自体富血小板凝胶治疗糖尿病慢性难愈合皮肤溃疡的住院时间和住院费用分析

目的明确自体富血小板凝胶在治疗糖尿病慢性难愈合皮肤溃疡时可能存在的经济优势。方法本研究为单中心、前瞻性、随机对照、平行开放实验。纳入2007年4月至2010年4月期间,于四川大学华西医院糖尿病足诊治中心住院治疗的患者中筛选的117例糖尿病慢性难愈合皮肤溃疡患者,并随机分配至自体富血小板凝胶(auotologous platelet-rich gel,APG)联合标准治疗组或单用标准治疗组。比较两组间的疗效结局、愈合时间以及住院费用和住院时间。结果 APG治疗组溃疡愈合率为84.75%(50/59),总有效率为98.31%;标准治疗组溃疡愈合率为68.97%(40/58),总有效率为75.86%,两组比较差异有统计学意义(P=0.026)。APG治疗组中位愈合时间为36(18～60)d;标准治疗组为45(30～60)d,两组比较差异有统计学意义(P=0.012)。总住院费用和住院时间在APG治疗组〔38223(23070～57398)元;57(41-94)d〕与标准治疗组〔35070(24 436～53649)元;58(31.75～58.50)d〕间的差异无统计学意义(P分别为0.455和0.301)。包括药物费、治疗费、材料费、放射治疗费、外科手术费、检查费、住宿费、膳食费、护理费以及创面局部清创换药的费用等的各种单项费用的比较也未发现差异有统计学意义(P>0.05)。结论自体富血小板凝胶能提高糖尿病慢性难愈合皮肤溃疡的愈合率,减少溃疡愈合时间,且不增加患者的住院费用和时间,是一种性价比较好的局部治疗技术。

Impact of Topical Application of Autologous Platelet-rich Gel on Medical Expenditure and Length of Stay inHospitals in Diabetic Patients with Refractory Cutaneous Ulcers

Objective To evaluate the potential financial benefit of topical application of autologous platelet-rich gel(APG) in treating diabetic refractory cutaneous ulcers.Methods A single-center prospective randomized controlled trial was undertaken,with 117 patients with proven diabetic refractory cutaneous ulcers participating in the study.The patients who gave informed consents were randomly assigned into standard care group(n=58) or standard care plus topical application of APG treatment group(n=59).The outcome of healing and the medical expenditur and length of stay in the patients were compared between the two groups.Results The APG-treated group had better healing outcomes than the standard-treated group.The APG-treated group had 84.75%(50/59) complete healing and 98.31% improvement,higher than the 68.97%(40/58) and 75.86%,respectively,in the standard-treated group(P=0.026).The median length for healing in the APG-treated patients was 36 days,shorter than the 45 days in the standard-treated patients(P=0.012).The total medical expenditure and length of stay in hospitals were not significantly different between APG-treated patients($38223(23070-57398);57(41-94) days) and standard-treated patients($35070(24436-53649);58(31.75-58.50) days)(P=0.455 and 0.301 respectively).Spendings on items such as medicine,artificial treatment,materials,interventional operation,surgical procedures,laboratory tests and other auxiliary examination,accommodations,meals,nursing care and debridement and dressing change were similar between the two groups(P>0.05).Conclusion There is an advan tage for the topical application of APG on diabetic refractory cutaneous ulcers in terms of the healing outcomes.APG is a cost-effective choice for patients w ith diabetic refractory cutaneous ulcers.