【摘要】：目的:慢性糖尿病足部潰瘍病程長、療效差、常合并感染,長期抗感染治療易導(dǎo)致機(jī)體對抗生素不敏感。本研究擬評估一種新型的生物療法——活體五谷蟲清創(chuàng)對慢性糖尿病足部潰瘍的療效。方法:本研究從自2013年7月至2013年11月期間于外科門診常規(guī)換藥治療的糖尿病足部潰瘍遷延不愈而其他保守治療無效患者中選取受試者。選取符合納入標(biāo)準(zhǔn),而不符合排除標(biāo)準(zhǔn)的患者14人,詳細(xì)向其和家屬解釋本臨床研究的目的和流程,說明基本的研究方法,將愿意參加本次研究的患者隨機(jī)分組。將應(yīng)用五谷蟲生物清創(chuàng)的患者作為實(shí)驗(yàn)組,而將常規(guī)換藥治療的患者編為對照組。醫(yī)囑兩組患者每日于門診更換潰瘍處敷料并記錄其創(chuàng)面每日恢復(fù)情況,取其分泌物做菌培養(yǎng)。五谷蟲治療組每日換藥同時(shí)仔細(xì)計(jì)數(shù)從創(chuàng)面取出的蟲體數(shù)量,與前一日換藥放置的蟲體數(shù)量做對比。對照組患者則行醫(yī)院常規(guī)換藥,病情需要時(shí)給予外科清創(chuàng)治療。以潰瘍處分泌物細(xì)菌培養(yǎng)轉(zhuǎn)陰時(shí)間、創(chuàng)面肉芽出現(xiàn)時(shí)間和潰瘍愈合時(shí)間為評估指標(biāo)。使用SPSS20.0統(tǒng)計(jì)分析數(shù)據(jù),并結(jié)合其伴隨疾病深入分析五谷蟲治療與創(chuàng)面愈合的關(guān)系。本研究中,雙側(cè)檢驗(yàn)P0.05,將視為有明顯統(tǒng)計(jì)學(xué)差異。結(jié)果:1.本研究實(shí)際有效病例為13人,五谷蟲生物清創(chuàng)治療組為7人,常規(guī)換藥組為6人,且兩組數(shù)據(jù)基線資料一致。2.五谷蟲治療組細(xì)菌培養(yǎng)轉(zhuǎn)陰時(shí)間明顯少于常規(guī)換藥治療組,具有統(tǒng)計(jì)學(xué)意義(P值0.05)。3.五谷蟲治療組肉芽組織出現(xiàn)時(shí)間明顯少于常規(guī)換藥治療組,具有統(tǒng)計(jì)學(xué)意義(P值0.05)。4.五谷蟲治療組創(chuàng)面完全愈合時(shí)間明顯少于常規(guī)換藥治療組,具有統(tǒng)計(jì)學(xué)意義(P值0.05)。結(jié)論:活體五谷蟲生物清創(chuàng)是治療慢性糖尿病足部潰瘍創(chuàng)面的一種有效方法,其療效高于常規(guī)外科換藥。
[Abstract]:Objective: chronic diabetic foot ulcers have long course of disease, poor curative effect, often complicated with infection, and long-term anti-infection treatment may lead to insensitivity to antibiotics. The aim of this study was to evaluate the efficacy of a new biotherapy-the debridement of gluten in vivo for chronic diabetic foot ulcers. Methods: from July 2013 to November 2013, subjects were selected from patients with diabetic foot ulcers who had been treated with routine dressing change from July 2013 to November 2013. Fourteen patients who met the inclusion criteria but did not meet the exclusion criteria were selected to explain to them and their families in detail the purpose and procedure of the clinical study and to explain the basic research methods. Patients who were willing to participate in the study were randomly divided into groups. The patients treated with biological debridement of gluten were used as the experimental group, while the patients treated with routine dressing change were divided into the control group. The two groups of patients were ordered to change the ulcer dressing and record the wound recovery every day. In the gluten treatment group, the number of worm bodies removed from the wound was counted carefully at the same time, which was compared with that of the previous day. The patients in the control group were treated with surgical debridement. The time of bacterial culture to negative, the time of granulation and the time of ulcer healing were used as the evaluation index. The relationship between the treatment of gluten and wound healing was analyzed by SPSS20.0 statistical analysis and combined with its concomitant diseases. In this study, bilateral test P0.05 will be considered to have a significant statistical difference. The result is 1: 1. The actual effective cases in this study were 13, 7 in the biological debridement treatment group and 6 in the routine dressing change group, and the baseline data of the two groups were the same. 2. The negative time of bacterial culture in the gluten treatment group was significantly shorter than that in the routine dressing change group (P 0.05). The time of granulation appeared in gluten treatment group was significantly shorter than that in routine dressing change group (P 0.05). The wound healing time in the gluten treatment group was significantly shorter than that in the routine dressing change group (P 0.05). Conclusion: the biological debridement of glutenella in vivo is an effective method for the treatment of chronic diabetic foot ulcer.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2

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