本文選題：糖尿病　切入點：糖尿病足潰瘍　出處：《天津醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的回顧性分析負壓封閉引流技術(shù)(Vacuum sealing drainage)在治療糖尿病足潰瘍(Wagner 2-3級)中的臨床療效。方法1.研究對象回顧分析2012年1月~2014年12月,天津市第一中心醫(yī)院燒傷科住院部收治的糖尿病足患者。2.納入標準(1)臨床確診,經(jīng)住院手術(shù)治療,病情穩(wěn)定的出院患者;(2)未合并其它類型血管性病變、皮膚性病變;(3)住院期間糖尿病病情趨于穩(wěn)定,非終末期腎臟病患者,以糖尿病足潰瘍?yōu)橹靼Y就診;(4)患者住院期間依從性良好,未出現(xiàn)放棄治療或自動出院;(5)糖尿病足潰瘍Wagner分級2-3級。3.研究對象分組共納入糖尿病足患者120例,男42例,女78例,年齡55~78歲、平均(64.4±5.1)歲,糖尿病病程1~16年、平均(7.4±2.2)年,糖尿病足潰瘍病程8~194d、平均(81±40)d,潰瘍面積3cm×4cm~10cm×10cm。根據(jù)是否應用負壓封閉引流將患者分為試驗組和對照組。試驗組60例,男18例,女42例,年齡(55~74)歲,平均(65.1±5.5)歲,平均糖尿病病史(7.5±2.2)年,平均糖尿病足潰瘍史(83±40)天。對照組60例,男24例,女36例,年齡(60~78)歲,平均(63.8±4.6)歲,平均糖尿病病史(7.4±2.3)年,平均糖尿病足潰瘍史(80±40)天。4.治療方法試驗組:手術(shù)清創(chuàng)后應用負壓封閉引流治療,負壓維持在80mm Hg~125mm Hg,術(shù)后當天開始給予0.9%生理鹽水500ml沖洗引流,沖洗3-5天,VSD連續(xù)應用7-10天,視肉芽生長及創(chuàng)面感染情況更換新的VSD敷料或行手術(shù)植皮治療。對照組:手術(shù)清創(chuàng)后給予傳統(tǒng)換藥處理,無菌紗布覆蓋,每日換藥1次,根據(jù)肉芽生長情況行手術(shù)植皮治療。其他治療:兩組患者均給予控制血糖、控制合并癥、抗感染、改善微循環(huán)、手術(shù)清創(chuàng)等常規(guī)基礎治療。5.觀察指標根據(jù)出院及隨訪記錄,統(tǒng)計兩組患者換藥平均次數(shù)、創(chuàng)面平均愈合時間及患者換藥時疼痛峰值;根據(jù)問卷調(diào)查表,統(tǒng)計患者滿意度。6.統(tǒng)計方法以SPSS19.0軟件包處理所獲數(shù)據(jù)資料,計量資料采用(x±s)表示,組間比較采用t檢驗,計數(shù)資料用x2檢驗,P㩳0.05表示差異具有統(tǒng)計學意義。結(jié)果(1)試驗組負壓封閉引流治療后,肉芽組織創(chuàng)面達到植皮條件后行創(chuàng)面植皮治療,平均換藥次數(shù)(5.8±0.9)次,與對照組平均換藥次數(shù)(31.6±3.3)比較,差異具有統(tǒng)計學意義(P0.05)。(2)試驗組糖尿病足創(chuàng)面平均愈合時間(28.9±5.6),與對照組(50.6±5.4)天創(chuàng)面平均愈合時間比較,差異具有統(tǒng)計學意義(P0.05)。(3)試驗組與對照組相比,治療期間患者痛苦程度明顯減輕,通過視覺模擬評分法評分得出疼痛峰值分別為(4.3±2.0)和(6.8±1.7),差異具有統(tǒng)計學意義(P0.05)。(4)試驗組患者滿意度評分為(88.6±6.5),對照組為(69.2±10.6),兩組均數(shù)差異具有統(tǒng)計學意義(P0.05)。結(jié)論負壓封閉引流技術(shù)用于治療糖尿病足潰瘍Wagner2-3級患者,臨床療效較好,與傳統(tǒng)換藥和手術(shù)治療方法比較,降低換藥頻次、節(jié)省人力、促進創(chuàng)面愈合、減輕患者痛苦、患者滿意度好,值得臨床推廣應用。缺點是價格較貴限制了它在臨床上的廣泛應用。
[Abstract]:Objective to retrospectively analyze the clinical efficacy of vacuum sealing drainage in the treatment of diabetic foot ulcers (Wagner 2-3 grade). Diabetic foot patients admitted in the Department of Burn and Trauma of the first Central Hospital of Tianjin. Patients with non-end-stage kidney disease, with diabetic foot ulcer as the main treatment, had good compliance during hospitalization. There were 120 diabetic foot ulcers (male 42, female 78, mean 64.4 鹵5.1) years old (mean 64.4 鹵5.1) years. The course of diabetes was 1 ~ 16 years (mean 7.4 鹵2.2) years. The course of diabetic foot ulcerative ulcer was 8194d, with an average ulcer area of 3cm 脳 4cm / 10cm 脳 10cm 脳 10cm 路cm. The patients were divided into experimental group (n = 60) and control group (n = 60, male 18, female 42, mean age: 65.1 鹵5.5) years, mean diabetes history (7.5 鹵2.2) years. The average history of diabetic foot ulcers was 83 鹵40 days in the control group (n = 60, male 24, female 36, age: 6078) years, mean age was 63.8 鹵4.6 years, mean diabetes history was 7.4 鹵2.3 years. The average history of diabetic foot ulcer was 80 鹵40 days. 4. Treatment group: after debridement, the treatment group was treated with negative pressure sealing drainage, the negative pressure was maintained at 80mm Hg~125mm Hg, 0.9% normal saline 500ml wash and drainage was given on the day of operation, and 3 to 5 days after operation, Hg~125mm was continuously used for 7-10 days. Visual granulation growth and wound infection were treated with new VSD dressing or skin grafting. Control group was treated with traditional dressing after debridement, covered with sterile gauze, and changed once a day. According to the growth of granulation, the patients in both groups were treated with conventional basic treatment, such as controlling blood sugar, controlling complications, anti-infection, improving microcirculation, debridement, and so on. The average number of times of dressing change, the average healing time of wound and the peak value of pain in the two groups were counted, according to the questionnaire, the patients' satisfaction degree was .6.The statistical method was used to process the data obtained by SPSS19.0 software package, and the measurement data were expressed as "x 鹵s". T test was used for comparison among groups, and X2 test was used for counting data. Results after the treatment of negative pressure sealing drainage, the granulation tissue wound was treated with skin grafting, the average times of dressing change was 5.8 鹵0.9 times, compared with that of the control group (31.6 鹵3.3). The average healing time of diabetic foot wound in the experimental group was 28.9 鹵5.6g, and that in the control group was 50.6 鹵5.4 days. The difference was statistically significant. During the treatment, the pain degree of the patients was obviously alleviated. The results of visual analogue score showed that the peak value of pain was 4.3 鹵2.0 and 6.8 鹵1.7, respectively. The difference was statistically significant (P 0.05. 05). The score of patient satisfaction was 88.6 鹵6.5 in the trial group and 69.2 鹵10.6 in the control group. The difference between the two groups was statistically significant (P0.050.Conclusion negative pressure sealing is a significant difference between the two groups. Drainage technique is used to treat Wagner2-3 grade diabetic foot ulcer patients. Compared with the traditional methods of dressing change and surgical treatment, it can reduce the frequency of dressing change, save manpower, promote wound healing, alleviate the pain of patients, and improve the patients' satisfaction. It is worthy of clinical application. The disadvantage is that the high price limits its wide application in clinic.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R587.2

【參考文獻】

相關(guān)期刊論文 前1條

1 呂小星;曹大勇;陳紹宗;李望舟;張翠英;李學擁;;封閉負壓引流技術(shù)對人慢性創(chuàng)面周圍組織中PDGF及TGF-β表達的影響[J];中國美容整形外科雜志;2006年06期

，

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