摘要
目的:探索糖尿病足的中医临床思路与方法,在基础治疗糖尿病的同时,以中医外治法局部辨证治疗糖尿病足的思想为指导,应用清热解毒、益气活血、祛腐生肌中药外敷法促进糖尿病足疮面愈合的临床研究。探索糖尿病足治疗过程中局部治疗的有效方法,提高患肢的疮面愈合率。
方法:采用随机分组对照法,将符合入选标准糖尿病足患者90例分为治疗组(60例)、和对照组(30例)。治疗组于常规换药后外敷清热解毒、益气活血之中药软膏,对照组行常规换药后以混合液纱布湿敷。疗程一个月。并在治疗前后对比观察两组患者患足疮面愈合情况,生化指标,周围血液循环情况,凝血机制的影响,C-反应蛋白的影响等方面,来证实局部辩证应用中药外敷法在治疗糖尿病足,促进疮面愈合的作用。
结果:研究结果显示:
1、应用清热解毒、益气活血中药外敷治疗糖尿病足具有良好的疗效。治疗组总有效率84.21%,显效率66.67%;对照组总有效率64.29%,显效率39.29%。治疗组总有效率优于对照组(P<0.01);治疗组显效率优于对照组(P<0.01);
2、中药外敷法能明显改善糖尿病足疮周微循环状态,提高氧分压水平。激光多普勒检查与经皮氧分压检查情况显示,中药外敷能明显改善糖尿病足疮周微循环状态,提高氧分压水平。研究表明,治疗前两组无明显差异,治疗后治疗组明显优于对照组(P<0.05);经皮氧分压检查,治疗前两组无明显差异,治疗后治疗组明显优于对照组(P<0.01);
结论:中药外敷法是通过辨证外敷中药治疗的方法,它应用在糖尿病足的治疗上,具有清热解毒、消肿止痛、益气活血、祛腐生肌、改善局部血液循环、促进肉芽生长的功效,从而使疮面较快达到良好的生长状态,并有效促进疮面愈合的作用。对于糖尿病足的治疗必须将整体辨证和局部辨证结合起来。为中医局部辨证施治提供了新思路。
objective:To discuss the effect of diabetic foot treated by External treatment funginert on the theory of TCM plus dressing change.And compare with infusion of Chinese herbal medicine and simply dressing change.And study its mechanism.
Methods:60 patients is divided into the External treatment funginert on the theory of TCM group(30)and dressing change group(30)by the method of random sampling.the External treatment funginert on the theory of TCM group washes the disease-food in dressing change according to syndrome discrimination based on the theory of TCM after dressing change,and dressing change group was dressing changed only.1 month as one circle of treatment,to observe the clinical curative effect of depleting decay,regenerating tissue and the disorder of microcirculation in all patients,and observe the TcP02 of the disease—food and the histopathology of the sore.
The results:In the end of the treatment,the eligible cases in the External treatment funginert on the theory of TCM group and dressing change group were 28and 27 respectively.The total effective rates of 2 groups were66.42%and 40.37%respectively . The significant effective rates were 55.71 % and 10.74 %respectively.There were significance difference in two groups.The curative effect of he External treatment funginert on the theory of TCM group was better than the others(P<0.01).According to detection,the disorder of microcirculation and TcP02 in the two groups was also significance different,The he External treatment funginert on the theory of TCM group was better in the groups.In Histomorphology,the granulation in the sore had less necro—tissue,inflammatory cell infiltration and more new vessel than other groups.And the quality of the fibroblast of the granulation was the best in the he External treatment funginert on the theory of TCM group and the arrangement of collaganous fiber was the most neatly in two groups.
Conclusion:The External treatment funginert method was washing the disease-body of human with Chinese herbal medicine according to syndrome discrimination based on the theory of TCM.It was good for depleting decay from the disease-food;improving the microcirculation of the disease-food;promoting the regenerating tissue.To make the wound well repaired.
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