纳米银敷料结合封闭负压吸引对糖尿病性慢性创面患者愈合效果的影响
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摘要
目的探讨纳米银敷料结合封闭负压吸引治疗对糖尿病性慢性创面患者愈合效果的影响。方法选取2015年2月至2017年12月华北石油管理局总医院收治的糖尿病性慢性创面患者172例,分为纳米银组(60例),常规组(54例)和对照组(58例),纳米银组在常规封闭负压引流技术的基础上结合纳米银敷料治疗,常规组则采用常规封闭负压引流技术,对照组患者采用常规换药治疗。比较患者治疗14 d后肉芽生长情况、创面愈合率,记录创面愈合时间和治疗期间感染发生情况。结果纳米银组、常规组创面肉芽生长良好率均明显高于对照组,差异具有统计学意义(P分别=0.002和0.040),纳米银组、常规组创面肉芽生长良好率比较,差异无统计学意义(P=0.329);纳米银组、常规组和对照组中任意两组间创面愈合率比较,差异有统计学意义(P均<0.001);纳米银组、常规组和对照组中任意两组间创面愈合时间比较,差异均有统计学意义(P分别<0.001,=0.018和<0.001);纳米银组患者感染率明显低于常规组和对照组患者(P分别=0.006和0.040),常规组和对照组感染率比较,差异无统计学意义(P=0.501)。结论封闭负压吸引治疗可显著提高糖尿病性慢性创面愈合效果,结合纳米银敷料可有效预防感染。
Objective To investigate the effect of Nano-silver dressing combined with vacuum sealing drainage(VSD) on the healing of diabetic patients with chronic wounds. Methods A total of 172 patients with diabetic chronic wounds admitted in our hospital from February 2015 to December 2017 were selected and divided into Nano-silver group(n=60), conventional group(n=54) and control group(n=58),patients on Nano-silver group received Nano-silver dressing combined with VSD, patients on conventional group received VSD alone, and patients on control group received conventional dressing. The granulation growth, rate of wound healing after 14 days, time of wound healing and infection during the treatment, were compared between the three groups. Results The well growth rate of wound granulation on nano-silver group and the conventional group were significantly higher than that on control group(P=0.002 and 0.040,respectively), there was no significant difference on well growth rate of wound granulation between the nano-silver group and the conventional group(P =0.329). There were statistically significant difference between the any two groups on rate of wound healing and time of wound healing(P <0.001). There were statistically significant difference between the any two groups on time of wound healing(P<0.001, =0.018 and <0.001, respectively). The infection rate of nano-silver group was significantly lower than that of conventional group and control group(P=0.006 and 0.040, respectively), there was no significant difference on the infection rate between the conventional group and control group(P=0.501). Conclusion VSD can significantly improve the healing effect of diabetic chronic wounds, and Nano-silver antimicrobial dressing can effectively prevent infection.
Objective To investigate the effect of Nano-silver dressing combined with vacuum sealing drainage(VSD) on the healing of diabetic patients with chronic wounds. Methods A total of 172 patients with diabetic chronic wounds admitted in our hospital from February 2015 to December 2017 were selected and divided into Nano-silver group(n=60), conventional group(n=54) and control group(n=58),patients on Nano-silver group received Nano-silver dressing combined with VSD, patients on conventional group received VSD alone, and patients on control group received conventional dressing. The granulation growth, rate of wound healing after 14 days, time of wound healing and infection during the treatment, were compared between the three groups. Results The well growth rate of wound granulation on nano-silver group and the conventional group were significantly higher than that on control group(P=0.002 and 0.040,respectively), there was no significant difference on well growth rate of wound granulation between the nano-silver group and the conventional group(P =0.329). There were statistically significant difference between the any two groups on rate of wound healing and time of wound healing(P <0.001). There were statistically significant difference between the any two groups on time of wound healing(P<0.001, =0.018 and <0.001, respectively). The infection rate of nano-silver group was significantly lower than that of conventional group and control group(P=0.006 and 0.040, respectively), there was no significant difference on the infection rate between the conventional group and control group(P=0.501). Conclusion VSD can significantly improve the healing effect of diabetic chronic wounds, and Nano-silver antimicrobial dressing can effectively prevent infection.
引文
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[12]郭春兰,席祖洋,邓红艳,等.纳米银敷料用于体表慢性难愈合伤口的效果及安全性评价[J].广东医学,2016,37(22):3477-3480.
[13]刘京,徐曌,张庚良,等.不同敷料对糖尿病足感染患者创面闭合指数及临床疗效的影响研究[J].中华医院感染学杂志,2017,27(21):4880-4883.
[14]成沛玉,邹惠美,王蓉,等.负压引流联合纳米银敷料促进感染切口愈合的实验及临床研究[J].中国感染控制杂志,2017,16(10):931-935.
[15]Liu M,Luo G,Wang Y,et al.Nano-silver-decorated microfibrous eggshell membrane:processing,cytotoxicity assessment and optimization,antibacterial activity and wound healing[J].Sci Rep,2017,7(1):436.
[2]刘晖,佘文莉,黄海玲,等.165例慢性创面住院患者临床特点调查及分析[J].广东医学,2010,31(9):1183-1185.
[3]周岳平,李志清,张春新,等.负压封闭引流联合冲洗液冲洗在深Ⅱ度烧伤创面的应用[J].广东医学,2012,33(8):1161-1162.
[4]Shi B,Sun J,Cao Y,et al.Application of vacuum sealing drainage to the treatment of seawater-immersed blast-injury wounds[J].Int Wound J,2016,13(6):1198-1205.
[5]Hao S,Juan L,Xin W.Treatment of traumatically cutaneous necrosis of buttocks using vacuum sealing drainage combined with ileostomy[J].Eur J Trauma Emerg Surg,2016,42(1):87-90.
[6]Li RG,Ren GH,Tan XJ,et al.Free flap transplantation combined with skin grafting and vacuum sealing drainage for repair of circumferential or sub-circumferential soft-tissue wounds of the lower leg[J].Med Sci Monit,2013,19:510-517.
[7]梁月英,伍淑文,谢小英,等.伤口负压治疗在下肢静脉性溃疡创面床准备的应用[J/CD].中国血管外科杂志(电子版),2013,5(1):58-59.
[8]孙亚楠,孙树,张挺,等.负压封闭引流技术在GustiloⅢ型开放性骨折术后难愈性创面感染治疗中的应用[J].山东医药,2016,56(23):80-82.
[9]马兆坤.负压封闭引流技术联合湿性敷料在骨伤感染创面修复中的应用价值[J].中国老年学杂志,2017,37(8):2014-2015.
[10]李季春.封闭负压引流序贯纳米银敷料对慢性伤口患者的影响[J].齐鲁护理杂志,2017,23(4):122-124.
[11]Dhatariya K,Gooday C,Franke B,et al.An open,noncomparative,multicentre evaluation of performance and safety using an antimicrobial exudate transfer dressing on diabetic foot ulcers:a case series[J].J Wound Care,2016,25(5):256-265.
[12]郭春兰,席祖洋,邓红艳,等.纳米银敷料用于体表慢性难愈合伤口的效果及安全性评价[J].广东医学,2016,37(22):3477-3480.
[13]刘京,徐曌,张庚良,等.不同敷料对糖尿病足感染患者创面闭合指数及临床疗效的影响研究[J].中华医院感染学杂志,2017,27(21):4880-4883.
[14]成沛玉,邹惠美,王蓉,等.负压引流联合纳米银敷料促进感染切口愈合的实验及临床研究[J].中国感染控制杂志,2017,16(10):931-935.
[15]Liu M,Luo G,Wang Y,et al.Nano-silver-decorated microfibrous eggshell membrane:processing,cytotoxicity assessment and optimization,antibacterial activity and wound healing[J].Sci Rep,2017,7(1):436.