【摘要】 目的:观察将“创面床准备”理论引入糖尿病足部溃疡局部处理的实践效果,并与传统的创面处理方法进行比较。方法:收集中山大学附属第一医院烧伤外科、广东省肇庆市第一人民医院和深圳市宝安区人民医院2000-01/2005-01收治的糖尿病足部溃疡患者57例,在系统的内科治疗基础上,随机分为2组:①实验组(n=30):采用“创面床准备”方案进行创面处理,创面演进过程均依据其创基颜色特征相对划分为黑、黄、红、粉四期,黑期和黄期主要任务是清创、调节创面的“湿性平衡”,使用碱性成纤维细胞生长因子促进肉芽组织生长;红期和粉期则主要是采用碱性成纤维细胞生长因子和重组人表皮细胞生长因子及适宜的敷料保护和促进新生的肉芽组织以及上皮的增殖,在红期可选择自愈或合适的手术方式修复创面。②对照组(n=27):采用传统的皮维碘纱、生理盐水湿纱布、凡士林纱布等进行创面处理。观察两组创面分期间演进情况、手术方式及其Ⅰ期修复率、平均住院时间等;各期创面组织标本应用苏木精-伊红染色观察;黄期和红期标本胶原纤维苦味酸-天狼猩红染色及图像分析,检测Ⅰ,Ⅲ型胶原含量变化;粉期创面标本β1整合素免疫组化染色,检测表皮基底层增生活跃细胞数量。结果:57例全部进入结果分析。①各分期间演进速度实验组比对照组快(P<0.05),实验组各期间的演进表现出类似于急性创面愈合过程,对照组这些改变则相对不明显或较慢。②实验组自愈合时间、总的手术Ⅰ期修复率和平均住院时间均优于对照组(38.2±24.3)d比(50.4±26.1)d;81%比46%;(34.4±27.1)d比(53.2±36.9)d;P<0.05。③实验组黄期Ⅰ,Ⅲ型胶原总含量及Ⅰ型胶原含量低于对照组(P<0.01);实验组红期Ⅰ型胶原含量高于黄期及对照组红期(P<0.01,0.05)。④实验组粉期表皮基底层增生活跃细胞数量高于两对照组(85.3±5.7)%,(36.6±9.3)%,P<0.01。结论:在全面评估和系统的内科治疗基础上,糖尿病足部溃疡“创面床准备”方案具确实的临床价值:能促进较小创面较快自愈,经过创面床准备后的红期是理想的手术时机,在此期选择合适的手术方式可进一步加快创面的修复。更多还原

【Abstract】 AIM: To investigate the practical effect of wound bed preparation on local treatment of diabetic foot ulcer, and compare it with the traditional wound approach. METHODS: Fifty-seven patients with diabetic foot ulcer in the Department of Burn, First Affiliated Hospital, Sun Yat-sen University, People’s Hospital of Zhaoqing and People’s Hospital of Bao’an were selected from January 2000 to January 2005. Based on the systemic medical treatment, the patients were randomly divided into two groups: ①Experiment group (n=30): The patients were given wound bed preparation therapy. According to the character of wound bed color, the wound healing process was divided into black, yellow, red and pink four phases. The main task in black and yellow phases was to remove the wound and regular the "moist balance" of the wound, and the alkaline fibroblastic growth factor was used to improve the growth of granulation tissue; in the red and pink phases, the task was to protect and improve the proliferation of neonatal granulation tissue and epithelium with alkaline fibroblastic growth factor, recombinant human epidermal grouwth factor and suitable dressing, and in the red phase, spontaneous cure or proper operation could be used to repair the wound. ②Control group (n=27): The patients were given traditionary therapy including Providone Lodine gauze, saline wet gauze and vaseline gauze. The phase changing progress, operation patterns and itsⅠphase healing rate, average length of stay were observed. The wound specimen from all phases were observed by hematoxylin-eosin staining, and the change of Ⅰand Ⅲ type collagen in yellow and red phases was detected by picrosirius-polarization technique and image analysis. Immunohistological analysis of integrin β1 in pink phase was used to investigate epidermal basemental amplifying cells. RESULTS: All the 57 cases entered the result analysis. ①The phase progressing of the experiment group was faster than the control group (P < 0.05), which in the experiment group was similar to the acute wound healing course, but was delayed or slower in the control group. ②Compared with the control group, the healing time (days) and the length of stay were shorter, and the total operativeⅠphase repaired rate in experiment group was higher [(38.2±24.3) days, (50.4±26.1) days; 81.0%, 46%; (34.4±27.1) days, (53.2±36.9) days; P < 0.05]. ③Compared with the control group, the totalⅠand Ⅲ type collagen andⅠtype collagen was significantly lower (P < 0.01). But in the red phase, theⅠtype collagen was higher than the control group (P < 0.01, 0.05). ④In the experiment group, the epidermal basemental amplifying cells was more than the control group [(85.3±5.7)%, (36.3±9.3)%, P < 0.01]. CONCLUSION: Based on systemic evaluation and medical treatment, the wound bed preparation was effective on diabetic foot ulcer in clinic, it can accelerate the healing process of small wound.The red phase after WBP therapy was optimal for operation, in which the appropriate operation pattern can accelerate the wound healing process.更多还原