益气透脓法治疗糖尿病足湿性坏疽的临床疗效观察
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摘要
目的：通过临床观察益气透脓法治疗糖尿病足湿性坏疽在促进患肢的疮面愈合方面、改善中医症状体征方面、提高踝肱比与趾肱比指标方面的疗效,探索其中医临床治疗的思路与方法。在基础治疗的同时,应用临床经验方剂内服、外用相互结合共凑达到提高患肢的创面愈合率,降低患肢的截肢率的目的,同时也为糖尿病足湿性坏疽的临床治疗提供安全有效的治疗方案。
方法：采用随机、对照的试验方法,将符合标准的70例合格受试者随机分为治疗组35例和对照组35例,治疗组及对照组均给予基础治疗及外科清创换药,治疗组外加中药(内服用透脓散合四妙散加减,外用自拟二黄汤浸泡外洗)。在治疗前后主要对比观察两组患者湿性坏疽疮面的愈合情况、中医症状体征积分情况,双下肢踝肱比(ABI)、趾肱比(TBI)的指标改善情况。试验数据符合正态分布者,采用t检验和X2检验；不符合正态分布者采用秩和检验进行统计分析。
结果：
1、应用益气透脓法治疗糖尿病足湿性坏疽气虚血瘀、湿毒蕴阻证具有良好的疗效。疮面疗效评价结果显示p<0.01,临床治愈率治疗组为18%,而对照组仅为0,总显效率治疗组为100%,而对照组为28.57%,治疗组在促进疮面愈合上明显优于对照组；中医症状体征疗效评价结果显示p<0.05,治疗组临床治愈率为8%,而对照组仅为0,治疗组总有效率为100%,对照组仅为20%,治疗组在改善症状方面有较好的疗效。
2、糖尿病足湿性坏疽患侧踝肱指数结果显示：治疗组治疗前后踝肱比、趾肱比自行比较结果显示p<0.01,有显著差异,治疗效果明显；对照组治疗前后踝肱比自行比较结果显示p>0.05,无统计学意义,可以认为没有改善,趾肱比自行比较结果显示0.05>P>0.01,有轻微改善,但疗效并不明显；两组踝肱比、趾肱比治疗前后组间比较,治疗前比较p>0.05,具有可比性,治疗后两组趾肱比比较结果显示p<0.01,可认为治疗组疗效明显优于对照组,治疗后两组踝肱比比较结果显示0.05>P>0.01,可认为在改善踝肱比指标方面治疗组较对照组有差异,但差异不明显。
结论：益气透脓法治疗糖尿病足湿性坏疽气虚血瘀、湿毒蕴阻证,明显改善了临床症状,并且具有祛腐生肌、促进炎症消退,改善疮周血液循环,促进肉芽生长,使疮面较快达到良好的生长状态,使疮面尽早愈合的作用。为益气透脓法治疗糖尿病湿性坏疽有效的提供了中医治疗思路与方法,因此,对糖尿病足湿性坏疽的治疗应辨证论治、专方专药专证治疗,系统结合内治与外治,早期干预截断疾病恶性循环。
Objective:Through the clinical observation yiqi through pus treatments for diabetes foot moist gangrene in promoting the wound healing aspects of diseased limb, improving TCM symptoms and signs, improve ankle brachial and toes brachial index than than the effect of TCM clinical treatment and explore its the train of thought and method. In the foundation treatment at the same time, the application of internal and external use proprietary clinical experience of gather together to enhance mutual combination of limb coagulant rate, lower limb amputation rate of the purpose of diabetic foot, but also for the clinical treatment of moist gangrene provide safe and effective treatment.
Methods:A randomized, controlled trial methods, will meet the standard 70 cases qualified participants randomly divided into treatment group 35 examples and the control group 35 examples, the treatment group and control group is assigned a foundation treatment and surgical debridement treatment group, plus Chinese medicine (taken within four wonderful scattered through pus and scattered to add and subtract, hope to immerse topical since washed two outside. Before and after treatment were observed in the main two groups patients moist gangrene wound healing, TCM symptoms and signs, double lower limbs points than an ankle brachial (ABI), toe than (TBI) brachial index improvement. The test data of meet normal distribution, using t-test and X2 inspection; Don't conform to the normal distribution by rank and inspection of statistical analysis.
Results:
1, application yiqi through pus treatments for diabetes foot moist gangrene and blood stasis, wet poison accumulate resistance syndrome has good curative effect. Wound effect assessment results showed that p< 0.01, clinical cure rate of treatment group is 18% compared to just 0, total significant efficiency of treatment group is 100%,28.57% in the placebo group, the treatment group in promoting wound healing was better than control; on TCM effect assessment results showed signs and symptoms (p< 0.05), and the treatment group clinical cure rate of 8%, while the control group only 0, treatment group total effectiveness to 100%, and the control group, the treatment group just 20 percent in improving the symptoms has good effect.2, diabetes foot moist gangrene had an ankle brachial index side showed: treatment group than before and after the treatment ankle brachial than to compare, toe humerus (p< 0.01), the results showed there were significant differences, the treatment effect is obvious; The control group than before and after the treatment itself an ankle brachial> 0.05 compared results showed that p, no statistical significance, can think no improvement, toe than to comparison results show humeral> p> 0.05 slightly 0.01, improvement, but the effect is not obvious; Two groups of ankle brachial ratio, before and after the treatment group than toe humerus, before treatment is compared between> 0.05, comparative p after treatment with comparable, two groups than comparison results show toe humerus (p< 0.01), but think the curative effect of treatment group was better than control, after treatment, the two groups of ankle brachial than comparison results show 0.05> p> 0.01, can think in improving ankle brachial index in treatment group than in control group were different, but is no obvious difference.
Conclusion:Yiqi through pus treatments for diabetes foot moist gangrene and blood stasis, wet poison accumulate resistance card, can significantly improve the clinical symptoms, and remove saprophytic muscle and promote with sores weeks, inflammation disappeared to improve blood circulation, promote granulation growth, make wound quickly achieve good growth state as soon as possible, the role of wounds to heal. For yiqi through pus method in the treatment of diabetes moist gangrene effective provides TCM treatment idea and method, therefore, for diabetes foot moist gangrene of syndrome differentiation, treatment should be specially designed square designed drug treatment within the system combines syndrome with external treatment for truncated disease, early intervention vicious cycle.
方法：采用随机、对照的试验方法,将符合标准的70例合格受试者随机分为治疗组35例和对照组35例,治疗组及对照组均给予基础治疗及外科清创换药,治疗组外加中药(内服用透脓散合四妙散加减,外用自拟二黄汤浸泡外洗)。在治疗前后主要对比观察两组患者湿性坏疽疮面的愈合情况、中医症状体征积分情况,双下肢踝肱比(ABI)、趾肱比(TBI)的指标改善情况。试验数据符合正态分布者,采用t检验和X2检验；不符合正态分布者采用秩和检验进行统计分析。
结果：
1、应用益气透脓法治疗糖尿病足湿性坏疽气虚血瘀、湿毒蕴阻证具有良好的疗效。疮面疗效评价结果显示p<0.01,临床治愈率治疗组为18%,而对照组仅为0,总显效率治疗组为100%,而对照组为28.57%,治疗组在促进疮面愈合上明显优于对照组；中医症状体征疗效评价结果显示p<0.05,治疗组临床治愈率为8%,而对照组仅为0,治疗组总有效率为100%,对照组仅为20%,治疗组在改善症状方面有较好的疗效。
2、糖尿病足湿性坏疽患侧踝肱指数结果显示：治疗组治疗前后踝肱比、趾肱比自行比较结果显示p<0.01,有显著差异,治疗效果明显；对照组治疗前后踝肱比自行比较结果显示p>0.05,无统计学意义,可以认为没有改善,趾肱比自行比较结果显示0.05>P>0.01,有轻微改善,但疗效并不明显；两组踝肱比、趾肱比治疗前后组间比较,治疗前比较p>0.05,具有可比性,治疗后两组趾肱比比较结果显示p<0.01,可认为治疗组疗效明显优于对照组,治疗后两组踝肱比比较结果显示0.05>P>0.01,可认为在改善踝肱比指标方面治疗组较对照组有差异,但差异不明显。
结论：益气透脓法治疗糖尿病足湿性坏疽气虚血瘀、湿毒蕴阻证,明显改善了临床症状,并且具有祛腐生肌、促进炎症消退,改善疮周血液循环,促进肉芽生长,使疮面较快达到良好的生长状态,使疮面尽早愈合的作用。为益气透脓法治疗糖尿病湿性坏疽有效的提供了中医治疗思路与方法,因此,对糖尿病足湿性坏疽的治疗应辨证论治、专方专药专证治疗,系统结合内治与外治,早期干预截断疾病恶性循环。
Objective:Through the clinical observation yiqi through pus treatments for diabetes foot moist gangrene in promoting the wound healing aspects of diseased limb, improving TCM symptoms and signs, improve ankle brachial and toes brachial index than than the effect of TCM clinical treatment and explore its the train of thought and method. In the foundation treatment at the same time, the application of internal and external use proprietary clinical experience of gather together to enhance mutual combination of limb coagulant rate, lower limb amputation rate of the purpose of diabetic foot, but also for the clinical treatment of moist gangrene provide safe and effective treatment.
Methods:A randomized, controlled trial methods, will meet the standard 70 cases qualified participants randomly divided into treatment group 35 examples and the control group 35 examples, the treatment group and control group is assigned a foundation treatment and surgical debridement treatment group, plus Chinese medicine (taken within four wonderful scattered through pus and scattered to add and subtract, hope to immerse topical since washed two outside. Before and after treatment were observed in the main two groups patients moist gangrene wound healing, TCM symptoms and signs, double lower limbs points than an ankle brachial (ABI), toe than (TBI) brachial index improvement. The test data of meet normal distribution, using t-test and X2 inspection; Don't conform to the normal distribution by rank and inspection of statistical analysis.
Results:
1, application yiqi through pus treatments for diabetes foot moist gangrene and blood stasis, wet poison accumulate resistance syndrome has good curative effect. Wound effect assessment results showed that p< 0.01, clinical cure rate of treatment group is 18% compared to just 0, total significant efficiency of treatment group is 100%,28.57% in the placebo group, the treatment group in promoting wound healing was better than control; on TCM effect assessment results showed signs and symptoms (p< 0.05), and the treatment group clinical cure rate of 8%, while the control group only 0, treatment group total effectiveness to 100%, and the control group, the treatment group just 20 percent in improving the symptoms has good effect.2, diabetes foot moist gangrene had an ankle brachial index side showed: treatment group than before and after the treatment ankle brachial than to compare, toe humerus (p< 0.01), the results showed there were significant differences, the treatment effect is obvious; The control group than before and after the treatment itself an ankle brachial> 0.05 compared results showed that p, no statistical significance, can think no improvement, toe than to comparison results show humeral> p> 0.05 slightly 0.01, improvement, but the effect is not obvious; Two groups of ankle brachial ratio, before and after the treatment group than toe humerus, before treatment is compared between> 0.05, comparative p after treatment with comparable, two groups than comparison results show toe humerus (p< 0.01), but think the curative effect of treatment group was better than control, after treatment, the two groups of ankle brachial than comparison results show 0.05> p> 0.01, can think in improving ankle brachial index in treatment group than in control group were different, but is no obvious difference.
Conclusion:Yiqi through pus treatments for diabetes foot moist gangrene and blood stasis, wet poison accumulate resistance card, can significantly improve the clinical symptoms, and remove saprophytic muscle and promote with sores weeks, inflammation disappeared to improve blood circulation, promote granulation growth, make wound quickly achieve good growth state as soon as possible, the role of wounds to heal. For yiqi through pus method in the treatment of diabetes moist gangrene effective provides TCM treatment idea and method, therefore, for diabetes foot moist gangrene of syndrome differentiation, treatment should be specially designed square designed drug treatment within the system combines syndrome with external treatment for truncated disease, early intervention vicious cycle.
引文
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