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牟天易, 汤洋, 曾勇, 谭兴琴. 中药水煎液冲洗联合负压伤口治疗对糖尿病足创面的疗效及病理观察[J]. 解放军医学院学报, 2021, 42(9): 927-933. DOI: 10.3969/j.issn.2095-5227.2021.09.007
引用本文: 牟天易, 汤洋, 曾勇, 谭兴琴. 中药水煎液冲洗联合负压伤口治疗对糖尿病足创面的疗效及病理观察[J]. 解放军医学院学报, 2021, 42(9): 927-933. DOI: 10.3969/j.issn.2095-5227.2021.09.007
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MU Tianyi, TANG Yang, ZENG Yong, TAN Xingqin. Effect and pathological outcomes of traditional Chinese herbal medicine washing combined with negative pressure wound therapy on diabetic foot wounds[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(9): 927-933. DOI: 10.3969/j.issn.2095-5227.2021.09.007
Citation: MU Tianyi, TANG Yang, ZENG Yong, TAN Xingqin. Effect and pathological outcomes of traditional Chinese herbal medicine washing combined with negative pressure wound therapy on diabetic foot wounds[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(9): 927-933. DOI: 10.3969/j.issn.2095-5227.2021.09.007
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中药水煎液冲洗联合负压伤口治疗对糖尿病足创面的疗效及病理观察

Effect and pathological outcomes of traditional Chinese herbal medicine washing combined with negative pressure wound therapy on diabetic foot wounds

    摘要
  • 摘要:
      背景  糖尿病足(diabetic foot，DF)是糖尿病严重并发症之一，大部分糖尿病足创面为慢性难愈合创面。负压伤口治疗技术(negative pressure wound therapy，NPWT)在糖尿病足及慢性创面、溃疡的治疗中取得了良好的临床疗效；中医中药外治法对慢性感染创面抑制细菌生长、化腐生肌的治疗历史源远流长。中医中药联合负压伤口治疗技术对糖尿病足慢性创面的协同治疗作用需临床观察。
      目的  探讨中药水煎液冲洗联合负压伤口治疗技术对糖尿病足创面细菌生物膜(bacterial biofilm，BBF)的清除作用及创面治疗作用，明确联合应用是否存在协同作用，为治疗糖尿病足提供新的治疗思路。
      方法  收集2018年7月- 2020年12月重庆医科大学附属第二医院各临床科室经临床确诊的糖尿病足溃疡病例(Wagner分级2～4级)150例并随机分成5组(A组：常规换药组；B组：单独NPWT组；C组：黄柏水煎液联合NPWT组；D组：金银花水煎液联合NPWT组；E组：黄柏+金银花水煎液联合NPWT组)，每组30例，对比5种治疗方法治疗糖尿病足创面组织病理变化，创面的BBF，溃疡创面愈合、治疗有效率、炎症因子C反应蛋白(C reactive protein，CRP)、白细胞介素-6(interleukin-6，IL-6)和降钙素原(procalcitonin，PCT)、抗氧化功能丙二醛(malondialdehyde，MDA)、超氧化物歧化酶(superoxide dismutase，SOD)和内皮功能一氧化氮(NO)活力、内皮素(endothelin，ET)的变化。
      结果  治疗前，5组患者皮肤的鳞状上皮和鳞状上皮胶原纤维增生，存在间质炎症反应，鲜见皮肤附属物。治疗6周后，各组的鳞状上皮和鳞状上皮胶原纤维增生逐渐减少，间质炎症反应减轻，可见皮肤附属物，从A组至E组的顺序逐渐改善。治疗前，5组患者的溃疡面积、血清CRP、IL-6、PCT、MDA、SOD、ET和NO差异无统计学意义(P > 0.05)。治疗6周后，患者BBF、溃疡面积、愈合时间、血清CRP、IL-6、PCT、MDA和ET测量情况：A组 > B组 > C组 > E组；患者SOD和NO测量情况：A组 < B组 < C组 < E组，组间比较差异均有统计学意义(P < 0.05)；C组与D组溃疡面积、愈合时间、血清CRP、IL-6、PCT、MDA、SOD、ET和NO差异无统计学意义(P > 0.05)。5组患者创面愈合率依次为E组 > D组≈C组 > B组 > A组(P < 0.05)。
      结论  中药黄柏、金银花自制水煎液联合NPWT技术对糖尿病足创面BBF有清除作用，促进创面愈合，且存在协同作用，可在临床上推广应用。

     

    Abstract:
      Background  Diabetic foot (DF) is a serious complication of diabetes. Most diabetic foot wounds are chronic and difficult to heal. Negative pressure wound therapy (NPWT) has achieved good clinical efficacy in the treatment of diabetic foot, chronic wound and ulcer, and the external treatment of traditional Chinese medicine has a long history of inhibiting bacterial growth and transforming saprophytic muscle on chronic infection wound. The synergistic effect of traditional Chinese medicine combined with negative pressure wound therapy on chronic wound of diabetic foot needs clinical observation.
      Objective  To investigate the application of Chinese herbal medicine washing (CHMW) combined with negative pressure wound therapy (NPWT) in debridement and treatment of bacterial biofilm of diabetic foot wounds, and evaluate the synergistic effect of CHMW and sNPWT compared with standard single therapy, so as to provide a new treatment of diabetic foot in clinic therapeutics.
      Methods  From July 2018 to December 2020, 150 diabetic foot ulcer patients (Wagner Grade 2-4) were diagnosed in the Emergency Department of the Second Affiliated Hospital of Chongqing Medical University. They were randomly divided into five groups (group A with conventional treatment, group B: NPWT, group C: Phellodendron amurense washing combined with NPWT, group D: Honeysuckle washing combined with NPWT, and group E: Phellodendron amurense + Honeysuckle washing combined with NPWT, 30 cases in each group). The pathological changes, characteristics of BBF wound, ulcer wound healing, treatment efficiency, and the change of inflammatory factors such as C reactive protein (CRP), interleukin-6 (IL-6), Procalcitonin (PCT), antioxidant function malondialdehyde (MDA), superoxide dismutase (SOD) and endothelial function as nitric oxide (NO) activity, endothelin (ET) after using five different treatments were evaluated and compared.
      Results  We found that all wounds showed squamous epithelial collagen fiber hyperplasia, interstitial inflammation, and skin appendages before treatment. After six weeks of treatment, the squamous epithelial fibrous epithelial and the mesenchymal response generally decreased, with visible appendages, and the symptoms improved successively from group A to group E. Before treatment, there was no difference in CRP, IL-6, PCT, MDA, SOD, ET or NO between the five groups (P > 0.05). After six weeks of treatment, the BBF clearance rate increased, while ulcer area and healing time decreased successively from group A to group E, and serum CRP, IL-6, PCT, MDA, and ET concentrations also decreased. SOD and NO concentration increased successively from group A to group E (P < 0.05). The wound size, ulcer area, healing time, and the concentration of CRP, IL-6, PCT, MDA, SOD-1, ET and NO between group C and group D showed no statistically significant difference (P > 0.05). The wound healing rate of five groups of patients was as follows: group E > group D ≈ group C > group B > group A (P < 0.05).
      Conclusion  The traditional Chinese herbal medicine including Phellodendron amurense and Honeysuckle washing combined with NPWT can promote healing of diabetic foot wounds with a synergistic effect, which can be promoted and applied in clinical practice.

     

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