广州医科大学学报

目的:总结纳米银联合火针治疗老年褥疮的临床疗效。方法:选取2019年1月至12月广东江南医院收治的120例无法行皮瓣修复的老年Ⅲ期以上褥疮住院患者作为研究对象,随机分为4组,每组各30例。对照组采用无菌纱布覆盖包扎,纳米银组采用纳米银敷料,火针组采用火针治疗,联合组采用纳米银敷料联合火针治疗。比较治疗21 d后4组临床疗效,炎症因子指标[白细胞计数(WBC)、中性粒细胞百分比(N)、C反应蛋白(CRP)、降钙素原(PCT)]水平,治疗第14 d肉芽组织微血管密度(MVD)、血管内皮生长因子(VEGF)、成纤维细胞生长因子(bFGF)表达水平。结果:治疗21 d后,联合组总有效率高于对照组,治愈率高于其他3组,WBC、CRP、PCT水平低于其他3组(均P<0.05);治疗14 d后,联合组MVD、VEGF、bFGF高于其他3组(P<0.05)。结论:纳米银联合火针治疗老年褥疮,可改善机体炎症反应,预防或减轻细菌感染的发生,促进创面愈合,其机制可能与上调MVD、VEGF、bFGF有关。

Objective:To investigate the clinical efficacy of nano-silver dressing combined with fire needleacupuncture in the treatment of bedsores in the elderly.Methods:A total of 120 elderly patients with stage III orhigher bedsores admitted to Guangdong Jiangnan Hospital between January 2019 and December 2019 wereenrolled in this study and randomly divided into 4 groups(n= 30 each). The control group received sterile gauzedressing,the nano silver group received nano silver dressing,the fire needle group received fire needleacupuncture,and the combination treatment group was treated with nano silver dressing combined with fire needleacupuncture. The four groups were compared for therapeutic efficacy and inflammation[as reflected by whiteblood cell(WBC)counts,neutrophil percentage(N),C-reactive protein(CRP),and procalcitonin(PCT)levels]at 21 days of the treatment,as well as the microvascular density(MVD),vascular endothelial growthfactor(VEGF)and fibroblast growth factor(bFGF)expression in granulation tissue,at 14 days of the treatment.Results:At 21 days of treatment,the combination treatment group showed higher total effective rate than thecontrol group,higher rate-of-cure,and lower levels of WBC counts,CRP and PCT compared with the other threegroups(all P<0.05). At 14 days of treatment,the MVD,VEGF and bFGF levels in the combination treatmentgroup were higher than those in the other three groups(all P<0.05).Conclusion:Nano-silver dressing combinedwith fire needle acupuncture,as a treatment of bedsores in the elderly,may improve host inflammatory response,prevent or reduce bacterial infection,and promote wound healing. The mechanism may be related to up-regulationof MVD,VEGF and bFGF.