纳米银抗菌敷料应用对糖尿病足患者感染控制的研究
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摘要
目的探讨纳米银抗菌敷料对糖尿病足患者感染控制效果。方法选择2017年1月～2018年1月在我院治疗的糖尿病足患者60例为研究对象,随机分为干预组与对照组,各30例。两组均严格控制血糖水平。清创后干预组采用纳米银抗菌敷料包扎,对照组采用凡士林敷料包扎。分别于入组时、治疗4周对伤口疼痛程度、伤口溃疡严重程度、溃疡面积进行评价。统计两组患者溃疡愈合时间、换药次数。结果干预后,两组Wagner分级均较治疗前显著改善,差异有统计学意义(P<0.05);治疗后干预组Wagner分级显著优于对照组,差异有统计学意义(P<0.05)。干预后,两组溃疡面积显著低于干预前(P<0.05);干预组溃疡面积干预后较对照组小(P<0.05)。两组VAS干预后显著低于干预前(P<0.05);干预组VAS干预后显著较对照组低(P<0.05)。溃疡愈合时间干预组显著较对照组短,差异有统计学意义(P<0.05);换药次数显著少于对照组,差异有统计学意义(P<0.05)。结论纳米银抗菌敷料应用对糖尿病足可促进溃疡的愈合,缩小溃疡面积,改善Wagner分级,减少换药次数。
Objective To investigate the effect of nano-silver antibacterial dressing on infection control in the patients with diabetic foot. Methods 60 patients with diabetic foot who were treated in our hospital from January 2017 to January 2018 were selected as the study subjects. They were randomly divided into intervention group and control group,with 30 cases in each group. Both groups strictly controlled blood glucose levels. After debridement, the intervention group was given nano-silver antibacterial dressing. The control group was given vaseline dressing. The degree of wound pain, the severity of wound ulcer, and the area of ulcer were evaluated at the time of enrollment and 4 weeks after treatment. The ulcer healing time and the number of dressing changes were counted in both groups. Results After intervention, the Wagner grading of the two groups was significantly improved compared with that before treatment, and the difference was statistically significant(P<0.05); after treatment, the Wagner grading in the intervention group was significantly better than that in the control group, and the difference was statistically significant(P<0.05). After intervention,the ulcer area of the two groups was significantly lower than that before the intervention(P<0.05); the ulcer area in the intervention group was smaller than that in the control group after intervention(P<0.05). The VAS in the two groups after intervention was significantly lower than that before the intervention(P<0.05); the VAS in the intervention group was significantly lower than that in the control group after intervention(P<0.05). The ulcer healing time in the intervention group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.05); the number of dressing changes was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion The application of nano-silver antibacterial dressing can promote the healing of ulcers,reduce the ulcer area, improve the Wagner grading and reduce the number of dressing changes.
Objective To investigate the effect of nano-silver antibacterial dressing on infection control in the patients with diabetic foot. Methods 60 patients with diabetic foot who were treated in our hospital from January 2017 to January 2018 were selected as the study subjects. They were randomly divided into intervention group and control group,with 30 cases in each group. Both groups strictly controlled blood glucose levels. After debridement, the intervention group was given nano-silver antibacterial dressing. The control group was given vaseline dressing. The degree of wound pain, the severity of wound ulcer, and the area of ulcer were evaluated at the time of enrollment and 4 weeks after treatment. The ulcer healing time and the number of dressing changes were counted in both groups. Results After intervention, the Wagner grading of the two groups was significantly improved compared with that before treatment, and the difference was statistically significant(P<0.05); after treatment, the Wagner grading in the intervention group was significantly better than that in the control group, and the difference was statistically significant(P<0.05). After intervention,the ulcer area of the two groups was significantly lower than that before the intervention(P<0.05); the ulcer area in the intervention group was smaller than that in the control group after intervention(P<0.05). The VAS in the two groups after intervention was significantly lower than that before the intervention(P<0.05); the VAS in the intervention group was significantly lower than that in the control group after intervention(P<0.05). The ulcer healing time in the intervention group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.05); the number of dressing changes was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion The application of nano-silver antibacterial dressing can promote the healing of ulcers,reduce the ulcer area, improve the Wagner grading and reduce the number of dressing changes.
引文
[1]高优,李金虎,郭志谦,等.亲水纤维含银敷料在小儿头面部深Ⅱ度烧伤创面治疗中的应用[J].中国美容整形外科杂志,2017,28(8):485-487.
[2]蒋瑞明,张元海,叶春江,等.纳米银烧伤敷料与磺胺嘧啶银乳膏治疗深Ⅱ度烧伤患者创面感染的研究[J].中华医院感染学杂志,2015,25(22):5228-5230.
[3]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:733.
[4]许樟荣.2017年糖尿病足病防治进展[J].中华糖尿病杂志,2018,10(1):68-71.
[5]陈孝平,汪建平.外科学[M].第8版,北京:人民卫生出版社,2013:766.
[6]Pscherer S,Dippel FW,Lauterbach S,et al.Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany[J].Prim Care Diabetes,2012,6(3):241-246.
[7]Armstrong DG,AJM B,Bus SA.Diabetic foot ulcers and their recurrence[J].N Engl J Med,2017,376(24):2367-2375.
[8]Morbach S,Furchert H,Gr Blinghoff U,et al.Long-term prognosis of diabetic foot patients and their limbs:Amputation and death over the course of a decade[J].Diabetes Care,2012,35(10):2021-2027.
[9]Sun JH,Tsai JS,Huang CH,et al.Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification[J].Diabetes Res Clin Pract,2012,95(3):358-363.
[10]耿健,柳大烈,张阳,等.纳米银抗菌医用敷料创面外用后纳米银在体内的分布[J].中国组织工程研究与临床康复,2011,15(16):2915-2919.
[11]周艳红,郝彤,李俊杰,等.新型纳米银基抗感染敷料的研制及生物学效应评价[J].军事医学,2016,40(6):497-501.
[12]熊雪蓉,邝红芬,梁顺兴,等.纳米银医用抗菌敷料在烧伤患者治疗中的应用及护理[J].护士进修杂志,2012,27(12):1134-1136.
[13]黄念,林清,苏永华.纳米银敷料治疗烧伤创面的疗效与安全研究进展[J].北京生物医学工程,2015,34(4):427-431.
[14]朱冬梅,苏明海,王丽平,等.含银抗菌敷料在治疗糖尿病足溃疡中的疗效观察[J].安徽医药,2012,16(3):371-372.
[15]李昌林,邹旭,朱焕金,等.血清降钙素原与C反应蛋白对糖尿病足感染患者的预后评估价值[J].中国当代医药,2017,(14):59-61.
[16]陶岚.爱康肤银抗菌敷料加速感染切口愈合效果的对照研究[J].中华现代护理杂志,2011,17(15):1766-1769.
[17]石萍,张娜,杨敏.纳米银敷料在Ⅲ期压疮治疗及护理中的应用[J].中国实用护理杂志,2013,29(4):31-32.
[18]徐云侠.银离子抗菌敷料在感染性压疮护理中的应用[J].安徽医学,2011,32(7):1010-1012.
[19]吴玉琴,卢姝姝,金磊磊,等.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中华医院感染学杂志,2013,23(9):2079-2081.
[2]蒋瑞明,张元海,叶春江,等.纳米银烧伤敷料与磺胺嘧啶银乳膏治疗深Ⅱ度烧伤患者创面感染的研究[J].中华医院感染学杂志,2015,25(22):5228-5230.
[3]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:733.
[4]许樟荣.2017年糖尿病足病防治进展[J].中华糖尿病杂志,2018,10(1):68-71.
[5]陈孝平,汪建平.外科学[M].第8版,北京:人民卫生出版社,2013:766.
[6]Pscherer S,Dippel FW,Lauterbach S,et al.Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany[J].Prim Care Diabetes,2012,6(3):241-246.
[7]Armstrong DG,AJM B,Bus SA.Diabetic foot ulcers and their recurrence[J].N Engl J Med,2017,376(24):2367-2375.
[8]Morbach S,Furchert H,Gr Blinghoff U,et al.Long-term prognosis of diabetic foot patients and their limbs:Amputation and death over the course of a decade[J].Diabetes Care,2012,35(10):2021-2027.
[9]Sun JH,Tsai JS,Huang CH,et al.Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification[J].Diabetes Res Clin Pract,2012,95(3):358-363.
[10]耿健,柳大烈,张阳,等.纳米银抗菌医用敷料创面外用后纳米银在体内的分布[J].中国组织工程研究与临床康复,2011,15(16):2915-2919.
[11]周艳红,郝彤,李俊杰,等.新型纳米银基抗感染敷料的研制及生物学效应评价[J].军事医学,2016,40(6):497-501.
[12]熊雪蓉,邝红芬,梁顺兴,等.纳米银医用抗菌敷料在烧伤患者治疗中的应用及护理[J].护士进修杂志,2012,27(12):1134-1136.
[13]黄念,林清,苏永华.纳米银敷料治疗烧伤创面的疗效与安全研究进展[J].北京生物医学工程,2015,34(4):427-431.
[14]朱冬梅,苏明海,王丽平,等.含银抗菌敷料在治疗糖尿病足溃疡中的疗效观察[J].安徽医药,2012,16(3):371-372.
[15]李昌林,邹旭,朱焕金,等.血清降钙素原与C反应蛋白对糖尿病足感染患者的预后评估价值[J].中国当代医药,2017,(14):59-61.
[16]陶岚.爱康肤银抗菌敷料加速感染切口愈合效果的对照研究[J].中华现代护理杂志,2011,17(15):1766-1769.
[17]石萍,张娜,杨敏.纳米银敷料在Ⅲ期压疮治疗及护理中的应用[J].中国实用护理杂志,2013,29(4):31-32.
[18]徐云侠.银离子抗菌敷料在感染性压疮护理中的应用[J].安徽医学,2011,32(7):1010-1012.
[19]吴玉琴,卢姝姝,金磊磊,等.银离子抗菌敷料在压疮感染性伤口中的应用与效果观察[J].中华医院感染学杂志,2013,23(9):2079-2081.