负压创伤治疗技术在糖尿病足难愈性溃疡中的应用研究

目的探讨负压创伤治疗技术(NPWT)在糖尿病足难愈性溃疡治疗中的适应证、持续负压运行的可行性、安全性、有效性及不良反应。方法糖尿病足难愈性溃疡患者139例,分2组。负压创伤治疗组104例,其中男性61例,女性43例;年龄33～87岁,平均年龄64.3岁。常规治疗组35例,其中男性21例,女性14例;年龄32～94岁,平均年龄63.6岁。溃疡形成时间最短2周,最长2.5年,糖尿病病程1个月～40年。负压创伤治疗组采用智能负压治疗技术治疗糖尿病足难愈性溃疡,治疗时间最长120 d,最短15 d。常规治疗组采用传统清创、换药方法,治疗时间最长97 d,最短14 d。2组均辅以控制血糖及血压、抗凝、抗感染及对症支持治疗。两组分别于出院后1个月和3个月进行随访。结果负压治疗组溃疡愈合31例,显效55例,有效13例,无效5例。常规治疗组溃疡愈合17例,显效10例,有效2例,无效6例。两组治疗总有效率比较,差异有统计学意义(P<0.05)。出院后随访1个月溃疡无复发,3个月负压治疗组68例随访中4例下肢出现新溃疡。常规治疗组10例随访中1例下肢出现新溃疡。治疗安全性:负压泵运行过程中噪声小,连续运行最长120 d(更换辅料时停机)无故障,无出现并发症。结论智能负压治疗技术在糖尿病足部皮肤难愈性溃疡治疗中显示良好的安全性和有效性,有较好的应用前景。

Clinical application research of negative-pressure wound therapy in refractory ulcers of diabetic foot

Objective To study the indications,feasibility of continuous operation,efficacy,safety and adverse reaction of negative-pressure wound therapy(NPWT) on the treatment of chronic diabetic foot refractory wounds.Methods A total of 139 patients with chronic diabetic foot refractory wounds were divided into 2 groups.There were 104 cases in NPWT group,male 61,female 43,aged 33-87 years old,mean age 64.3 years old;And 35 cases in routine treatment group,male 21,female 14,aged 32-94 years old,mean age 63.6 years old.The shortest time of ulceration was two-week,the longest of 2.5-year,duration of diabetes were 1-month to 40-year.The NPWT group performed intelligent pressure treatment techniques for diabetic foot ulcers refractory in 104 cases,the longest treatment time was 120-day,and the shortest was 15-day.The 35 cases of routine treatment group used traditional debridement and treatment methods.The longest treatment time was 97-day and the shortest was 14-day.Both of groups were accompanied by blood sugar and blood pressure control,anticoagulation,anti-infection treatment and supportive treatment,the 1-month and 3-month follow-up were carried out.Results In NPWT group,31 cases were healed,significantly more effective in 55 cases,effective in 13 cases,and ineffective in 5 cases.In routine treatment group,17 cases were healed,significantly more effective in 10 cases,effective in 2 cases,and ineffective in 6 cases.The total effect between 2 groups had significant difference(P < 0.05).There was no ulcer recurred in 1-month follow-up.And 4 of 68 cases in NPWT group were found new ulcer in lower limbs in 3-month after hospitalization.And 1 of 10 in routine group was found new ulcer in lower limbs.The security in treatment of vacuum pump was lower noise,and the function of suction pump which had been continuously run for 120-day,which without failure and complication.Conclusion It is demonstrated that NPWT is safe and effective on the treatment of chronic diabetic foot refractory wounds.Therefore,there is a bright future for NPWT on the treatment of chronic diabetic foot refractory wounds.