润肌丹油外用联合自体富血小...浆治疗糖尿病足溃疡疗效观察_夏联恒.pdf

润肌丹油外用联合自体富血小板血浆治疗糖尿病足溃疡疗效观察夏联恒1，2，张航2，丁戊坤2，宋美玉2，赵钢2，高杰2(1 黑龙江中医药大学，黑龙江 哈尔滨 150040;2 黑龙江中医药大学附属第一医院，黑龙江 哈尔滨 150040)摘要 目的观察润肌丹油外用联合自体富血小板血浆(PP)治疗糖尿病足溃疡的临床疗效。方法选取2021 年4 月2022 年4 月在黑龙江中医药大学附属第一医院治疗的80 例糖尿病足溃疡患者，采用随机数字表法分为治疗组与对照组，每组 40 例。2 组患者均给予常规治疗及清创换药，对照组同时予以 PP 治疗，治疗组同时予以润肌丹油纱条外用结合 PP 治疗。观察 2组患者治疗前及治疗 14 d、28 d 创面面积、肉芽组织生长厚度、创面细菌阳性率，计算治疗 28 d 后创面缩小率、肉芽组织覆盖率、创面抑菌率、临床总有效率。结果治疗后，2 组创面面积均明显缩小，肉芽组织生长厚度均明显增加，且治疗组治疗14 d、28 d 创面面积均明显小于同期对照组，肉芽组织生长厚度均明显高于同期对照组，创面缩小率、肉芽组织覆盖率均明显高于对照组，差异均有统计学意义(P 均 0 05)。治疗后，2 组创面细菌培养阳性率均明显降低(P 均 0 05);治疗组治疗 14 d、28 d 创面细菌培养阳性率均明显低于同期对照组(P 0 05)，抑菌率明显高于对照组(P 0.05)。治疗组临床总有效率为 95 0%(38/40)，对照组临床总有效率为 80 0%(32/40)，治疗组明显高于对照组(P 0 05)。结论润肌丹油外用联合 PP 治疗糖尿病足溃疡效果更好，可明显促进创面愈合，显著抑制创面细菌生长。关键词 润肌丹油;自体富血小板血浆;糖尿病足;溃疡doi:10 3969/j issn 1008 8849 2022 22 005 中图分类号 5872 文献标识码 A 文章编号 1008 8849(2022)22 3090 05 作者简介 夏联恒，男，在读博士，主治医师，研究方向为中西医结合治疗周围血管疾病。通信作者 高杰，E mail:angel731025163 com 基金项目 黑龙江中医药大学“双一流”中西医结合学科优秀青年基金(HLJSYL2001);黑龙江省中医药科研项目(ZHY19 036，ZHY2022 184);黑龙江中医药大学新药研究基金项目(2017XY02);黑龙江省自然科学基金联合引导项目(LH2022H075)Efficacy of un-ji-dan oil combined with autologous platelet-rich plasma on diabetic foot ulcersXIA Lianheng1，2，ZHANG Hang2，DING Wukun2，SONG Meiyu2，ZHAO Gang2，GAO Jie2(1 Heilongjiang University of Traditional Chinese Medicine，Harbin 150040，Heilongjiang，China;2 The First AffiliatedHospital of Heilongjiang University of Traditional Chinese Medicine，Harbin 150040，Heilongjiang，China)Abstract:Objective It is to observe the clinical efficacy of un-ji-dan oil combined with autologous platelet-rich plas-ma(PP)in the treatment of diabetic foot ulcers Methods Eighty patients with diabetic foot ulcers treated at the FirstHospital of Heilongjiang University of Traditional Chinese Medicine from April 2021 to April 2022 were selected and dividedinto treatment group and control group by random number table method，40 patients in each group Both groups were givenconventional treatment，debridement and dressing change，the control group was treated with PP at the same time，thetreatment group was treated with external application of un-ji-dan oil gauze combined with PP at the same time Thetrauma area，growth thickness of granulation tissue and trauma bacterial positive rate of the patients in both groups were ob-served before treatment and after 14 and 28 days of treatment The trauma reduction rate，granulation tissue coverage rate，trauma bacterial inhibition rate and total clinical efficiency rate were calculated after 28 d of treatment esults After treat-ment，the trauma area of both groups was significantly reduced and the thickness of granulation tissue growth was signifi-0903现代中西医结合杂志 Modern Journal of Integrated Traditional Chinese and Western Medicine 2022 Nov，31(22)cantly increased，and the trauma area of the treatment group was significantly smaller than that of the control group after 14days and 28 days of treatment，the thickness of granulation tissue growth was significantly higher than that of the controlgroup at the same time，and the trauma reduction rate and granulation tissue coverage rate were significantly higher thanthose of the control group，and the differences were all statistically significant(all P 0 05)After treatment，the positiverate of trauma bacterial culture in both groups was significantly decreased(P 0 05);the positive rates of trauma bacterialculture in the treatment group after 14 days and 28 days of treatment were significantly lower than those in the control groupat the same time(P 0 05)，and the inhibition rate was significantly higher than that in the control group(P 0 05)The total clinical efficiency of the treatment group was 95 0%(38/40)and that of the control group was 80 0%(32/40)，the rate of the treatment group was significantly higher than that of the control group(P 0 05)Conclusion Thetopical application of un-ji-dan oil combined with PP is more effective in the treatment of diabetic foot ulcers，which cansignificantly promote wound healing and significantly inhibit the growth of traumatic bacteriaKeywords:un-ji-dan oil;autologous platelet-rich plasma;diabetic foot;ulcers糖尿病足是由于糖尿病中小血管病变及神经系统功能障碍，导致下肢微循环障碍，继而出现患足的坏疽、溃疡，即糖尿病足溃疡(diabetic foot ulcer，DFU)1。DFU 是糖尿病最严重并发症之一，具有病程长、迁延不愈等特点，严重者甚至需要截肢2。DFU 严重影响患者生活质量，也给患者家庭带来巨大经济负担3。中医药外治 DFU 历史悠久、疗效显著。高杰教授将疡医大全 中经方润肌膏与多年临床经验相结合，研制出润肌丹油，应用于 DFU 治疗中取得良好疗效4。随着现代医疗技术的发展，出现了多种治疗 DFU 的新方法，如负压引流、自体富血小板血浆(platelet rich plasma，PP)、新型敷料等，其中 PP 技术具有抑制局部炎症反应、加速创面修复、促进微循环等作用5。本研究探讨了润肌丹油外用联合 PP 治疗 DFU 的临床疗效，现报道如下。1资料与方法1.1诊断标准糖尿病足西医标准参考 2017 年版中国糖尿病足诊治指南6:有多年糖尿病病史;发病年龄在 40 岁以上;有下肢缺血症状的临床表现，如间歇性跛行、发凉、疼痛等;排除其他缺血性疾病;踝肱指数小于 0 9;影像学证实存在肢体动脉狭窄或闭塞。糖尿病足中医标准参考中医外科病证诊断疗效标准7:初起趾、指冷痛，小腿酸麻胀痛，行走多时加重，休息时减轻，呈间歇性跛行，趺阳脉减弱。病情日久则见患趾酸胀疼痛加重，步履沉重乏力，活动艰难;患趾肤色由苍白转为暗红，下垂时更甚，抬高则见苍白;疼痛持续加重，彻夜不能入寐;舌质黯红或有瘀斑，苔白，脉弦或涩，趺阳脉消失。1.2纳入标准符合糖尿病足的西医诊断标准及中医诊断标准;糖尿病足 Wagner 评级 1 4 级;性别不限，年龄 40 80 周岁;ABI0 5 0 9;积极配合治疗，入组前签署知情同意书。1.3排除标准不符合纳入标准者;患肢出现严重缺血症状，应立即行介入治疗者;患肢严重感染或坏死，需行截肢手术者;有接受放化疗的进展性恶性肿瘤者;孕妇或哺乳期妇女;有精神疾病者;正在接受其他治疗者;不能接受 PP 治疗者。1.4一般资料选取2021 年4 月2022 年4 月在黑龙江中医药大学附属第一医院周围血管病一科入院符合纳入标准的