管病科住院治疗的120例符合纳入标准的糖尿病足溃疡患者,按随机数字表法分为自制橡皮生肌膏试验组(试验组)和重组人表皮生长因子对照组(对照组),每组60例。最终试验组脱落1例,对照组脱落2例,试验组共纳入59例,对照组共纳入58例。两组患者入院后均接受溃疡清创、换药、抗感染、降压、抗血小板聚集等基础治疗,在达到手术标准后,接受在Angiosome理念指导下的精准血运重建手术。术后试验组使用自制橡皮生肌膏对溃疡进行换药治疗,对照组使用重组人表皮生长因子凝胶对溃疡进行换药治疗。1个月后,对两组患者的足溃疡症状、溃疡愈合指标(溃疡面积、肉芽组织覆盖率、溃疡容积)、经皮氧分压(TcPCO_(2))、血管内皮生长因子(VEGF)以及踝肱指数(ABI)等指标进行观察比较。结果 与本组治疗前比较,两组治疗后,皮温、疼痛程度、皮色、渗出评分均降低(P<0.05);溃疡面积及溃疡容积减少(P<0.05),肉芽组织面积覆盖率、TcPCO_(2)、VEGF、ABI升高(P<0.05)。与对照组比较,试验组皮温、疼痛程度、皮色、渗出评分降低(P<0.05,P<0.01),溃疡面积及溃疡容积减少,肉芽组织面积覆盖率、TcPCO_(2)、VEGF、ABI升高(P<0.01)。试验组的总有效率为98.3%(58/59),对照组的总有效率为93.1%(54/58,P<0.05)。结论 自制橡皮生肌膏对Angiosome理念指导下的精准血运重建术后的糖尿病足溃疡恢复具有明显的促进作用,同时能减轻足溃疡症状,提高TcPCO_(2)、VEGF以及ABI的水平。Objective To observe the effect of self-made rubber muscle ointment on diabetic foot ulcer after precise revascularization guided by Angiosome concept.Methods A total of 120 patients with diabetic foot ulcer who met the inclusion criteria and hospitalized in the Department of Peripheral Vascular Diseases,Hebei Provincial Hospital of Traditional Chinese Medicine from November 2020 to April 2022 were recruited and assigned into self-made rubber myogenic plaster experimental group(experimental group) and recombinant human epidermal growth factor control group(control group) according to the random number table method,60 cases in each group.One case of the experimental group dropped out and 2 cases of the control group dropped out.A total of 59 cases were included in the experimental group and 58 cases in the control group.After admission,patients in both groups received basic treatment such as ulcer debridement,dressing change,anti-infection,anti-hypertension,anti-platelet aggregation,etc.until the patients met the surgical standard,and then received precise revascularization surgery under the guidance of Angiosome concept.After operation,the experimental group was treated with self-made rubber myogenic ointment,and the control group was treated with recombinant human epidermal growth factor gel.After 1 month,the foot ulcer symptoms,ulcer healing indicators(ulcer area,granulation tissue coverage rate,ulcer volume),transcutaneous oxygen partial pressure(TcPCO_(2)),vascular endothelial growth factor(VEGF)and ankle brachial index(ABI) were observed and compared between the 2 groups.Results Compared with before treatment,skin temperature,pain degree,skin color,exudation score,ulcer area,and ulcer volume decreased(P<0.05),and granulation tissue area coverage,TcPCO_(2),VEGF,ABI levels increased in both groups after treatment(P<0.05).Compared with the control group,the scores of skin temperature,pain degree,skin color and exudation in experimental groups decreased(P<0.05,P<0.01),ulcer area and ulcer volume were less,and gr

关 键 词：自制橡皮生肌膏 糖尿病足溃疡 Angiosome 精准血运重建术 经皮氧分压 血管内皮生长因子 踝肱指数 中药 

分 类 号：R587.2[医药卫生—内分泌] R658.3[医药卫生—内科学]