人工真皮联合负压引流技术修复糖尿病足创面的疗效研究

目的:分析人工真皮+负压引流技术修复糖尿病足创面的疗效。方法:将笔者医院2017年6月-2018年6月收治的90例糖尿病足患者作为研究对象。按随机数表法,分为对照组(45例)和观察组(45例)。对照组给予传统换药治疗,观察组在上述基础上,给予人工真皮+负压引流修复治疗。观察两组患者治疗效果、换药次数、餐后血糖控制、创面准备时间、愈合时间等情况。结果:观察组总有效率为93.3%显著高于对照组的77.8%,差异具有统计学意义(P0.05)。观察组换药次数、餐后血糖控制时间明显少于对照组,创面准备时间及愈合时间明显短于对照组,而治疗费用则明显高于对照组,差异均具有统计学意义(P0.05)。对照组住院时间(52.3±6.6)d,10例患者进行截肢,截肢率为22.2%;观察组住院时间(30.5±5.8)d,3例患者需截肢,截肢率为6.7%,组间比较,差异具有统计学意义(χ~2=6.113,P=0.031;t=4.982,P=0.011)。结论:人工真皮+负压引流技术对糖尿病足患者创面修复效果显著,可明显减少换药次数,缩短愈合时间,安全可靠,在临床中值得推广应用。     

清创术联合负压封闭引流技术治疗糖尿病足创面的临床观察

目的:探讨清创术联合负压封闭引流(Vacuum sealing drainage,VSD)技术治疗糖尿病足创面的临床疗效。方法:对2015年7月-2017年7月笔者科室收治的68例糖尿病足患者进行研究,随机分为观察组及对照组各34例。观察组采用清创术联合VSD技术进行治疗,对照组采用清创术联合普通敷料定期换药治疗,对比两组患者创面愈合时间、换药次数及并发症发生率等情况。结果:68例患者经治疗观察,观察组患者22例经VSD治疗后直接愈合,12例经VSD治疗后二期植皮愈合,出现皮片移位1例,并发症发生率为2.9%,创面愈合时间为(34.0±4.5)d,平均换药次数为(7.6±1.5)次;对照组患者20例经普通敷料定期换药后愈合,14例经换药后二期植皮愈合,出现创面感染2例,创面积液1例,皮片移位3例,并发症发生率为17.6%,创面愈合时间为(65.0±7.8)d,平均换药次数为(35.0±3.8)次。观察组与对照组在创面愈合时间及平均换药次数比较,差异均具有统计学意义(P0.05)。结论:清创术联合VSD技术治疗糖尿病足创面临床效果良好,相比传统方式愈合更快,换药次数更少,并发症发生率更低,操作简便且安全有效,值得临床应用。     

真空负压引流技术治疗糖尿病足的临床效果观察

目的探讨使用真空负压引流技术治疗糖尿病足的临床效果。方法回顾性分析2012年3月~2016年3月糖尿病足56例临床资料,28例采用真空负压引流技术(观察组),28例传统换药(对照组)。比较2组创面愈合结果、截肢率及住院时间。结果 56例创面均愈合(包括截肢创面)。观察组瘢痕愈合、植皮愈合、截肢分别为9例、18例、1例,对照组为7例、10例、11例,观察组明显优于对照组(Z=-2.179,P=0.029)。观察组住院时间(28.1±2.0)d,截肢率3.6%(1例);对照组住院时间(51.3±6.3)d,截肢率39.3%(11例)。观察组住院时间、截肢率均明显优于对照组(t=-18.453,P=0.000;χ~2=10.606,P=0.001)。结论相较于传统换药方法,真空负压引流技术能明显促进糖尿病足创面愈合,缩短病程,并降低截肢率。     

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。     

封闭式负压引流联合点状植皮在糖尿病足溃疡治疗中的临床应用

目的探讨封闭式负压引流联合点状植皮治疗人糖尿病足溃疡的疗效。方法将20例Wagner分级2~4级的糖尿病足溃疡患者分成对照组和观察组,每组10例,对照组溃疡创面持续应用封闭式负压引流,观察组溃疡创面应用封闭式负压引流联合点状植皮治疗。比较两组患者创面愈合率及创面愈合时间。结果观察组与对照组相比,创面愈合率明显增加(98.39%±1.61%vs 78.80%±1.85%)、创面愈合时间明显缩短(56.40±5.33天vs 74.70±8.55天),两组比较差异具有统计学意义。结论封闭式负压引流联合点状植皮可以促进糖尿病足溃疡创面愈合,缩短愈合时间,降低了截肢率。     

负压封闭引流技术在骨科临床中的应用

目的:评价负压封闭引流技术在骨科患者中的临床应用效果。方法:选取136例顽固性软组织感染、骨髓炎及关节感染等骨科疾病患者并随机分为两组,68例采用负压封闭引流技术作为观察组,68例采用常规负压引流技术作为对照组,随访患者1年,观察两组患者更换引流管次数、创面愈合、感染复发、住院时间、医疗费用的情况。结果:观察组68例患者在采用负压封闭引流时,无1例发生变态反应,更换引流管次数(2.3±0.8)次,住院时间(18.4±5.1)天,医疗费用(5685.6±313.1)元,对照组分别为(3.1±0.5)次、(24.2±6.1)天、(7125.3±362.5)元,两组差异有统计学意义(P<0.05)。观察组创面愈合率高于对照组,感染复发率低于对照组,但差异无统计学意义。结论:负压封闭引流引流效果好,可明显缩短治疗周期,降低医疗费用,而且创面愈合快,将负压封闭引流技术应用于骨科临床的治疗,更利于患者局部创面的恢复。     

新型敷料治疗糖尿病足感染的疗效及对血清相关指标的影响

目的:分析藻酸盐银离子敷料治疗糖尿病足感染的疗效及对血清相关指标的影响。方法:选取 2021年 1月—10月我院收治的 80例糖尿病足感染患者,采用随机数字表法分为对照组(40例)和观察组(40例)。对照组采用凡士林敷料,观察组采用藻酸盐银离子敷料。比较两组患者愈合时间、换药情况、创面面积与症状评分、血清指标水平及临床疗效。结果:观察组创面愈合时间、换药次数明显低于对照组(P<0.05),治疗总有效率明显高于对照组(P<0.05);两组患者治疗后 2周、 4周创面面积、创面症状评分、白细胞介素 -6(IL-6)及红细胞沉降率( ESR)水平明显低于治疗前( P<0.05),治疗后 4周明显低于治疗后 2周(P<0.05),且观察组明显低于对照组( P<0.05)。结论:相较于凡士林敷料,采用藻酸盐银离子敷料治疗糖尿病足感染疗效更好,可有效促进创面愈合,缓解创面症状,减少创面面积及换药次数,控制机体炎症反应。     

中药泡足联合局部换药治疗溃疡性糖尿病足效果观察

目的 探讨中药泡足联合局部换药治疗溃疡性糖尿病足的临床效果.方法 将58例溃疡性糖尿病足患者随机分为观察组和对照组各29例,观察组采用中药泡足联合常规局部换药治疗,对照组采用常规局部换药治疗,均连续治疗4周后评价创面愈合情况.结果 观察组总有效率72.4%,对照组为37.9%,两组比较,差异有显著性意义(P＜0.05).结论 中药泡足联合局部换药治疗溃疡性糖尿病足可提高疗效,减轻患者痛苦.     

银离子藻酸盐敷料在儿童四肢深II度烧伤创面中的应用效果观察

目的:探讨藻酸盐银离子敷料治疗儿童深II度烧伤创面中临床效果.方法:选取2015年7月—2016年5月我院烧伤整形科收治的四肢深II度烧伤患儿共60例,随机分为观察组和对照组.在创面清创后,观察组外用藻酸盐银离子敷料覆盖,无菌纱布包扎;对照组采用银锌霜皮肤黏膜抗菌剂涂抹,无菌纱布包扎.两组均根据创面渗出情况换药.比较两组患儿的换药次数、入院第7天的发热率、创面愈合率及愈合时间.结果:与对照组相比,观察组换药次数(8.63±2.37)次,明显少于对照组(14.70±2.30)次,差异有统计学意义(P<0.05).观察组治疗第7天患儿发热率为6.67%(2例),明显低于对照组23.33%(7例),差异有统计学意义(P<0.05);观察组治疗第7、11、15和19天创面愈合率明显高于对照组,差异有统计学意义(P<0.05);观察组创面愈合时间为(20.70±2.30)d,住院时间为(21.33±3.67)d,均较对照组[(27.63±3.63)d和(28.30±3.30)d]缩短,差异具有统计学意义(P<0.05).结论:应用银离子藻酸盐敷料治疗儿童四肢深II度烧伤创面能减少换药次数,加速创面愈合,减少患者痛苦,值得推广和应用.     

实用闭式负压装置的研制及临床应用效果评价

[目的]观察自制实用闭式负压装置治疗慢性难愈合创面的临床效果。[方法]61例难愈合创面患者随机分为观察组和对照组。观察组使用自制闭式负压引流装置处理创面,对照组使用传统方法换药。比较伤口形态变化、细菌培养结果和植皮成活率的差异。皮肤缺损较大的创面,经过伤口床准备,行邮票法植皮。比较均次成活率、创面愈合时间和换药次数及费用的差异。[结果]观察组治疗1周后,创面细菌培养菌落数(21.00±5.43)CFU/cm2,植皮成活率95%,平均创面愈合时间18.4 d。对照组创面细菌培养菌落数(57.00±12.37)CFU/cm2,植皮成活率82%,创面愈合时间23.7 d。两组比较,差异有统计学意义(P<0.05)。观察组换药均次6次,换药费用972.66元。对照组换药11次,换药费用1 576.31元。差异有统计学意义(P<0.05)。[结论]自制闭式负压引流装置替代传统换药方法用于治疗慢性难愈合创面,具有明显的技术优势。具有操作简单、取材方便、疗效肯定、患者经济负担小等优点。     

An open multicenter comparative randomized clinical study on chitosan

Chitosan, a natural polysaccharide derivate from chitin, offers a promising alternative biomaterial for use in wound dressings. In this work, the safety and efficacy of a next‐generation KA01 chitosan wound dressing in facilitating the healing of nonhealing chronic wounds was studied. This open multicenter comparative prospective randomized clinical study was conducted at three medical centers in China. A total of 90 patients (45 in test group and 45 in control group) with unhealed chronic wounds including pressure ulcers, vascular ulcers, diabetic foot ulcers, and wounds with minor infections, or at risk of infection, were treated with the next generation chitosan wound dressing as the test article or traditional vaseline gauze as a control. Baseline assessments were undertaken with the primary end point being wound area reduction. The secondary end points included pain reduction (using the NRS11 pain scale) at dressing change, wound exudate levels, wound depth and duration of the treatment. After 4 weeks treatment, the wound area reduction was significantly greater in the test group (65.97 ± 4.48%) than the control group (39.95 ± 4.48%). The average pain level in the test group was 1.12 ± 0.23 and 2.30 ± 0.23 in the control group. The wound depth was also lower in the test group 0.30 ± 0.48 cm than the control group 0.54 ± 0.86 cm. The level of exudate fell and the dressing could be removed integrally in both the test and control groups. The mean duration of the test group was 27.31 ± 5.37 days and control group 27.09 ± 6.44 days. No adverse events were reported in either group. In conclusion this open multicenter comparative prospective randomized clinical study has provided compelling evidence that the next generation chitosan wound dressing can enhance wound progression towards healing by facilitating wound reepithelialization and reducing the patients pain level. Furthermore the dressing was shown to be clinically safe and effective in the management of chronic wounds.     

A parallel open-label trial to evaluate microbial cellulose wound dressing in the treatment of diabetic foot ulcers

The purpose of this study was to compare the rate of wound healing in diabetic foot ulcers (DFU) using either a microbial cellulose (MC) wound dressing or Xeroform? Petrolatum gauze. In a parallel, open‐label trial in which the primary outcome was the rate of wound healing and the time to wound closure, 15 ulcers in type II diabetic patients received an MC dressing. Wounds in 19 control patients with type II diabetes were treated with a Xeroform gauze dressing. All wounds were non infected, Wagner stage II or III and received standard care including debridement, non weight bearing limb support and weekly wound evaluation. The mean time to heal in the MC (±SE) treated group was 32 days ± 2·5 and for controls it was 48 days ± 4·7 (P < 0·01). The rate of weekly wound closure (mean ± SE) was 1·7 times faster in the MC‐treated group (cellulose treated, ?5·04% per week ± 0·38 versus control, ?2·93% per week ± 0·19), (P < 0·001). Among covariants tested by univariate regression, only the original wound area correlated with the time to wound closure (P < 0·001). In conclusion, with the provision of current standards of care, the application of an MC dressing to a diabetic ulcer may enhance the rate of wound healing and shorten the time course of epithelisation.     

The associations between diode laser (810 nm) therapy and chronic wound healing and pain relief: Light into the chronic wound patient's life

Chronic wounds have become one of the major issues in medicine today, the treatments for which include dressing changes, negative pressure wound therapy, hyperbaric oxygen, light irradiation, surgery and so forth. Nevertheless, the application of diode lasers in chronic wounds has rarely been reported. This retrospective cohort study aimed to evaluate the therapeutic effect of diode laser (810 nm) irradiation on chronic wounds. Eighty-nine patients were enrolled in the study. The control group (41 patients) received traditional dressing change therapy, while the diode laser treatment group (48 patients) were patients received additional treatment with diode laser (810 nm) irradiation for 10 min at each dressing change. Wound healing time was compared between two groups, while the pain relief index was creatively introduced to evaluate the effect of relieving wound pain, which was calculated by the difference in pain scores between the first and last dressing changes divided by the number of treatment days. The wound healing time of the diode laser treatment group was 22.71 ± 8.99 days, which was significantly shorter than that of the control group (37.44 ± 23.42 days). The pain relief index of the diode laser treatment group was 0.081 ± 0.055, which was significantly increased compared with that of the control group (0.057 ± 0.033). Our findings suggest that diode laser irradiation has the potential to promote healing in chronic wounds and relieve wound pain.     

中药浸浴疗法联合脂质水胶体敷料及优质护理在中度烧伤后残余创面修复中的应用效果

目的 分析中药浸浴疗法联合脂质水胶体敷料及优质护理在中度烧伤后残余创面修复中的应用 效果。方法 选取2022年6月-2023年2月我院烧伤整形外科收治的50例中度烧伤后残余创面患者为研究对 象，随机分为对照组和观察组，各25例。对照组采用常规西医治疗配合常规护理，观察组采用中药浸浴 疗法联合脂质水胶体敷料法治疗，同时配合优质护理，比较两组临床指标、创面恢复情况、疼痛程度及 瘢痕情况。结果 观察组换药持续时间、创面愈合时间、住院时间均短于对照组（P＜0.05）；两组创面 感染发生率、创面愈合率比较，差异无统计学意义（P＞0.05）；两组治疗6 d后VAS评分均低于治疗前， 且观察组低于对照组（P＜0.05）；两组治疗后3个月VSS评分均低于治疗后1个月，且观察组低于对照组 （P＜0.05）。结论 中药浸浴疗法联合脂质水胶体敷料及优质护理在中度烧伤后残余创面修复中的应用效 果确切，可缩短换药时间，减少换药次数，加快创面愈合愈合速度，同时能够减轻疼痛，促进患者尽早康 复出院，并有效改善瘢痕情况     

液体伤口敷料联合负压滴灌治疗糖尿病足感染的临床效果观察

目的:探讨普朗特液体伤口敷料联合负压滴灌治疗糖尿病足创面感染的效果.方法:选取2017年1月-2019年1月于北京中医药大学东直门医院周围血管科收治的糖尿病足患者80例,按照随机数字法分为观察组和对照组各40例,均接受标准化内科基础治疗,创面床准备完善后,观察组采用普朗特液体伤口敷料负压滴灌治疗,对照组采用康复新液负压...     

银离子敷料结合负压引流技术在糖尿病足溃疡中的应用及疗效观察

目的 分析银离子敷料结合负压引流技术在糖尿病足溃疡中应用的安全性及疗效。方法 选择2014年12月～2016年12月期间于我院进行的患者共110例为研究对象,按照随机化原则将其分为观察组（55例）和对照组（55例）,对照组采用常规清创术+凡士林纱布,观察组采用银离子敷料+负压引流技术,比较两组患者创面愈合情况、换药次数、住院时间、术后VAS疼痛评分及治疗效果。结果 观察组新鲜肉芽组织出现时间、创面愈合时间、换药次数及住院时间明显少于对照组［（6.74±1.86vs10.55±1.73）d、（33.04±5.82vs42.29±4.77）d、（8.87±2.85vs20.29±3.06）次、（15.38±5.51vs22.08±4.85）d］,而创面缩小百分比明显高于对照组［（48.83±7.37vs34.49±6.94）%］,差异有统计学意义（P<0.05）。观察组、对照组患者治疗后VAS疼痛评分明显低于治疗前［（2.71±1.39vs5.44±1.58）分、（4.13±1.44vs5.51±1.49）分］,差异有统计学意义（P<0.05）;治疗后观察组的VAS疼痛评分明显低于对照组［（2.71±1.39vs4.13±1.44）分］,差异有统计学意义（P<0.05）。观察组治疗有效率明显高于对照组（90.91%vs66.45%）,差异有统计学意义（P<0.05）。结论 银离子敷料结合负压引流技术可有效治愈糖尿病足溃疡,促进患者的康复。     

犀角地黄汤联合创面清洗治疗糖尿病足

目的：探究犀角地黄汤联合创面清洗治疗糖尿病足的效果。方法：选取糖尿病足病人 56 例,根据随机数字法分为对照组及治疗组各 28 例,入组患者全部给予控制血糖处理;治疗组行犀角地黄汤联合创面清洗治疗,对照组给予中药汤药安慰剂联合创面清洗治疗,持续 3 个月,对比两组疗效、足背动脉内径、血管收缩期峰值流速、创面愈合率及血管内皮生长因子（vascular endothelial growth factor,VEGF）表达情况。结果：治疗组临床有效率 96.42%,对照组 75.00%（P<0.05）;治疗组足背动脉内径及血管收缩期峰值流速分别为 (0.19±0.014) mm、(31.79±2.15) mL/s,对照组分别为 (0.11±0.015) mm、(29.07±1.61) mL/s（P<0.05）;治疗组创面愈合 15 例,占 53.57%,对照组创面愈合 8 例,占 28.57%（P<0.05）;治疗组治疗后 VEGF 表达水平为 (128.34±39.35) ng/L,对照组为 (108.94±28.72) ng/L（P<0.05）。结论：犀角地黄汤联合创面清洗可以有效治疗糖尿病足。     

低压力负压治疗糖尿病缺血性足溃疡的临床研究

目的：观察低压力负压治疗中度缺血的糖尿病足溃疡的效果。方法：选择中度缺血的糖尿病足溃疡患者 160 例, 均进行系统的内科治疗。按随机数字表法分为观察组 120 例,对照组 40 例。观察组分为 3 个亚组,分别采用 120 mmHg、90 mmHg、60 mmHg 负压治疗（间歇模式）,每组各 40 例,以比较常规负压治疗与低压力负压治疗的疗效差异。对照组采用常规换药治疗。记录治疗 2 周、4 周后伤口面积、局部症状积分及治疗过程的疼痛评分。结果：治疗 2 周、4 周时,观察组效果优于对照组（P<0.05）;3 个亚组之间,伤口面积和局部症状积分方面无统计学差异（P>0.05）。疼痛评分方面,60 mmHg 负压治疗组疼痛评分最低,2 周时（2.76±2.75）,4 周时（2.25±2.21）;90 mmHg 负压治疗组次之,2 周时（3.75±3.01）,4 周时（3.88±2.59）;120 负压治疗组疼痛评分最高,2 周时（5.13±2.64）,4 周时（4.38±2.92）;差异有统计学意义（P<0.05）。在治疗期间各组不良反应无明显差异（P>0.05）。60 mmHg 负压治疗组为本次研究的最优治疗方案。结论：低压力负压治疗糖尿病缺血性足溃疡,疗效确切,可以有效促进伤口愈合,减轻患者疼痛。     

Analysis of curative effect of insulin external application on burn wounds of diabetic patients with different depths

To explore the curative effect of insulin external application on burn wounds of diabetic patients with different depths. A retrospective analysis of 114 diabetic burn patients in the First Hospital of Hebei Medical University from June 2019 to June 2022. According to the different treatment methods, they were divided into study group (insulin therapy) and control group (conventional therapy) with 57 cases in each. The wound healing time, dressing changes, scar healing after wound healing and adverse events were compared between two groups. Pain level, serum inflammatory factors, vascular endothelial growth factor (VEGF) and oxidative stress factors before and after treatment were compared. The wound healing time (17.23 ± 2.18 vs 20.31 ± 2.09 days) and the number of dressing changes (7.01 ± 1.23 vs 8.93 ± 1.32 times) in study group were significantly lower than those in control group (P < 0.05). Before treatment, there was no difference in pain level, VEGF, interleukin-1 (IL-1), tumour necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) between two groups (P > 0.05). However, the pain level, scar healing, IL-1, TNF-a and MDA in study group were significantly lower than those in control group after treatment (P < 0.05). And the VEGF and SOD in study group was significantly higher than that in control group (P < 0.05). External application of insulin can shorten the wound healing time of diabetic patients with different depths, reduce the number of dressing changes, promote scar healing after wound healing, relieve pain and reduce the level of inflammatory factors, which is worthy of clinical promotion.