CN103566359A - Application of self-made flushing liquid and punching-sucking-type medicine changing method for treatment of diabetic foot - Google Patents

Abstract

Application of a self-made flushing liquid and a punching-sucking-type medicine changing method for treatment of diabetic foot is mainly used for patients with the diabetic foot of Wagner stage method 2-3 stage, and also can be used for the treatment of skin ulcer and wound surfaces of diabetic patients. Diabetic foot ulcer and gangrene is a serious complication of diabetes and one of the important disability and death causes of the diabetic patients. When foot ulcer develops to Wagner 2-3 stage, the diabetic foot reaches a serious stage, and ulcer surfaces usually show cellulitis like changes with abscess or bone tissue lesions, so that debridement and drainage are the basic treatment means. According to traditional methods, routine surgical medicine changing is performed for removal of wound surface necrotic tissues, drainage of larger and deeper wound cavities is performed by using a drainage tube or a drainage strip, the total efficiency is only 63.6%, and 12%-25% of the diabetic foot ulcer patients are required amputation. In order to promoting wound surface healing and reducing the amputation rate, a principle of wound surface moist healing is used, and the self-made flushing liquid and the punching-sucking-type medicine changing method are used for treatment of the diabetic foot, so that the wound surface healing time is significantly shortened, and the total effective rate reaches 91.7%.

Description

From intending flushing liquor, add the application that suction formula change dressing is treated diabetic foot

Technical field: clinical medicine

Background technology: in the flushing liquor of 1, certainly intending, the local insulin that uses both can reduce wound surface blood sugar concentration, can promote again epidermal tissue's growth; Maleic acid osmanthus Pai Qite can suppress the degraded of adenosine and heavily absorb, and participates in the protection of ischemia pre-adaptation, has antagonism local vascular spasm, and anticoagulant, alleviates tissue edema, recovers the effect of diseased region blood circulation; Anisodamine has blood vessel dilating, improves microcirculatory effect; Foot ulcers mostly is gram negative bacteria through bacteriology checking, uses gentamycin can reach infection object.

2, suction formula change dressing, with medical transparent sticker wound closure, suction catheter connects vacuum extractor, make wound surface district form a relatively clean sealed negative-pressure environment, continuous negative pressure drainage can impel wound surface telangiectasis, hypertrophy, alleviate tissue edema, promote repairing cell proliferation, thereby accelerate granulation tissue generation, reach the object of impelling wound healing.And lasting, drain all sidedly, can remove potential slough and wound exudate, the various Mediators of inflammations of drain, toxin etc., alleviate its impact of pathologic on wound surface part.

3, the negative pressure that suction formula dressing change device forms, micro-acid environment of hypoxia, suppressed ulcer surface bacterial growth, effectively controlled infection.Continual rinsing can keep wound surface moistening, moistening environmental energy is avoided the formation of devitalized tissue, be conducive to the epidermis cell formation of flap coverage, new born microvessels quickly and synthesizing of connective tissue, promote blood perfusion, make granulation tissue growth vigorous, for wound healing or surgery skin grafting provide advantage.

Summary of the invention: be mainly used in patient, the diabetics skin ulcer of 2～3 grades of diabetic foot Wagner stagings, the treatment of wound surface.

The specific embodiment: the configuration normal saline solution 500ml+ insulin 4U+ maleic acid osmanthus Pai Qite 160mg+ Anisodamine 20mg+ gentamycin 160,000 U configurations of 1, certainly intending flushing liquor form.Gentamycin can, according to antibacterial culturing and the drug sensitive test result fed back subsequently, be selected more responsive antibiotic.

2, the manufacture method of suction formula dressing change device: press aseptic technique, get 2 general infusion sets, cut off syringe needle, at its end, cut respectively 2 pieces of oval apertures that are about 5mm at a distance of about 1cm place, by the small bore end of transfusion device in opposite directions shape be placed in ulcer surface, with medical transparent sticker, fix, with 5ml syringe, extract air in it out, make maintenance negative pressure state in it, a termination flushing liquor, another termination vacuum extractor.Flushing liquor, with the fast persistent instillation that drips of 40ml/h, is opened vacuum extractor simultaneously, with 20～40KP negative pressure, continues to attract ulcer surface, the next day of conventional, changes pipeline one time, if any obstruction, changes in time.

3, studies have shown that 46 routine patient with diabetic feet, all meet the relevant type 2 diabetes mellitus diagnostic criteria of WHO in 1999, foot ulcers belongs to 2～3 grades of Wagner stagings, ulcer is darker, and area 1.5cm * 2cm～2.5cm * 3cm is cellulitis sample and changes, 5 routine tendon exposed, with osseous tissue pathological changes.The equal intravascular color Doppler ultrasonography of this group case, get rid of the macroangiopathies such as suffering limb arterial occlusion, be divided at random treatment group and matched group, the sex of two groups of cases, age, the course of disease, diabetic foot classification etc. are compared, the equal not statistically significant of difference (the equal > 0.05 of P).

4, Therapeutic Method: two groups all give identical Primary Care, comprising: (1) diabetic diet standard; (2) blood sugar lowering: all adopt insulin blood sugar lowering: the short length of subcutaneous injection three or insulin pump strengthening glucose-lowering treatment, by glycemic control, in empty stomach 6mmol/L left and right, fluctuation in 2 hours is after the meal in 10mmol/L left and right; (3) trophic nerve: 1 times/day of mecobalamin 500ug intramuscular injection, continuous application 14～30 days; (4) improve peripheral circulation: 1 times/day of oral aspirin enteric coatel tablets 100mg/ day and Alprostadil 10ug intravenous injection, continuous application 14～30 days; (5) infection control: before changing dressings first, get wound secretion and do antibacterial culturing and Analysis of Drug Susceptibility, drug sensitivity tests not out before, select quiet of cephalo three generations antibiotic, by drug sensitivity tests, select medicine later, the course for the treatment of is by infection control situation and determining; (6) change dressings in part: when secretions is more, wound surface is changed dressings and all adopted iodophor disinfection periphery skin, normal saline flushing ulcer surface; If have abscess to form, at localised waving place tension force maximum point incision and drainage pus; And spread on wound surface outward with your sliver of 1% acrinol ethacridine, with sterile gauze wrapping, change dressings every day 1 time.Treatment group is carried out after Primary Care, with adding the treatment of suction formula change dressing from intending flushing liquor.Matched group adopts after Primary Care, and with certainly intending flushing liquor soak ulcer surface, change dressings every day.

5, curative effect determinate standard: the criterion of therapeutical effect with reference to the diagnosis and treatment > > [3] of < < diabetic foot and related complication is drafted.Cure: skin color, temperature are normal, and without senses of discomfort such as pain, sense of touch is normal, and open wound surface heals completely.Take a turn for the better: suffer from the cacesthenic scope of skin of foot and before dwindle, merocrine secretion's thing is front minimizing, has fresh granulation tissue growth, and wound surface significantly dwindles.Invalid: suffer from the cacesthenic scope of skin of foot without changing or expanding, wound surface is without dwindling, and secretions is without minimizing.Cure and adding the calculating total effective rate that takes a turn for the better.

6, statistical analysis: application SPSS 10.0 statistical software deal with data.Measurement data with

represent, between group, data are relatively with t check, the relatively employing X of rate ²check, P < 0.05 represents that difference has statistical significance.

Claims (4)

1. total effective rate of the present invention is 91.7%, has embodied and has certainly intended the superiority that flushing liquor maintenance wound surface is moistening, improve wound surface microenvironment, control traumatic infection, wound healing, meets wound surface wet union theoretical.

2. in the treatment of 2～3 grades of diabetic foots of Wagner, applied and certainly intended flushing liquor and add suction formula dressing change device, obviously shortened the average healing, reduced medical expense.

3. from intending flushing liquor, by the 160000 U configurations of normal saline solution 500m1+ insulin 4U+ maleic acid osmanthus Pai Qite 160mg+ Anisodamine 20mg+ gentamycin, formed.

4. suction formula dressing change device, be that two transfusion device ends are cut into respectively to porous syringe pipe and suction catheter, be placed in ulcer surface two ends, two pipes connect successively from intending flushing liquor and vacuum extractor, ulcer surface is fixing with medical transparent sticker sealing, extracts air in it and is negative pressure state.