摘要
目的:观察复方黄柏液涂剂联合封闭负压引流治疗压疮创面的效果及对相关炎症因子的影响.方法:选取2017年12月-2022年12月我院收治的压疮创面患者90例,均使用封闭负压引流技术治疗创面,根据灌洗液不同,分为生理盐水组(A组)、庆大霉素组(B组)、复方黄柏液涂剂组(C组),每组30例.对比不同灌洗液冲洗后三组患者治疗前、治疗后7 d、14d、21 d各项指标的变化,包括创面愈合情况、血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)及C反应蛋白(CRP)水平,并对创面分泌物行细菌培养和药敏试验.结果:创面愈合情况评分:治疗后7d、14d、21 d各组创面愈合情况评分均较治疗前降低(P＜0.05),治疗后14 d,B组、C组评分下降较A组更明显(P＜0.05);而治疗后21 d,C组评分下降较A组和B组明显(P＜0.05).相关炎症因子:治疗后7 d,A、B、C三组的血清SAA、IL-6、CRP水平均较治疗前下降(P＜0.05),B、C组较A组水平更低(P＜0.05);治疗后14 d,B、C组的SAA、IL-6、CRP水平均较治疗后7 d进一步下降(P＜0.05),而A组的SAA、IL-6\CRP水平与治疗后7 d比较差异无统计学意义(P＞0.05);治疗后21 d,C组的SAA、IL-6、CRP水平均较治疗后14 d进一步下降(P＜0.05),而A、B组的SAA、IL-6、CRP水平与治疗后7 d相比较差异无统计学意义(P＞0.05).细菌学变化:治疗后7 d,A、B、C三组患者细菌培养阳性比例均较治疗前有所下降(P＜0.05),B、C组较A组细菌阳性率更低(P＜0.05);治疗后14 d,三组患者细菌培养阳性比例较治疗后7 d后均有下降(P＜0.05);治疗后21 d,C组阳性比例较治疗后14 d下降更明显(P＜0.05),细菌培养结果显示以革兰阴性菌为主,治疗后14d、21 d时,B组细菌对庆大霉素的耐药率明显高于A组和C组.结论:复方黄柏液涂剂滴灌联合封闭负压引流能改善压疮创面局部症状,有利于患者疾病转归,效果优于庆大霉素和生理盐水负压滴灌治疗.
Abstract
Objective To explore the effect of compound Huangbai liquid coating combined with closed negative pressure drainage on pressure ulcer wounds and its impact on related inflammatory factors.Methods 90 patients with pressure ulcers were selected and treated with closed negative pressure drainage technology.They were divided into physiological saline group(group A),gentamicin group(group B),and compound Huangbai liquid coating group(group C)based on different irrigation solutions,with 30 cases in each group.Compare the changes in various indicators of three groups of patients before treatment,7 days,14 days,and 21 days after treatment,including wound healing,serum amyloid A(SAA),interleukin-6(IL-6),and C-reactive protein(CRP)levels,and conduct bacterial culture and drug sensitivity tests on wound secretions.Results(1)Score of wound healing:On the 7th,14th,and 21st days after treatment,the scores of wound healing in each group decreased compared to before treatment(P＜0.05).On the 14th day after treatment,the scores of group B and group C decreased more significantly compared to group A(P＜0.05);On the 21st day after treatment,the score of group C decreased significantly compared to group A and group B(P＜0.05).(2)Related inflammatory factors:7 days after treatment,the levels of SAA,1L-6,and CRP in groups A,B,and C decreased compared to before treatment(P＜0.05),while the levels in groups B and C were lower than those in group A(P＜0.05);On the 14th day after treatment,the levels of SAA,IL-6,and CRP in groups B and C further decreased compared to the 7th day after treatment(P＜0.05),while the levels of SAA,IL-6,and CRP in group A showed no statistically significant difference compared to the 7th day after treatment(P＞0.05);On the 21st day after treatment,the levels of SAA,IL-6,and CRP in group C further decreased compared to the 14th day after treatment(P＜0.05),while the levels of SAA,IL-6,and CRP in group A and B showed no statistically significant difference compared to the 7th day after treatment(P＞0.05).(3)Bacteriology changes:7 days after treatment,analyze the positive rates of bacterial culture in group A,B and C,which were lower than those before treatment(P＜0.05).The positive rates of bacteria in group B and C were lower than those in group A(P＜0.05);On the 14th day after treatment,the positive rates of bacterial culture in groups A,B,and C,which decreased compared to the 7th day after treatment(P＜0.05);On the 21st day after treatment,the positive rate in group C decreased more significantly compared to the 14th day after treatment(P＜0.05).The bacterial culture results showed that Gram negative bacteria were the main bacteria,and on the 14th and 21st day after treatment,the resistance rate of bacteria detected in group B to gentamicin was significantly higher than that in group A and C.Conclusion The combination of compound Huangbai liquid coating drip irrigation and closed negative pressure drainage can improve the local symptoms of pressure ulcer wounds,and is beneficial for the disease prognosis of patients.The effect is better than that of gentamicin and physiological saline negative pressure drip irrigation treatment.
基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20191274)
安阳市科技攻关计划(2021C01SF047)
安阳市科技攻关计划(2023C01SF149)
维普
万方数据