本文選題：負(fù)壓封閉引流技術(shù) + 輸氧　； 參考：《蘭州大學(xué)》2015年碩士論文

【摘要】：目的：觀察負(fù)壓封閉引流聯(lián)合輸氧治療Wagner3級糖尿病足潰瘍的臨床療效,以探討糖尿病足的有效治療方法。方法：本研究自2011年3月至2014年3月在本院內(nèi)分泌科及骨科住院的糖尿病足患者66例。其中治療組患者36例,男24例,女12例,年齡48-70歲,平均(59.6±2.8)歲。創(chuàng)面面積從1.Ocm × 1.6cm-5.1cm×8.6cm不等。對照組患者30例,男17例,女13例,年齡46-75歲,平均57.2±3.1歲。創(chuàng)面面積從1.2cmx0.8cm-4.0cm×8.1cm不等。所入選對象均符合1999年WHO的糖尿病診斷標(biāo)準(zhǔn),糖尿病病程5-12年(平均7年),平均HbAic8.3%,足潰瘍創(chuàng)面按照《糖尿病足國際臨床指南》Wagner分級：符合Wagner3級。2組均給予常規(guī)治療,采取有效措施積極控制血糖,在糖尿病飲食的基礎(chǔ)上,適度增強(qiáng)膳食營養(yǎng),采取氣圈、棉墊等工具支撐,減輕創(chuàng)面周圍的局部壓迫；若創(chuàng)面?zhèn)诔霈F(xiàn)感染,則取分泌物或膿液進(jìn)行細(xì)菌培養(yǎng)并常規(guī)做藥敏試驗(yàn),選擇敏感抗菌素積極進(jìn)行抗感染治療,對照組在常規(guī)處理的基礎(chǔ)上,采用傳統(tǒng)敷料進(jìn)行包扎,并可根據(jù)創(chuàng)面周圍滲出情況和局部的血液循環(huán)狀態(tài)酌情調(diào)整換藥頻次,一般的換藥間隔時(shí)間為前7天每天換藥1次,第八天以后可以每隔1-3天換1次藥,一直換到創(chuàng)面愈合為止。治療組在常規(guī)治療的基礎(chǔ)上,給予負(fù)壓封閉引流聯(lián)合輸氧,根據(jù)創(chuàng)面大小裁剪或拼接負(fù)壓封閉引流裝置,運(yùn)用生物半透薄膜封閉被引流區(qū)同時(shí)使創(chuàng)面與外界隔絕。連接負(fù)壓源及氧氣源,形成一個(gè)單向、封閉、高效引流及創(chuàng)面給養(yǎng)系統(tǒng)。兩組均觀察30天,治療30天前后均觀察血流變和足背動(dòng)脈流體力學(xué)指標(biāo),并保持跟蹤隨訪6個(gè)月到一年。結(jié)果：全體患者血糖均得到有效控制,體溫、血常規(guī)檢查正常,局部無竇道、無疼痛,感染均得到有效控制。術(shù)后隨訪4個(gè)月到一年,無感染復(fù)發(fā)。2組患者經(jīng)負(fù)壓引流聯(lián)合輸氧治療或者傳統(tǒng)治療后均獲得滿意療效。其中,負(fù)壓引流聯(lián)合輸氧治療組療效(總有效率94%)明顯優(yōu)于傳統(tǒng)治療法組(總有效率83%)。且治療組患者的治愈、顯效、好轉(zhuǎn)時(shí)間均明顯短于于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。與對照組比較,治療組患者在植皮或皮瓣轉(zhuǎn)移的時(shí)間、換藥次數(shù)、總體治療費(fèi)用等方面均有顯著差異(P0.05)。治療前后兩組血液流變學(xué)指標(biāo)和足背動(dòng)脈血流動(dòng)力學(xué)指標(biāo)均有所改善,治療組明顯優(yōu)于對照組。結(jié)論：VSD聯(lián)合輸氧對糖尿病足潰瘍Wagner3級創(chuàng)面修復(fù)具有良好的作用,可以有效促進(jìn)創(chuàng)面愈合,其作用明顯優(yōu)于傳統(tǒng)方法,且能夠?yàn)橹财せ蚱ぐ贽D(zhuǎn)移成功奠定良好基礎(chǔ)。此外,本方法還具有技術(shù)操作簡便,易于掌握的優(yōu)勢。因此,適合在臨床治療糖尿病足時(shí)進(jìn)行推廣應(yīng)用。
[Abstract]:Objective: to observe the clinical effect of negative pressure sealing drainage combined with oxygen infusion in the treatment of Wagner3 grade diabetic foot ulcer. Methods: from March 2011 to March 2014, 66 patients with diabetic foot were hospitalized in Department of Endocrinology and Orthopaedics. There were 36 patients in the treatment group, 24 males and 12 females, aged from 48 to 70 years, with an average age of 59.6 鹵2.8 years. The wound area ranged from 1.Ocm 脳 1.6cm-5.1cm 脳 8.6cm. There were 30 patients in the control group, 17 males and 13 females, aged 46 to 75 years (mean 57.2 鹵3.1 years). The wound area ranged from 1.2cmx0.8cm-4.0cm 脳 8.1cm. The subjects were all in accordance with the diagnostic criteria of WHO in 1999. The course of diabetes was 5-12 years (mean 7 years, average HbAic8.3a). The wound of foot ulcer was treated with routine therapy according to the Wagner grading of Diabetic foot International Clinical guidelines: according to Wagner3 grade .2 group. Take effective measures to actively control blood sugar, on the basis of diabetes diet, moderately enhance dietary nutrition, take air rings, cotton pads and other tools support, reduce the local pressure around the wound; if the wound infection, Then take the secretion or pus for bacteria culture and routine drug sensitivity test, select sensitive antibiotics for active anti-infection treatment, the control group on the basis of conventional treatment, using traditional dressing for dressing, The frequency of dressing change can be adjusted according to the condition of exudation around the wound and local blood circulation. The general interval time of dressing change is 1 time per day for the first 7 days, and once every 1-3 days after the eighth day. Until the wound is healed. On the basis of routine treatment, the treatment group was given negative pressure sealing drainage combined with oxygen, cutting or splicing the negative pressure sealing drainage device according to the size of the wound, using biological semi-permeable membrane to seal the drainage area and make the wound cut off from the outside world at the same time. Connect negative pressure source and oxygen source to form a unidirectional, closed, efficient drainage and wound feeding system. The hemorheology and hydrodynamics of dorsal foot artery were observed before and after treatment for 30 days in both groups, and follow-up was maintained for 6 months to 1 year. Results: blood sugar was effectively controlled, body temperature, blood routine examination were normal, no sinus tract, no pain, infection were effectively controlled. After 4 months to 1 year follow-up, the patients in group 2 were treated with negative pressure drainage combined with oxygen therapy or conventional therapy. Among them, the effect of negative pressure drainage combined with oxygen therapy group (total effective rate 94) was significantly better than that of traditional therapy group (total effective rate 83%). The cure, effect and improvement time of the patients in the treatment group were significantly shorter than those in the control group, and the difference was statistically significant (P 0.05). Compared with the control group, there were significant differences in the time of skin graft or flap transfer, the times of dressing change and the total treatment cost in the treatment group. Before and after treatment, the hemorheology index and the hemodynamic index of dorsal foot artery were improved in both groups, and the treatment group was better than the control group. ConclusionVSD combined with oxygen infusion has a good effect on the repair of Wagner3 grade wound of diabetic foot ulcer and can effectively promote wound healing. The effect is obviously superior to the traditional method and can lay a good foundation for successful skin grafting or flap transfer. In addition, this method also has the technical operation simple, easy to grasp the superiority. Therefore, it is suitable for popularizing and applying in clinical treatment of diabetic foot.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2

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本文編號：1949191