下肢动脉腔内血管成形术联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果研究  

Effect of lower extremity endovascular angioplasty combined with local application of insulin on diabetes foot ulcer

作　　者：刘飞 宋庆宏[1] 魏成志[1] 吴楠[1] 崔洪雨 刘汉冲 LIU Fei;SONG Qing-hong;WEI Cheng-zhi(Department of Vascular,Tianjin Medical Union Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院血管疾病诊疗中心,天津300121

出　　处：《中国中西医结合外科杂志》2024年第1期24-28,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生健康委员会科技项目(ZC20112);天津市卫生健康委员会科技项目(KJ20131);天津市医学重点学科(专科)建设项目(TJYXZDXK-058B)。

摘　　要：目的:观察下肢动脉腔内血管成形术(PTA)联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果。方法:选取2020年8月-2023年8月我院收治的糖尿病足溃疡合并下肢动脉硬化闭塞症患者65例,所有患者均接受下肢动脉PTA治疗,根据治疗方法不同,将患者分为对照组35例和观察组30例。对照组采用常规外科换药法,即局部清创、清洁换药;观察组在常规外科换药基础上应用局部注射胰岛素及胰岛素溶液湿敷。对比两组的踝肱指数(ABI)、创面愈合情况及治疗有效率。结果:两组患者性别、年龄、糖尿病足病程、糖化血红蛋白、空腹血糖水平、Wanger分级、Fontaine分期、Rutherford分级、疼痛分级无显著性差异(P <0.05);两组术前及术后ABI指数对比无显著性差异(P <0.05),术后第4周,观察组愈合情况优于对照组(P <0.05);观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);两组组内比较,术后4周ABI指数较术前明显提高,差异有统计学意义(P <0.05),术后创面面积较术前明显缩小,差异有统计学意义(P<0.05)。结论:下肢动脉PTA手术联合创面局部应用胰岛素治疗糖尿病足溃疡,可促进创面愈合,提高创面愈合率,同时下肢PTA手术可改善糖尿病足溃疡患者下肢血供,对创面愈合起到促进作用,临床效果确切。Objective To observe the clinical effect of lower extremity endovascular angioplasty combined with local application of insulin on diabetes foot ulcer.Methods 65 patients with diabetes foot ulcer complicated with arteriosclerosis obliterans of lower limbs were enrolled from August 2020 to August 2023 in this study.All patients received percutaneous transluminal angioplasty(PTA)of lower limbs.The patients were randomly divided into control group(35 cases)and observation group(30 cases)by random number method.The control group patients were treated with conventional surgical dressing changes,including local debridement and clean dressing changes;The observation group applied local injection of insulin and insulin solution wet compress on the basis of routine surgical dressing changes.Compare the Ankle Brachial Index(ABI),wound healing and treatment effectiveness between the two groups.Results There were no significant differences between the two groups in gender,age,course of diabetes foot,glycosylated hemoglobin,fasting blood glucose level,Wanger grade,Fontaine stage,Rutherford grade and pain grade(P>0.05).There was no significant difference in ABI index between the two groups of patients before and after surgery(P>0.05).There was a significant difference in wound healing between the two groups at week 4,and the observation group had better healing than the control group(P<0.05).The effective rate of treatment in the observation group was higher than that in the control group,with a statistically significant difference(P<0.05).The ABI index at 4 weeks after surgery was significantly increased compared to before surgery between the two groups of patients,with a statistically significant difference(P<0.05).The postoperative wound area was significantly reduced compared to before surgery,with a statistically significant difference(P<0.05).Conclusion PTA operation of lower limb artery combined with local application of insulin on the wound surface can promote wound healing and improve the wound healing rate in the tre

关 键 词：下肢动脉腔内血管成形术 糖尿病足溃疡 胰岛素 下肢动脉硬化闭塞症 

分 类 号：R654.4[医药卫生—外科学]