CAJ | 학술논문

目的研究持续负压吸引技术对严重感染的糖尿病足患者保肢的临床价值.方法回顾性分析Wagner分级Ⅲ级以上的严重感染的糖尿病足患者183例的临床资料.其中162例在控制血糖、抗感染、开通闭塞血管、对症治疗等“外科一站式”综合治疗基础上,采用持续负压吸引治疗(negative pressure wound therapy,NPWT)作为研究组.清创和NPWT间隔3～7d重复,直到创面清洁、肉芽生长,最终瘢痕愈合或植皮愈合.21例未采用NPWT者作为对照组.结果 NPWT组中,2例行膝上截肢术,8例行膝下截肢术,20例行半足截肢术,132例仅截趾.膝上、膝下截肢率分别为1.2％、4.9％,保肢率93.9％;照组分别为14.4％,23.8％,42.8％.分组异方差均值t检验显示:NPWT组比对照组平均高出1.598分,t值绝对值达到4.96,P＜0.000 1,2组差异有统计学意义.结论持续负压吸引是针对足部严重感染创面外科清创治疗的重要组成部分,在解决血液供应的基础上可以明显缩短创面愈合时间,可有效提高严重感染的糖尿病足WagnerⅢ级以上患者的保肢率,提高生活质量.
목적 연구지속부압흡인기술대엄중감염적당뇨병족환자보지적림상개치.방법 회고성분석Wagner분급Ⅲ급이상적엄중감염적당뇨병족환자183례적림상자료.기중162례재공제혈당、항감염、개통폐새혈관、대증치료등“외과일참식”종합치료기출상,채용지속부압흡인치료(negative pressure wound therapy,NPWT)작위연구조.청창화NPWT간격3～7d중복,직도창면청길、육아생장,최종반흔유합혹식피유합.21례미채용NPWT자작위대조조.결과 NPWT조중,2례행슬상절지술,8례행슬하절지술,20례행반족절지술,132례부절지.슬상、슬하절지솔분별위1.2％、4.9％,보지솔93.9％;조조분별위14.4％,23.8％,42.8％.분조이방차균치t검험현시:NPWT조비대조조평균고출1.598분,t치절대치체도4.96,P＜0.000 1,2조차이유통계학의의.결론 지속부압흡인시침대족부엄중감염창면외과청창치료적중요조성부분,재해결혈액공응적기출상가이명현축단창면유합시간,가유효제고엄중감염적당뇨병족WagnerⅢ급이상환자적보지솔,제고생활질량.
Objective To evaluate negative pressure wound therapy (NPWT) for limb salvage of diabetic foot with severe infection.Methods This study includes the severely infected diabetic foot patients that is classified as Vagner grade Ⅲ and higher.Among the 183 patients,162 received debridement plus NPWT on the base of "one-stop surgical treatment",including blood glucose control,anti-infectious therapy,symptomatic treatment,revascularization of the occluded lower limb arteries.The debridement and NPWT was repeatedly done every 3 to 7 days,till the wound became clean and was covered by granulation tissue,and cured by scar healing or dermoplasty.The 21 cases without NPWT served as control group.Results In the study group,there were 2 above-knee amputations,8 below-knee amputations,20 half-foot amputations,and 132 toe amputations.The above-and below-knee amputation ratio was 1.2％ and 4.9％,the limb salvage ratio was 93.9％.In the control group,the ratio was 14.4％,23.8％,and 42.8％ respectively.The average grade in the NPWT group was higher than the comparison group by 1.598,with an absolute value of the t-test equal to 4.96,P ＜ 0.000 1.Conclusions NPWT is an important and effective measure in the procedure of surgical treatment for severely infected wound of diabetic foot,increasing limb rescue rate of diabetic foot of Wagner grade Ⅲ and higher,and improving the quality of life.