四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床观察  

Clinical Efficacy of Simiao Yong'an Decoction with Negative Pressure Drip Irrigation in Treatment of Patients with Damp-Heat Intrinsic Diabetic Foot Accompanied by Critical Lower Limb Ischemia

作　　者：刘皓[1] 李树森[1] 吴广迎 冯军 姚书格 LIU Hao;LI Shu-sen;WU Guang-ying;FENG Jun;YAO Shu-ge(Department of Interventional Vascular Surgery,the Second Affiliated Hospital of Xingtai Medical College,Xingtai Hebei 054000)

机构地区：[1]邢台医学高等专科学校附属二院介入血管外科,河北邢台054000

出　　处：《世界中西医结合杂志》2024年第8期1582-1586,1591,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：2021邢台市市级科技计划自筹经费项目(2021ZC170)。

摘　　要：目的观察四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床疗效。方法选取2021年6月—2023年10月期间邢台医学高等专科学校附属二院收治的糖尿病足(Diabetic foot,DF)伴严重下肢缺血(Critial limb ischemia,CLI)患者60例,采用随机数表法分为对照组和观察组,每组各30例,术前WIFI分级评估,进行相应的血管腔内治疗,血运重建成功后,分别行坏疽趾或趾列开放性切除或溃疡清创术,其中对照组术后采用负压封闭引流(VSD)进行治疗,观察组术后采用四妙勇安汤负压滴灌治疗,1周后拆除VSD敷料查看创面情况,创面内组织细菌培养阴性后,行创面修复,直至创面愈合,分别检测治疗1、2周后血清C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT),治疗2周后创面细菌转阴率;检测治疗2周后经皮氧分压(Transcutaneous oxygen pressure,T_(C)PO_(2))及踝肱指数(Ankle-brachialindex,ABI)、创面愈合时间及不良反应。结果治疗后观察组总有效率90.00%(27/30)明显高于对照组80.00%(24/30),差异有统计学意义(P<0.05)。治疗后两组患者CRP、PCT水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组创面细菌转阴率90%(27/30)明显高于对照组70%(21/30),差异有统计学意义(P<0.05)。治疗后两组患者T_(C)PO_(2)水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组T_(C)PO_(2)水平明显高于对照组,差异有统计学意义(P<0.05),观察组ABI指数与对照组比较,治疗前后差异无统计学意义(P>0.05)。治疗后观察组创面愈合时间(28.63±5.30)d明显优于对照组(40.87±5.14)d,差异有统计学意义(P<0.05)。治疗期间,两组患者均无过敏、肿胀、感染加重等不良反应发生。结论四妙勇安汤负压滴灌治疗糖尿病足伴严重下肢缺血腔内治疗术后湿热内蕴型可有效控制感染,改善�Objective To investigate the clinical efficacy of Simiao Yong'an decoction with negative pressure drip irrigation in treating patients with damp-heat intrinsic diabetic foot(DF)accompanied by critical lower limb ischemia(CLI).Methods A total of 60 patients with diabetic foot accompanied by critical lower limb ischemia,treated at The Second Affiliated Hospital of Xingtai Medical College between June 2021 and October 2023 were selected.They were divided into a control group and an observation according to the random number table method,with 30 patients in each group.Preoperative WIFI classification was performed,and appropriate endovascular treatments were applied.After successful revascularization,open amputation or debridement of gangrenous toes or toe rows was performed.The control group received negative pressure closed drainage(VSD)postoperatively,while the observation group received Simiao Yong'an decoction via negative pressure drip irrigation.One week post-treatment,the VSD dressing was removed to assess the wound.Wound repair was performed after negative bacterial culture results were confirmed until the wound healed.Serum C-reactive protein(CRP)and procalcitonin(PCT)levels were measured after 1 and 2 weeks of treatment.The bacterial conversion rate of the wound,transcutaneous oxygen pressure(T_(C)PO_(2)),ankle-brachial index(ABI),wound healing time,and adverse reactions were also assessed after 2 weeks of treatment.Results The overall efficacy rate in the observation group(90%,27/30)was significantly higher than that in the control group(80%,24/30),with a statistically significant difference(P<0.05).After treatment,CRP and PCT levels in both groups were significantly lower than before treatment,with statistically significant differences(P<0.05);the CRP and PCT levels in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The negative bacterial culture conversion rate of the wound in the observation group(90%,27/30)was significan

关 键 词：四妙勇安汤 灌洗 负压封闭引流 糖尿病足 重症肢体缺血 

分 类 号：R587.2[医药卫生—内分泌]