两种伤口负压治疗模式对糖尿病足溃疡治疗作用的比较

目的比较两种伤口负压治疗模式对糖尿病足溃疡的治疗作用。方法选取2018年4至8月广西壮族自治区人民医院内分泌科收治的糖尿病足溃疡患者,经全身综合治疗和创面评估、清创后,对创面床适合伤口负压治疗的16例患者(男10例,女6例)按入组时间顺序进行随机分组,采用开放、平行、交叉方法,分为先负压辅助闭合(VAC)组(8例)和先负压封闭引流(VSD)组(8例),先VAC组第一周采用VAC治疗,第二周接受VSD治疗;先VSD组第一周采用VSD治疗,第二周接受VAC治疗。分别于治疗前、治疗1周末及治疗2周末对所有患者足部溃疡创面拍照,采用Image J软件分析溃疡面积及肉芽组织面积变化,同时采用丹麦雷度经皮氧分压测定仪测定2个部位的组织氧分压。运用两阶段交叉设计的方差分析方法,对治疗期间第1周和第2周两种治疗模式的溃疡面积及肉芽组织面积变化、经皮氧分压变化进行比较。结果(1)16例糖尿病足溃疡患者与治疗前比较,治疗后溃疡面积缩小4.61(3.11)比9.51(6.55)cm^2,Z=3.517]、肉芽面积增加4.08(2.49)比0.90(1.12)cm^2,Z=-3.516],2个部位的经皮氧分压值均升高(54.19±6.91)比(32.16±10.16)mmHg(1 mmHg=0.133 kPa)、(56.75±12.95)比(30.56±11.93)mmHg,t=-11.814、-14.028],差异均有统计学意义(均P<0.05)。(2)VSD和VAC两种不同负压治疗模式对患者的溃疡面积、肉芽组织面积及2个部位的经皮氧分压变化有统计学意义(F=5.763~22.090,均P<0.05),且VAC治疗后的经皮氧分压增大值、溃疡面积缩小值及肉芽组织面积增加值要大于VSD治疗后(P<0.05)。(3)无论采用哪种负压治疗模式,治疗第1周后的2个部位的经皮氧分压增大值均大于治疗第2周后,差异有统计学意义(F=13.254、11.205,均P<0.05)。结论VAC在缩小糖尿病足溃疡面积,增加创面肉芽组织面积及提高溃疡周围组织氧分压方面要优于VSD,VAC治疗模式在治疗糖尿病足溃疡上更具有优势。

Comparison of two wound negative pressure treatment modes in the treatment of diabetic foot ulcer

Objective To compare the therapeutic effects of two wound negative pressure treatments on diabetic foot ulcer.Methods Sixteen patients(10 male,6 female)with diabetic foot ulcer admitted to the Department of Endocrinology of Guangxi Zhuang Autonomous Region People′s Hospital from April to August 2018 were selected.After comprehensive systemic treatment,wound evaluation and debridement,patients with wound bed suitable for wound negative pressure treatment were randomized into this open label cross-over trial.They were divided into the first vacuum assisted closure(VAC)group(8 cases)and the first vacuum sealing drainage(VSD)group(8 cases).The first VAC group received VAC treatment in the first week,then VSD treatment in the second week.The first VSD group was treated with VSD in the first week and VAC in the second week.The foot ulcer wounds of all the patients were photographed before treatment,after 1 week of treatment,and after 2 weeks of treatment.Changes of ulcer area and granulation tissue area were analyzed using Image J software.Meanwhile,the tissue oxygen partial pressure of the two sites around ulcer were measured with Danish Raydo Percutaneous Oxygen Partial Pressure Analyzer.The changes of ulcer area,granulation tissue area and percutaneous partial pressure of oxygen were compared between two treatments during the first and second weeks of treatment using two-stage cross-design analysis of variance.Results(1)Sixteen patients with diabetic foot ulcer were compared with those before treatment.After treatment,there was significant differences observed including decreased area of ulcer4.61(3.11)vs 9.51(6.55)cm^2,Z=3.517],expandedarea of granulation4.08(2.49)vs 0.90(1.12)cm^2,Z=-3.516],and increased values of percutaneous oxygen partial pressure(54.19±6.91)vs(32.16±10.16)mmHg(1 mmHg=0.133 kPa),(56.75±12.95)vs(30.56±11.93)mmHg,t=-11.814,-14.028](all P<0.05).(2)Two negative pressure treatments of VSD and VAC had statistical significance on the changes of ulcer area,granulation tissue area and percutaneous partial pressure of oxygen in two lesions of subjects(F=5.763-22.090,all P<0.05).The increasesof percutaneous oxygen partial pressure and granulation tissue area,and reduction in ulcer area after VAC treatment were greater than those after VSD treatment(all P<0.05).(3)No matter which negative pressure treatment was adopted,the increase value of percutaneous partial oxygen pressure in the two sites after the first week of treatment was greater than that after the second week of treatment,and the difference was statistically significant(F=13.254,11.205,both P<0.05).Conclusion VAC is superior to VSD in the improvement of diabetic foot ulcerarea,area of granulation tissue on wound surface and oxygen partial pressure of surrounding tissues,indicating that VAC treatment has more advantages in treating diabetic foot ulcer.