化腐再生法治疗糖尿病足肌腱坏死

目的: 观察化腐再生法对糖尿病足坏死肌腱的化除及对伤口愈合的影响。 方法: 107例糖尿病足患者,随机分为化腐再生组35例,化腐组36例,再生组36例,针对其创面情况适时行蚕食清创,而后分别采用不同药物换药治疗,观察8周后坏死肌腱脱落、伤口愈合状况以及治疗前后血常规分析中白细胞、C反应蛋白等炎性指标的变化。同时在治疗0,3,7,14 d分别提取伤口分泌物进行病理涂片以及肿瘤坏死因子-α (TNF-α)、白介素-6 (IL-6)检测,观察3种换药方法对糖尿病创面愈合的影响,并加以分析。 结果: 化腐再生组坏死肌腱治疗后较其他两组脱落明显;3组白细胞及C反应蛋白均呈下降趋势,化腐再生组下降迅速,与其他组比较差异有统计学意义(P＜0.05);分泌物病理涂片化腐再生组及化腐组炎细胞较再生组明显减少;3组分泌物TNF-α均呈上升趋势,化腐再生组较其他3组升高,差异有统计学意义(P＜0.05);3组分泌物IL-6在早期均呈先升后降趋势,化腐再生组分泌物IL-6值较其他组上升时间及回落时间较其他组迅速,差异有统计学意义(P＜0.05)。 结论: 应用化腐再生法换药,能够尽早液化坏死肌腱及坏死组织,促进创面的愈合,其机制可能与菠萝蛋白酶在象皮生肌膏联合作用下使创面引流通畅,激活并增强机体持久的抗炎免疫机制,从而利于控制糖尿病足感染,促进创面的愈合有关。

Clinical Research on Method of Huafu Zaisheng in Treating Diabetic Foot with Tendons Worsened

Objective:To observe the effect of liquefying the necrotic tendons of diabetic foot and promotion of wound healing using the treatment of Huafu Zaisheng.Method:One hundred and seven patients suffering from diabetic foot were randomLy divided into Huafu Zaisheng group(35 cases),Huafu group(36 cases),Zaisheng group(36 cases),then had eroded debridement timely for its wounds.After that,different drugs were used for the wound dressing and observe the condition of wound healing,liquefaction of necrotic tendons,the changing of inflammatory indicators as white blood cells,CRP before and after treatment.In addition,collecting the exudation from the wound at the time of four points after wound dressing: 0,3,7,14 d.Then using them as pathological smears and testing tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) to observe the effect in diabetic wound healing by different wound dressing method,and analyze afterwards.Result:The necrotic tendons of Huafu Zaisheng group were liquefied clearer than the other two groups;the white blood cells and CRP of the three groups are declining,and the Huafu Zaisheng group is the smallest,the difference is of significance in statistics science(P<0.05);the pathological smear of secretions shows that inflammatory cells in Huafu Zaisheng group and Huafu group significantly reduced comparing with Zaisheng group;the TNF-α in exudation of the three groups are rising,and the Huafu Zaisheng group is the highest,the difference is of significance in statistics science(P<0.05);the IL-6 in exudation of the three groups rise first and then decreased,while the IL-6 in exudation of Huafu Zaisheng group rising and decreasing quicker than the other groups,the difference is of significance in statistics science(P<0.05).Conclusion:Using the wound dressing method of Huafu Zaisheng,the necrotic tendons and tissues could be liquefied as early as possible,then promote the wound healing,the mechanism of which may correlated with the combination of bromelain and Shengji Xiangpigao could make the drainage unobstructed,then activate and enhance the anti-inflammatory immune mechanism of the organism,thus fits intocontrol diabetic foot infection,and promote wound healing.