负压创面治疗联合高压氧治疗糖尿病足的临床疗效

目的探讨负压创面治疗联合高压氧治疗糖尿病足的临床疗效。方法采用回顾性病例对照研究分析江苏大学附属人民医院整形烧伤科自2013年2月至2017年12月收治的46例糖尿病足患者的临床资料,根据治疗方法分为对照组(24例)和联合治疗组(22例)。糖尿病足创面按Wagner分级为3~5级;共46足。对照组采用控制血糖、抗感染、清创、创面湿性换药等方法,根据创面情况予以换药、植皮或截肢治疗。联合治疗组在对照组治疗方法基础上采用负压创面治疗联合高压氧治疗,并根据创面情况予以换药、植皮、放置负压引流材料或截肢治疗。治疗后观察患者创面愈合、住院时间及截肢情况。结果治疗总有效率:联合治疗组(59%)明显高于对照组(33%)。对照组和联合治疗组的住院时间分别为(25.2±16.5)d和(28.7±12.8)d。对照组中9例患者共截趾11趾,大腿截肢7例,小腿截肢1例。联合治疗组中5例患者共截趾8趾,小腿截肢2例。与对照组相比,联合治疗组截肢率明显降低(z=-2.617,P<0.05),且踝关节以上截肢率明显下降(33%∶9%,P<0.05)。结论采用负压创面治疗联合高压氧治疗糖尿病足患者,可显著降低截肢率,改善患者出院后的生活质量。

Clinical efficacy of negative pressure wound therapy combined with hyperbaric oxygen therapy for diabetic foot

Objective Explore the clinical efficacy of negative pressure wound therapy combined with hyperbaric oxygen therapy for diabetic foot.Methods From February 2013 to December 2017,the clinical data of 46 patients with diabetic foot were retrospectively analyzed.All patients were divided into control group(24 patients)and combined treatment group(22 patients)according to the treatment method.According to Wagner grade,the wounds of diabetic foot were classified as 3 to 5 grades,a total of 46 feet.The treatment method such as blood glucose control,anti-infection,debridement of wounds and wet-wrap dressings were performed in the control group.The dressing change,skin grafting or amputation was conducted according to the situation of wounds.The negative pressure wound therapy combined with hyperbaric oxygen therapy on the basis of treatment methods of control group were performed in the combined treatment group.The dressing change,skin grafting,vacuum sealing drainage or amputation was conducted according to the wounds.The wound healing,length of hospital stay and amputation after treatment were observed.Results The total effective rate of combined treatment group(59%)was significantly higher than that of the control group(33%).The length of hospital stay were(25.2±16.5)days in the control group and(28.7±12.8)days in the combined treatment group.There were 11 toe amputations in 9 patients in the control group,including 7 cases of thigh amputations and 1 case of calf amputation.There were 8 toe amputations in 5 patients,including 2 cases of calf amputation.Compared with the control group,the amputation rate was significantly decreased(z=-2.617,P<0.05)and the rate of amputation above the ankle was significantly reduced(33%vs 9%,P<0.05).Conclusion The negative pressure wound therapy combined with hyperbaric oxygen therapy for diabetic foot can significantly reduce the amputation rate and improve the quality of life for patients after discharge.