超声清创联合去腐生新膏治疗慢性下肢静脉性溃疡的临床疗效  

Observation on the effect of Ultrasonic debridement combined with Qufu Shengxin ointment in the treatment of lower limb venous ulcers

作　　者：陈海东[1] 陈德轩[2] 方勇 李逸梅[1] 杨旭[1] 龚旭初 CHEN Hai-dong;CHEN De-xuan;FANG Yong(Nantong Hospital Affiliated to Nanjing University of Chinese Medicine,Nantong 226001,China)

机构地区：[1]南京中医药大学南通附属医院,江苏南通226001 [2]南京中医药大学附属江苏省中医院,江苏南京210029

出　　处：《中国中西医结合外科杂志》2023年第6期741-745,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：南京中医药大学自然科学基金(XZR2021084);南通市卫健委青年基金(A类)(QA2020012);第七批全国名老中医师承项目(国中医药人教函[2022]76号);国家中医药管理局重点专科项目(国中医药办医政函[2019]210号);南通市“十四五”科教强卫工程临床医学中心及青年医学重点人才项目(通卫科教[2021]15号)。

摘　　要：目的:观察超声清创技术联合去腐生新膏治疗慢性下肢静脉性溃疡的临床疗效。方法:选取66例慢性下肢静脉性溃疡患者,采用随机对照非盲法方式设计分为研究组和对照组,每组各33例。两组入院后均采用常规基础治疗配合超声清创仪清理创面,研究组清创后予去腐生新膏外用,对照组清创后予重组人碱性成纤维生长因子(扶济复)外用。记录并比较两组临床指标(新鲜肉芽出现时间、愈合天数、创面细菌清除率、疼痛、肿胀、皮肤不良反应率、溃疡面积、溃疡深度)、炎症及细胞因子[C反应蛋白(CRP)、缺氧诱导因子(HIF)-1α、血管内皮生长因子(VEGF)]、踝肱指数(ABI)、下肢经皮氧分压(tcpO_(2))及震动感觉阈值(VPT)的差异。结果:治疗后,两组上述观察指标均较治疗前改善(P<0.05)。研究组新鲜肉芽出现时间、溃疡愈合时间均显著优于对照组,差异有统计学意义(P<0.01);治疗7 d后,研究组疼痛评分、肿胀范围亦优于对照组,差异有统计学意义(P<0.05);治疗14 d后,两组疼痛评分、肿胀范围、ABI、创面细菌清除率及皮肤不良反应率无统计学差异(P>0.05),研究组CRP、VEGF、HIF-α、tcpO2及VPT改善情况均优于对照组,差异有统计学意义(P<0.05)。结论:超声清创联合去腐生新膏治疗慢性下肢静脉性溃疡具有更好的临床效果,能显著缓解溃疡临床症状,缩短溃疡愈合时间,改善创面微环境及下肢循环,且不增加皮肤不良反应。Objective To observe the effect of Ultrasonic debridement combined with Qufu Shengxin ointment in the treatment of lower limb venous ulcers.Methods 66 patients with chronic lower limb venous ulcers were selected and divided into 2 groups,experimental group and control group,according to the random method,33 cases in each group.After admission,both groups were treated with conventional basic treatment combined with ultrasonic debridement for wound cleaning.Experimental group was treated with Qufu Shengxin ointment,control group with recombinant human basic fibroblast growth factor.Clinical indexes(Occurrence time of fresh granulation,healing days,wound bacterial clearance rate,pain,swelling,skin adverse reaction rate,ulcer area,ulcer depth),inflammation and cytokines[C-reactive protein(CRP),hypoxia-inducing factor(HIF-1α),vascular endothelial growth factor(VEGF)],lankle brachial index(ABI),transcutaneous pressure of owimetry(tcpO_(2))and vibration perception threshold(VPT)were observed and analyzed in two groups.Results After the treatment,all of these indicators have improved(P<0.05).The occurrence time of fresh granulation and healing time in experimental group were significantly better than those in control group(P<0.01).After 7 days treatment,pain score and swelling range were improved compared with control group(P<0.05).After 14 days treatment,there were no significant differences in pain score,swelling range,ABI,wound bacterial clearance rate and skin adverse reactions between the two groups(P>0.05).The improvement of CRP,VEGF,HIF-α,tcpO2 and VPT in experimental group was better than that in control group(P<0.05).Conclusion Ultrasonic debridement combined with Qufu Shengxin ointment in the treatment of lower limb venous ulcers has better clinical effect,can significantly relieve ulcer symptoms,shorten ulcer healing time,improve wound microenvironment and lower limb circulation,and do not increase skin adverse reactions.

关 键 词：超声清创 去腐生新膏 慢性下肢静脉性溃疡 

分 类 号：R633[医药卫生—外科学] R268[医药卫生—临床医学]