三黄汤洗剂联合湿性换药在Wagner2～3期糖尿病足创面中的应用
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摘要
目的研究三黄汤洗剂联合湿性换药对Wagner 2～3期糖尿病足创面的疗效。方法选取2017年3月至2018年3月在新疆维吾尔自治区中医医院骨三科治疗随访的Wagner 2～3期糖尿病足患者共48例,按照随机数字表法分为治疗组及对照组各24例。两组患者在治疗初期均常规胰岛素泵控制血糖;外科手术彻底清创并VSD引流一次;药敏培养后对症敏感抗生素应用;住院10～14d出院后予以门诊随访外科换药治疗开始纳入观察。治疗组每次换药前通过三黄汤冲洗并浸泡创面15min;评估创面情况予以适当清创,选用藻酸盐银离子敷料覆盖,外层用干燥无菌棉垫包扎。对照组采用生理盐水冲洗浸泡,对于创面的其余方案同治疗组完全相同。两组患者均隔1日换药,持续30d。观察两组治疗15d及30d后创面的愈合率,创面炎性反应及异常分泌物情况。结果治疗组新鲜肉芽组织外露所需时间平均为(5.2±1.4)d,对照组为(9.8±2.5)d,两组比较差异有统计学意义(t=7.712,P<0.05)。15d后,创面愈合率分别为(32.5±5.7)%和(24.5±4.8)%。30d后,创面愈合率分别为(74.7±8.4)%、(61.9±5.2)%,两组比较差异均有统计学意义(t_(15)=6.35、t_(30)=5.73,P_(15)<0.05、P_(30)<0.05)。治疗期间治疗组和对照组创面异常分泌物增多率分别为16.6%(4例)和45.8%(11例),两组比较差异有统计学意义(t=3.472,P<0.05)。两组均无不良反应发生。结论治疗糖尿病足创面,在换药过程中采用自制中药三黄汤洗剂配合湿性换药材料,能够更快的促进创面愈合,减轻创面的炎性反应及异常渗出,有利于糖尿病足创面肉芽组织的生长,缩短创面愈合的时间。
引文
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[2]Jiang Y,Huang S,Fu X,et al.Epidemiology of chronic cutaneous wounds in China[J].Wound Rep and Reg,62011,19(02):181-188.
[3]Jiang Y,Xia L,Jia L,et al.Survey of wound healing centers and wound care units in China[J].Int J Low Extrem Wounds,2016,15(03):274-279.
[4]Jiang Y,Ran X,Xu Z,et al.Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China[J].Int JLow Extrem Wounds,2015,14(01):19-27.
[5]Jiang Y,Wang X,Xia L,et al.A cohort study of diabetic patients and diabetic foot ulceration patients in China[J].Wound Rep Reg,2015,23(02):222-230.
[6]Jr WF.The dysvascular foot:a system for diagnosis and treatment[J].Foot&Ankle,1981,02(02):64.
[7]Jiang Y,Ran X,Jia L,et al.Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China[J].Int JLow Extrem Wounds,2015,14(01):19-27.
[8]姜玉峰,许樟荣,付小兵.糖尿病足创面修复过程中清创问题[J].中国实用内科杂志,2016,36(01):13-15.
[9]周艳斌,陈友华.糖尿病足伤口评估的临床价值[J].实用医院临床杂志,2010,07(05):133-134.
[10]Li X,Xiao T,Wang Y,et al.Incidence,risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital[J].Diabetes Research&Clinical Practice,2011,93(01):26-30.