摘要
目的分析糖尿病足患者使用负压创面治疗技术(negative pressure wound therapy,NPWT)失败的原因,并探讨预防措施,以提高治疗效果。方法回顾性分析2012年1月—2016年12月北京中医药大学东直门医院使用NPWT治疗的580例糖尿病足患者的临床资料,1个疗程后参照《中药新药临床研究指导原则》评价疗效,将治疗无效者纳入失败组,将治疗有效、显效、临床痊愈者纳入成功组。比较两组治疗前的一般情况、创面和全身相关指标,将存在统计学差异的因素纳入logistic多因素回归分析,寻找糖尿病足创面NPWT治疗失败的影响因素。结果 580例患者中,36例治疗失败,失败原因以创面感染加重为主。logistic多因素回归分析显示,踝肱指数<0.3、创面感染分级≥3级、创面有活动性出血、创面内肉芽组织覆盖率<25%、创面皮肤恶变是糖尿病足创面NPWT治疗失败的独立危险因素。结论糖尿病足患者在应用NPWT治疗前应对创面的缺血程度、感染程度、清创程度及患者全身状态做精细评估,并对创面床做相应准备,以提高治疗成功率。
Objective To analyze the causes of failure of negative pressure wound therapy(NPWT)in the treatment of diabetic foot wounds,and to explore preventive measures in order to improve therapeutic effects.Methods The clinical data of 580 patients with diabetic foot who were treated with NPWT in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2012 to December 2016 were analyzed retrospectively.After one course of NPWT treatment,the patients who did not respond to therapies were included in the failure group and those with effective and markedly effective treatment as well as those with clinically healed wounds were included in the success group according to curative effect evaluation based on the Guiding Principles of Clinical Research on New Drugs of Traditional Chinese Medicine.The general conditions,wound-related indicators and indicators related to the whole body before treatment were compared between the two groups.Logistic multivariate regression analysis was used to analyze the factors that had statistical differences.Thus,the factors influencing the failure of NPWT in diabetic foot wounds were investigated.Results Of 580 patients,36 cases failed in NPWT treatment,mainly due to the aggravation of wound infection.Multivariate Logistic analysis showed independent risk factors in treatment failure of diabetic foot wound by NPWT,including ankle brachial index less than 0.3,wound infection grade greater than or equal to grade 3,wound with active bleeding,wound granulation coverage less than 25%,and wound skin malignant transformation.Conclusion To improve the success rate of NPWT for patients with diabetic foot,it is the key to evaluate the
作者
张晓福
鞠上
杨博华
高瑜
曹欣
闫程程
王宁
连晓彤
范旭旋
李伟红
王刚
ZHANG Xiao-fu;JU Shang;YANG Bo-hua;GAO Yu;CAO Xin;YAN Cheng-cheng;WANG Ning;LIAN Xiao-tong;FAN Xu-xuan;LI Wei-hong;WANG Gang(Beijing University of Chinese Medicine,Beijing 100029,China;Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)
出处
《临床误诊误治》
2018年第7期59-64,共6页
Clinical Misdiagnosis & Mistherapy
关键词
糖尿病足
负压创面治疗技术
治疗失败
Diabetic foot
Negative pressure wound therapy
Treatment failure
