载万古霉素骨水泥联合负压封闭引流在中重度糖尿病足感染中的应用

Application of vancomycin-loaded bone cement combined with vacuum sealing drainage in moderate to severe diabetic foot infection

摘要:

目的： 观察中重度糖尿病足感染（diabetic foot infection，DFI）的病原菌分布特点和载万古霉素骨水泥联合负压封闭引流（vacuum sealing drainage，VSD）治疗中重度DFI的临床效果。方法： 回顾性收集2017年3月至2020年3月收治的中重度DFI患者71例，34例彻底清创后仅给予VSD治疗（传统组），37例彻底清创后给予载万古霉素骨水泥联合VSD治疗（联合组）。分析2组患者病原菌分布情况，比较2组患者治疗3个月后创面愈合率、愈合时间、总住院时间和治疗3个月后抑郁评定量表（depression rating scale，PHQ-9）和焦虑筛查量表（anxiety screening scale，GAD-7）评分。结果： 传统组检出病原菌29例：其中革兰阴性菌17例，占58.62%，革兰阳性菌12例，占41.38% ；联合组检出病原菌32例：其中革兰阴性菌19例，占59.38%，革兰阳性菌13例，占40.62%，2组患者病原菌分布无明显差异，且均以革兰阴性菌为主；治疗3个月后联合组愈合率为94.59%（35/37），传统组愈合率为76.47%（26/34）。与传统组比较，联合组患者创面愈合时间、总住院时间、治疗3个月后PHQ-9和GAD-7评分均明显降低，差异有统计学意义（P<0.05）。结论： 中重度DFI患者以革兰阴性菌感染为主，且载万古霉素骨水泥联合VSD治疗中重度DFI取得了良好的临床效果。

Abstract:

Objective: To observe the distribution of pathogenic bacteria of moderate to severe diabetic foot infection (DFI) and the clinical effect of vancomycin-loaded bone cement combined with vacuum sealing drainage (VSD) on the treatment of moderate to severe DFI. Methods: There were 71 patients with moderate to severe DFI admitted from March 2017 to March 2020 who were collected retrospectively in the study. According to the patient’s condition, 34 cases were treated with VSD only after thorough debridement (traditional group), and 37 cases were treated with vancomycin-loaded bone cement combined with VSD after thorough debridement (combined group). The distribution of pathogenic bacteria in patients were analyzed, and the wound healing rate, wound healing time, total hospitalization time and depression rating scale (PHQ-9) and anxiety screening scale (GAD-7) scores 3 months after first treatment were compared between the two groups. Results: The results showed that 29 cases of pathogenic bacteria were detected in the traditional group, of which 17 cases of gram-negative bacteria accounted for 58.62%, and 12 cases of gram-positive bacteria accounted for 41.38%; the combined group detected 32 cases of pathogenic bacteria, of which 19 cases of gram-negative bacteria accounted for 59.38%, and 13 cases of positive bacteria accounted for 40.62%. There was no significant difference in the distribution of pathogenic bacteria detected between the two groups, and most of them were gram-negative bacteria. After 3 months of treatment, the healing rate was 94.59% (35/37) in the combined group and 76.47% (26/34) in the traditional group. Compared with the traditional group, the wound healing time, the total length of hospitalization and PHQ-9 and GAD-7 scores 3 months after the first treatment of patients in the combined group were significantly reduced, with statistically significant differences (P<0.05). Conclusion: Patients with moderate to severe DFI are mainly infected by gram-negative bacteria. Vancomycin-loaded bone cement combined VSD has achieved good results in the treatment of moderate to severe DFI.