[1]包可久,刘颖,周丽娜,等.超声清创联合负压吸引对痛风石破溃创面疗效的随机对照研究[J].第三军医大学学报,2019,41(05):473-477.
 BAO Kejiu,LIU Ying,ZHOU Lina,et al.Efficacy of vacuum sealing drainage combined with ultrasonic debridement surgical system on gouty tophus ulcer: a randomized controlled trial[J].J Third Mil Med Univ,2019,41(05):473-477.
点击复制

超声清创联合负压吸引对痛风石破溃创面疗效的随机对照研究(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第05期
页码:
473-477
栏目:
临床医学
出版日期:
2019-03-15

文章信息/Info

Title:
Efficacy of vacuum sealing drainage combined with ultrasonic debridement surgical system on gouty tophus ulcer: a randomized controlled trial
作者:
包可久刘颖周丽娜陈兵
陆军军医大学(第三军医大学)第一附属医院内分泌科
 
Author(s):
 

Department of Endocrinology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
痛风石超声清创负压吸引创面
Keywords:
tophi ultrasonic debridement vacuum sealing drainage wound
分类号:
R454; R589.7; R632.1
文献标志码:
A
摘要:

目的 探讨痛风石破溃患者使用超声清创联合负压吸引治疗创面的临床疗效及安全性。方法 选择2014年9月至2017年12月我科住院的痛风合并痛风石破溃的患者96例,随机分为2组(n=48):试验组[年龄(51.3±7.6)岁,病程(6.8±1.1)年,BMI(25.7±1.2),创面面积(1.62±0.23)cm2]采取超声清创联合负压吸引术治疗,对照组[年龄(52.4±6.9)岁,病程(6.5±1.3)年,BMI(26.1±1.4),创面面积(1.65±0.21)cm2]采取常规手工清创换药治疗。比较2组患者的创面愈合程度、治愈率、显效率,以及治疗前后患处视觉模拟疼痛评分(visual analogue scale,VAS),住院费用和不良反应发生情况。结果 治疗后试验组:痛风石破溃创面疗效优于对照组(P<0.05);第5天的显效率和第10、15、20、25、30天的治愈率显著高于对照组,患处VAS评分显著低于对照组,差异均有统计学意义(P<0.05);2组间住院费用差异无统计学意义(P>0.05);试验组超声清创过程中出现2例(4.2%)患处剧烈疼痛,对照组3例(6.3%)出现延迟愈合,两组不良反应发生率差异无统计学意义(P>0.05)。结论 超声清创联合负压吸引能够缩短痛风石破溃创面愈合时间、提高创面愈合质量、不增加不良反应发生率及总住院费用。

Abstract:

Objective To investigate the clinical effects and safety of vacuum sealing drainage (VSD) combined with ultrasonic debridement surgical system (UDSS) on the patients with gouty tophus ulceration. Methods Totally 96 patients suffering from gout and gouty tophus ulceration admitted in our department from September 2014 to December 2017 were recruited, and then randomly divided into 2 groups (n=48 for each group). The patients from the experiment group (51.3±7.6 years old, disease course of 6.8±1.1 years, BMI 25.7±1.2, wound area 1.62±0.23 cm2) were treated with UDSS combined VSD, and those from the control group (52.4±6.9 years old, disease course of 6.5±1.3 years, BMI 26.1±1.4, wound area 1.65±0.21 cm2) were treated with conventional surgical debridement. Wound healing, cure rate, effective rate, visual analogue scale (VAS) score before and after treatment, cost of hospitalization, and incidences of adverse reactions were observed and compared between the 2 groups. Results Compared with the control group, the experimental group obtained better wound healing (P<0.05), higher effective rate on day 5, and higher cure rates on days 10, 15, 20, 25 and 30, but lower VAS score after the treatment (P<0.05). There were no differences in the costs of hospitalization or incidences of adverse reactions between the 2 groups (P>0.05). Two cases (4.2%) from the experimental group experienced acute pain in affected area during ultrasonic debridement, and 3 cases (6.3%) had delayed healing.  Conclusion UDSS combined with VSD can accelerate wound healing, improve healing outcome, and have no effect on the costs of hospitalization or incidences of adverse reactions.

参考文献/References:

[1]HUI M, CARR A, CAMERON S, et al. The british society for rheumatology guideline for the management of gout[J]. Rheumatology (Oxford), 2017, 56(7): e1-e20. DOI:10.1093/rheumatology/kex156.
[2]DABETH N, MERRMAN T R, STAMP L K. Gout[J]. Lancet, 2016, 388(10055): 2039-2052. DOI:10.1016/S0140-6736(16)00.46-9.
[3]PEREZRUIZ F,CASTILLO E, CHINCHILLA S P, et al. Clinical manifestations and diagnosis of gout[J]. Rheum Dis Clin North Am, 2014,  40(2): 193-206. DOI:10.1016/j.rdc.2014.01.003.
[4]Richette P, Bardin T. Gout[J]. Lancet, 2010, 375(9711): 318-28. doi:10.1016/S0140-6736(09)60883-7.
[5]PASCUAL E, ADDADI L, ANDRES M, et al. Mechanisms of crystal formation in gout-a structural approach[J]. Nat Rev Rheumatol, 2015, 11(12): 725-30. DOI:10.1038/nrrheum.2015.125.
[6]HARRIS R P, MCLEAN R M, QASEEM A. Management of acute and recurrent Gout[J]. Ann Intern Med, 2017, 166(10): 760. DOI:10.7326/L17-0146.
[7]DALBETH N, POOL B, GAMBLE G D, et al. Cellular characterization of the gouty tophus: a quantitative analysis[J]. Arthritis Rheum, 2010, 62(5): 1549-56. DOI:10.1002/art.27356.
[8]KHANNA D, FITZGERALD J D, KHANNA P P, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia[J]. Arthritis Care Res (Hoboken), 2012, 64(10): 1431-46. DOI:10.1002/acr.21772.
[9]MADHOK B M, VOWDEN K, VOWDEN P. New techniques for wound debridement[J]. Int Wound J, 2013, 10(3): 247-51. DOI10.1111/iwj.12045.
[10]WONG W D, SHAH S, MURRAY N, et al. Advanced Musculoskeletal Applications of Dual-Energy Computed Tomography[J]. Radiol Clin North Am, 2018, 56(4): 587-600. DOI:10.1016/j.rcl.2018.03.003.
[11]BOSSART S, SIDLER D, BLUM R, et al. Gout tophi on the soles resembling viral warts[J]. Clin Case Rep, 2018, 6(6): 1121-1123. DOI:10.1002/ccr3.1539.
[12]CHHANA A, DALBETH N. The gouty tophus: a review[J]. Curr Rheumatol Rep, 2015, 17(3): 19. DOI:10.1007/s11926-014-0492-x.
[13]XU J, ZHU Z, ZHANG W. Clinical characteristics of infectious ulceration over tophi in patients with gout[J]. J Int Med Res, 2018, 46(6): 2258-2264. DOI:10.1177/0300060518761303.
[14]XU J, LIN C, ZHANG P, et al. Risk factors for ulceration over tophi in patients with gout[J]. Int Wound J, 2017, 14(4): 704-707. DOI:10.1111/iwj.12680.
[15]HAN L Y, FU M X, HUANG Y L,  et al. Application of ultrasonic debridement machine combined by vacuum aspirationon diabetic foot[J]. Mod Prev Med,2012,39(21): 5713-5714+5716. 
[16]何敏, 郑焱玲, 邓武权, 等. 超声清创刀联合负压创面系统治疗糖尿病足溃疡的疗效观察[J]. 局解手术学杂志, 2015,24(1):1-3.
HE M, ZHENG Y L, DENG W Q, et al. Clinical observation on treatment effect of negative pressure wound therapy followed by ultrasonic debridement surgical system in patients with diabetic foot[J]. J Region Anat Oper Surg,2015,24(1): 1-3.
[17]施劭锋, 苏广瑞, 林日昌, 等. 超声清创术联合简易负压封闭引流技术在糖尿病足溃疡中的应用[J]. 白求恩医学杂志, 2016,14(2):186-188.DOI:10.16485 /j. issn. 2095-7858.2016.02.024.
SHI S F,SU G R, LIN R C, et al. Application of drainage technology in diabetic foot ulcers in the ultrasonic debridement Joint Improvised vacuum sealing[J]. J Bethune Med Sci, 2016, 14(2): 186-188. DOI:10.16485/j. issn. 2095-7858.2016.02.024.
[18]陈伟彬, 聂运修, 等. 超声清创术联合负压封闭引流技术治疗糖尿病足溃疡效果分析[J]. 白求恩医学杂志, 2017,15:(2):243-244.DOI:10.16485 /j. issn. 2095-7858.2017. 02.054.
CHEN W B, NIE Y X. Analysis of the effect of ultrasonic debridement combined with vacuum sealing drainage on diabetic foot ulcer[J]. J Bethune Med Sci, 2017, 15(2): 243-244.DOI:10.16485 /j. issn. 2095-7858.2017. 02.054.
 

更新日期/Last Update: 2019-03-05