感染糖尿病脚:负压伤口治疗与灌是否减少生物负担并改善伤口愈合?
Mehmet A Suludere1, Matthew Malone2, Michael C Siah3,4
1Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
The international journal of lower extremity wounds
|November 13, 2024
概括
负压伤口治疗 (NPWT) 和用聚甲比古安化灌 (NPWTi-P) 进行的NPWT在降低糖尿病足感染的微生物负载方面没有显著差异. 然而,传统的NPWT与较少的再感染有关.
科学领域:
- 伤口护理 伤口护理
- 传染性疾病 传染性疾病
- 糖尿病学 糖尿病学
背景情况:
- 糖尿病足部感染是致病率和肢体损失的重要原因.
- 负压伤疗法 (NPWT) 是复杂伤口的常见治疗方法.
- 添加抗菌灌剂,如聚乙烯比古安化物 (NPWTi-P),旨在进一步降低微生物负担.
研究的目的:
- 为了比较使用NPWT治疗的糖尿病足部感染中的微生物负荷与用聚乙烯比古安化灌 (NPWTi-P) 治疗的NPWT.
- 评估这些疗法对伤口愈合和再感染率的影响.
主要方法:
- 两项随机临床试验的后期分析,涉及中度至重度糖尿病足部感染需要手术的患者.
- 量化聚合酶连锁反应 (qPCR) 用于从最初的手术脱bridement和治疗前后获得的组织样本中确定微生物负载 (Log10 16S副本/克).
- 在NPWT和NPWTi-P组之间比较了伤口愈合率,愈合时间和再感染率.
主要成果:
- 在第一次手术前 (Log10:6.4±1.8对7.5±1.7) 或第二次手术前 (Log10:6.7±1.8对7.6±1.9,p=0.12) 在NPWT和NPWTi-P组之间的平均微生物负荷中没有发现统计学上显著的差异.
- 伤口愈合率 (59.5%与50.0%,p=0.51) 和愈合时间 (127±109.3与143±95.9天,p=0.71) 在两个治疗组之间相似.
- 与NPWTi-P组相比,在传统的NPWT组中观察到较少的再感染趋势 (28.6%对56.3%,p=0.05).
结论:
- 无论是NPWT还是NPWTi-P都没有在降低糖尿病足感染中的微生物负荷方面显示出显著的差异.
- 这两种治疗方法在伤口愈合和愈合时间方面表现相似.
- 传统的NPWT可能与糖尿病足感染患者的再感染率较低有关,需要进一步调查.
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