Effect of vacuum sealing drainage combined with targeted nursing on angiogenesis in diabetic foot ulcer area

doi:10.3760/cma.j.issn.1007-1245.2021.06.035

Abstract

Abstract: Objective To investigate the effect of vacuum sealing drainage combined with targeted nursing on angiogenesis in diabetic foot ulcer area. Methods A total of 116 patients with diabetic foot ulcer (DFU) admitted from July 2017 to October 2019 were selected as the research objects and were randomly divided into observation group and control group with 58 cases in each group. The control group was given conventional debridement, and the observation group was given vacuum sealing drainage (VSD) combined with targeted nursing on the basis of the control group. The differences of wound healing time, wound healing rate, wound angiogenesis index, SAS and SDS scores between the two groups were compared. Results The wound healing time of the observation group was significantly shorter than that of the control group [(16.12±2.66) d vs.(20.54±2.72) d], and the wound healing rate was significantly higher than that of the control group [(65.26±10.45)% vs.(38.98±11.26)%] (both P<0.05). There were no statistically significant differences in wound angiogenesis indexes between the two groups before treatment (all P>0.05); after 3, 5, 7 days of treatment, the expressions of VEGF, VEGFR, CD105, MMP9 protein in wound tissue of the observation group were significantly higher than those of the control group and those after treatment (all P<0.05). There were no statistically significant differences in SAS and SDS scores between the two groups (both P>0.05); after treatment, SAS and SDS scores in the observation group were (44.68±5.50) points, (42.56±5.52) points, which were significantly lower than those in the control group [(50.21±5.45) points, (52.16±5.47) points] (both P<0.05). Conclusion VSD can regulate the expression of VEGF, CD105, and other angiogenesis molecular factors in diabetic foot ulcer wound, promote angiogenesis of ulcer wound; combined with targeted nursing, it can relieve anxiety and depression of patients, shorten the healing time of DFU wound, and improve the wound repair rate.

Key words: Wound healing, Diabetic foot, Ulcer, Vacuum sealing drainage (VSD), Angiogenesis

摘要： 目的探讨封闭负压引流技术联合针对性护理对糖尿病足溃疡区血管新生的影响。方法选择2017年7月至2019年10月收治的糖尿病足溃疡(DFU)患者116例为研究对象,采用随机数字表法分为两组,各58例。对照组给予常规清创处理,观察组在对照组基础上给予封闭负压引流技术(VSD)联合针对性护理;比较两组患者创面愈合时间、创面愈合率、创面血管新生指标、SAS、SDS评分的差异。结果观察组创面愈合时间为(16.12±2.66)d,明显短于对照组(20.54±2.72)d,创面愈合率为(65.26±10.45)%,明显高于对照组(38.98±11.26)%,差异均有统计学意义(均P<0.05);治疗前,两组患者创面组织中血管新生分子指标表达量比较,差异均无统计学意义(均P>0.05);治疗后3、5、7 d时,观察组创面组织中血管新生分子VEGF、VEGFR、CD105、MMP9蛋白表达量均明显高于治疗前及对照组,差异均有统计学意义(均P<0.05);治疗前,两组患者SAS、SDS评分比较,差异均无统计学意义(均P>0.05);治疗后,观察组SAS、SDS评分分别为(44.68±5.50)分、(42.56±5.52)分,均明显低于对照组(50.21±5.45)分、(52.16±5.47)分,差异均有统计学意义(均P<0.05)。结论 VSD可调节糖尿病足溃疡创面VEGF、CD105等血管新生分子因子表达,促进溃疡创面血管新生;联合针对性护理,可缓解患者焦虑抑郁状态,缩短DFU创面愈合时间,提高创面修复率。

关键词: 创面愈合, 糖尿病足, 溃疡, 负压引流, 血管新生

Lou Xiue, Yang Huanzhi, Li Jing. Effect of vacuum sealing drainage combined with targeted nursing on angiogenesis in diabetic foot ulcer area[J]. International Medicine and Health Guidance News, 2021, 27(6): 920-924.

娄秀娥, 杨焕芝, 李静. 封闭负压引流技术联合针对性护理对糖尿病足溃疡区血管新生的影响[J]. 国际医药卫生导报, 2021, 27(6): 920-924.

References

[1] 胡家,霍丽霞,张玲,等.糖尿病足溃疡患者糖化血红蛋白与创面愈合的相关性分析[J].浙江临床医学,2020,22(7):1005-1007.
[2] 周海燕,黄珍霞,魏桂菊.综合护理干预对糖尿病足溃疡面修复相关因子的影响[J].实用医学杂志,2016,32(16):2752-2754.DOI:10.3969/j.issn.1006-5725.2016.16.047.
[3] 李松泽,荣新洲,张涛,等.负压封闭引流联合前列地尔促进糖尿病足溃疡创面愈合的疗效和机制研究[J/CD].中华损伤与修复杂志(电子版),2020,15(2):133-138. DOI:10.3877/cma.j.issn.1673-9450.2020.02.010.
[4] 范永超. 负压创面疗法加0.9％氯化钠溶液滴注冲洗治疗糖尿病足溃疡的效果观察[J].黑龙江中医药,2020,49(2):3-4.
[5] 郭坤. 持续封闭式负压引流(VSD)治疗糖尿病足的观察及护理[J].糖尿病新世界,2016,19(6):147-148,189.DOI:10.16658/j.cnki.1672-4062.2016.06.147.
[6] 郭正祥,章伏生,王史辉,等.封闭式负压引流联合前列地尔治疗糖尿病足溃疡创面愈合的临床疗效观察[J].中国现代医生,2019,57(20):100-103.
[7] 王兰兰. 持续冲洗加VSD负压吸引对糖尿病足感染的效果与护理体会[J].糖尿病新世界,2017,20(15):91-92.DOI:10.16658/j.cnki.1672-4062.2017.15.091.
[8] 何芳,朱慧娟,董颖越,等.负压创面治疗对糖尿病足溃疡的疗效观察[J].中华医学杂志,2017,97(32):2525-2527.DOI:10.3760/cma.j.issn.0376-2491.2017.32.011.
[9] 梁峰,胡大一,沈珠军.2014美国糖尿病指南:糖尿病诊疗标准[J/CD].中华临床医师杂志(电子版),2014,(6):1182-1190.DOI:10.3969/cma.j.issn.1674-0785. 2014. 06.042.
[10] 李志红,郭淑芹,李亭亭,等.糖尿病足Wagner分级方法和TEXAS大学分类法临床应用价值比较[J].中华糖尿病杂志,2012,04(8):469-473.DOI:10.3760/cma.j.issn.1674- 5809.2012.08.006.
[11] 张金枝. 护士角色拓展在糖尿病足患者临床治疗与护理中的应用[J].齐鲁护理杂志,2018,24(9):80-82. DOI:10.3969/j.issn.1006-7256.2018.09.032.
[12] 雷霆,孙东旭,周军,等.基于Wnt/β-catenin信号通路的三七/白及胶海绵促进糖尿病足溃疡模型大鼠创面愈合的作用机制研究[J].中国药房,2019,30(4):483-487. DOI:10.6039/j.issn.1001-0408.2019.04.11.
[13] 徐成,鲁延林,范锟铻.负压封闭引流在糖尿病足治疗中的应用研究[J].中国临床研究,2016,29(5):627-628. DOI:10.13429/j.cnki.cjcr.2016.05.014.
[14] 耿艳侠,卢思英,刘岩.封闭负压引流技术联合游离皮片植皮在糖尿病足感染创面的应用研究[J].重庆医学,2016,45(9):1260-1262.DOI:10.3969/j.issn.1671-8348. 2016. 09.032.
[15] Park JH,Yoon J,Park B.Pomolic acid suppresses HIF1α/VEGF-mediated angiogenesis by targeting p38-MAPK and mTOR signaling cascades[J].Phytomedicine,2016,23(14):1716-1726.DOI:10.1016/j.phymed.2016.10.010.
[16] 陈诚,吴艳,陈琴.生肌玉红膏治疗糖尿病足溃疡的临床疗效及对创面组织内PDGFR-α表达的影响[J].中国美容医学,2018,27(9):58-61.
[17] 蒋丽艳,周苏键,刘文玉.高压氧对糖尿病足溃疡患者创面愈合、生活质量及负性情绪的影响[J].临床与病理杂志,2018,38(1):108-113.DOI:10.3978/j.issn.2095-6959. 2018.01.019.
[18] 卢思英,刘兆华,樊子双,等.封闭负压引流术治疗糖尿病足感染的个性化护理研究[J].重庆医学,2017,46(11):1577-1578.DOI:10.3969/j.issn.1671-8348.2017.11.049.