| Objective To compare the therapeutic effect of vacuum sealing drainage, topical oxygen therapy(TOT) and topical external use of insulin in the treatment of diabetic foot ulcers, and to explore the individualized treatment of diabetic foot.Methods 31 patients with diabetic foot Wagner2 and 33 patients with diabetic foot Wagner3 who meet the inclusion criteria in our hospital from 2015 January to 2016 January are collected for this study. Patients of Wagner2 are divided into 3 groups i.e. Aw2(n=11)?Bw2(n=10)?Cw2(n=10),so do patients of Wagner3, i.e. Aw3(n=11)?Bw3(n=11)?Cw3(n=11). There is no statistically difference(P> 0.05) within each group on the aspect of ages, wound formation time and ankle brachial index. fasting blood glucose<8mmol/L, 2 hours postprandial blood glucose <11.2mmol/L; patients are given anti infective treatment based on drug sensitivity results of wound bacteria culture. All patients of the six groups are given radical debridement. Patients in group of Aw2, Aw3 are treated with Vacuum sealing drainage(VSD) by-125 mm Hg pressure, with daily topical oxygen therapy(TOT)(5L/min, 2h) and washing liquid(saline 2400ml+ insulin 24u) after debridement of ulcer wound for totally 7 days. Patients in group of Bw2, Bw3 are treated with Vacuum sealing drainage(VSD) by-125 mm Hg pressure and daily saline wash(2400ml) after debridement of ulcer wound for totally 7 days. Patients in group of Cw2, Cw3 are treated with Vacuum sealing drainage(VSD) by-125 mm Hg pressure after debridement of ulcer wound for totally 7 days. the "ten points" method is adopted to collect the wound the basal secretions, and bacterial culture of wound surface is applied here. The fresh tissue exudates is collected and analyzed about the p O2 via Blood Gas Analyzer; granulation tissue of the wound center is determined for LDH, SDH activity.Results 1 Wound reduction rate: Group Aw2 is significantly higher than group Bw2, Cw2 with statistical significance(P<0.05). No remarkable distinction between group Bw2 and group Cw2 is observed(P>0.05). The rate of group Aw3 is higher than group Bw3 and group Cw3 without statistical significance. The wound reduction rate of group Wagner2 is higher than that of group Wagner3, and the result is statistical significance(P value less than 0.05). 2 Granulation coverage rate: Group Aw2 is higher than group Bw2, and group Bw2 is higher than group Cw2. The difference is statistically significant(P<0.05). No statistically difference exists between group Aw3 and group Bw3, but the rates of the two are higher than group Cw3(P value less than 0.05). When the same method is applied among groups, it finds that the rate of groups Wagner2 is higher than that of groups Wagner3, and the result is statistically significant(Aw2>Aw3; Bw2>Bw3;Cw2>Cw3, P<0.05). 3 Bacterial clearance rate: The rate of group Aw2 is higher than that of group Bw2,and the rate of group Bw2 is higher than that of group Cw2. The result is statistical significant(P<0.05). Meanwhile, the rate of group Aw3 is higher than that of group Bw3,and the rate of group Bw3 is higher than that of group Cw3. The result is statistical significant(P<0.05). 4 p O2 of topical wound tissue: No difference is observed between group Aw2 and group Aw3(P > 0.05), but the result is significantly higher than that before treatment and the other groups(P value less than 0.05). No statistical difference is observed among group Bw2, Cw2, Bw3 and group Cw3 before treatment and within each group(P > 0.05). 5 Wound tissue LDH and SDH activity: No statistical difference is observed between group Aw2 and group Aw3(P > 0.05). Compared with the data before treatment, LDH activity in wound tissues decreases whereas SDH activity increases, and the difference is statistically significant(P < 0.05). Compared with the data before treatment, the other groups had no significant difference(P > 0.05).Conclusion 1 Vacuum sealing drainage(VSD) combined with topical oxygen therapy(TOT) and topical external insulin therapy on diabetic foot ulcer implementation can more effectively promote the grade of diabetic foot Wagner2 wound healing and promote better granulation tissue growth and effectively inhibit the reproduction of bacteria, when comparing with simply using Vacuum sealing drainage(VSD) and saline irrigation treatment. 2 Vacuum sealing drainage(VSD) combined with topical oxygen therapy(TOT) and topical external insulin therapy on diabetic foot ulcer implementation comparing with simply using Vacuum sealing drainage(VSD) and saline irrigation treatment, there is no obvious advantage on promotion of wound healing and the granulation tissue growth of diabetic foot Wagner3. 3 The optimal treatments are significantly different using in distinct diabetic foot ulcer wounds, the individual treatment of diabetic foot need to be further refined, and it is necessary to give optimal treatment for different wounds. |
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