注射用胰蛋白酶联合银离子藻酸盐抗菌敷料治疗老年脑卒中后Ⅱ期压疮的疗效  

Efficacy of injectable pancreatic enzymes combined with silver ion alginate dressing in treating stage Ⅱ pressure ulcers after elderly stroke

作　　者：郭小青[1] 孟阳 刘倩[1] GUO Xiao-qing;MENG Yang;LIU Qian(Department of Critical Care Medicine,the NO.2 Hospital of Baoding,Baoding 071000,Hebei,China)

机构地区：[1]保定市第二医院重症医学科,河北保定071000

出　　处：《广东医学》2023年第9期1074-1079,共6页Guangdong Medical Journal

基　　金：保定市科技计划项目(2241ZF015)。

摘　　要：目的 探讨注射用胰蛋白酶联合银离子藻酸盐抗菌敷料治疗老年脑卒中后Ⅱ期压疮的临床疗效,以及对患者创面血流灌注量和血清炎性标志物水平的影响。方法 选择2021年1月至2022年10月收治的98例老年脑卒中后Ⅱ期压疮患者作为研究对象,按随机数字表法分成两组,每组49例。对照组给予银离子藻酸盐抗菌敷料治疗,观察组在对照组基础上联合给予注射用胰蛋白酶治疗,连续治疗14 d后观察两组疗效。并比较两组创面愈合时间及换药次数。治疗前后对两组患者进行压疮愈合评分表(PUSH)、创面疼痛视觉模拟量表(VAS)评定;使用激光多普勒血流仪检测两组压疮创面局部血流灌注量,运用酶联免疫法检测两组血清炎性标志物[C反应蛋白(CRP)、白细胞介素-33(IL-33)、可溶性生长刺激表达基因2蛋白(sST2)]水平。记录两组不良反应情况。结果 观察组总有效率为97.96%,与对照组(85.71%)相比显著升高(P<0.05)。观察组创面愈合时间较对照组显著缩短(P<0.05),换药次数较对照组显著减少(P<0.05)。治疗后,两组PUSH评分、创面疼痛VAS评分均较治疗前显著降低(P<0.05),且均以观察组下降更显著(P<0.05)。治疗后,两组创面血流灌注量均较治疗前显著增加(P<0.05),且以观察组提高更显著(P<0.05)。治疗后,两组血清CRP、IL-33、sST2水平均较治疗前显著降低(P<0.05),且均以观察组下降更显著(P<0.05)。两组均未出现明显不良反应。结论 注射用胰蛋白酶联合银离子藻酸盐抗菌敷料治疗老年脑卒中后Ⅱ期压疮能有效改善患者创面血流灌注量,下调血清炎性标志物水平,促进创面愈合,提高临床疗效。Objective To investigate the clinical efficacy of injectable pancreatic enzymes combined with silver ion alginate dressing in treating stageⅡpressure ulcers after elderly stroke,and its impact on wound blood perfusion and serum inflammatory marker levels.Methods A total of 98 elderly patients with stageⅡpressure ulcers after stroke from January 2021 to October 2022,were enrolled as study subjects.They were randomly divided into two groups,with 49 patients in each group.The control group received treatment with silver ion alginate dressing,while the observation group received injectable pancreatic enzyme treatment in addition to the same dressing.The treatment lasted for 14 days,and the efficacy of the two groups was observed.The wound healing time and the frequency of dressing changes were compared between the two groups.The Pressure Ulcer Scale for Healing(PUSH)and Visual Analog Scale(VAS)were used to assess wound healing and pain,respectively.Laser Doppler flowmetry was used to measure the local blood perfusion of the pressure ulcer wounds,and enzyme-linked immunosorbent assay(ELISA)was used to measure the serum levels of inflammatory markers[C-reactive protein(CRP),interleukin-33(IL-33),soluble suppression of tumorigenicity 2(sST2)].Adverse reactions in both groups were recorded.Results The total effective rate in the observation group was 97.96%,which was significantly higher than the 85.71%in the control group(P<0.05).The wound healing time in the observation group was significantly shorter than that in the control group(P<0.05),and the frequency of dressing changes was significantly reduced(P<0.05).After treatment,both PUSH and wound pain VAS scores in both groups decreased significantly compared to before treatment(P<0.05),with a more significant decrease in the observation group(P<0.05).After treatment,the local wound blood perfusion in both groups increased significantly compared to before treatment(P<0.05),with a more significant increase in the observation group(P<0.05).After treatment,serum levels

关 键 词：注射用胰蛋白酶 银离子藻酸盐抗菌敷料 老年人 脑卒中 压疮 软组织灌注 炎症反应 

分 类 号：R269[医药卫生—中西医结合] R632.1[医药卫生—中医外科学]