中药足浴联合百多邦软膏外敷治疗早期糖尿病足的临床效果观察

中药足浴联合百多邦软膏外敷治疗早期糖尿病足的临床效果观察目的研究中药足浴联合百多邦软膏外敷治疗早期糖尿病足的临床效果。

方法选取婺源县中医院近期收治的符合《实用内科学》诊断标准的早期糖尿病足患者共计60例作为研究对象，按照随机数字表法进行分组，对照组30例，治疗组30例。治疗组患者采用中药足浴联合百多邦软膏外敷治疗，对照组患者选用胰岛素、庆大霉素创面湿敷治疗。1周为1个疗程，使用4个疗程后观察效果。分析两组患者的安全性以及疗效。结果治疗后治疗组血清总胆固醇为（4.8±0.3）mmol/L，三酰甘油为（1.2±0.2）mmol/L，低密度脂蛋白胆固醇为（2.5±0.2）mmol/L，均明显低于对照组；高密度脂蛋白胆固醇为（1.4±0.1）mmol/L，明显高于对照组；空腹血糖为（6.5±0.3）mmol/L，餐后2 h血糖为（8.4±0.6）mmol/L，均明显低于对照组；临床疗效明显高于对照组，差异有统计学意义（P＜0.05）。结论中药足浴联合百多邦软膏外敷治疗早期糖尿病足的效果确切，可作为临床治疗糖尿病足的基础方案加以推广。

[Abstract] Objective To study the clinical effect and value of foot bath with Chinese herbs combining with external application of bactroban ointment on treating patients with early diabetic foot. Methods Sixty patients who met the diagnostic criteria of early diabetic foot in Practice of Internal Medicine and were recently admitted into traditional Chinese medicine hospital of Wuyuan county were selected as research objects.They were evenly divided into control group in 30 cases and treatment group in 30 cases by random number table.In the treatment group,diabetic foot patients were treated by foot bath with Chinese herbs combining with external application of bactroban ointment,while in the control group,insulin and gentamicin wet compressing in the surface of wound were provided.One course of treatment lasted a week,and effect was observed after 4 courses of treatment.The observation indexes of safety and effect in both groups were comparatively analyzed. Results After therapy,in the treatment group,the values of serum total cholesterol,triglyceride,and low density lipoprotein cholesterin were (4.8±0.3) mmol/L,(1.2±0.2) mmol/L,and (2.5±0.2) mmol/L in turn,which were all lower than those after treatment in the control group.The high density lipoprotein cholesterin was (1.4±0.1) mmol/L in the treatment group much higher than that after therapy in the control group.The fasting and 2 h postprandial blood glucose in the treatment were (6.5±0.3) mmol/L and (8.4±0.6) mmol/L respectively.In comparison with those after treatment in the control group, they were obviously lower.The clinical effect in the treatment group was superior to that in the control group.All these indexes mentioned above displayed statistical differences in the two groups (P＜0.05). Conclusion Therapeutic regimen of foot bath with Chinese herbs combining with external application of bactroban ointment in the treatment of early diabetic foot can obtain a definite effect,which can be considered as a basic scheme to treat diabetic foot and expanded in clinic.

[Key words] Foot bath with Chinese herbs;Bactroban ointment;Diabetic foot;Effect

对于糖尿病足患者而言，早期控制血糖与感染能够使患者经络的畅通性得到显著提升，通过发挥活血通络功效的方式，达到改善创面愈合的目的[1]，此种方式能够使糖尿病足患者的病情发展速度得到有效控制[2-4]。从人体生理学角度上来说，足部是运行气血，联系脏腑，沟通内外上下经络的重要起止部位，足三阳与足三阴经均交接于此，足部有内脏及全身反射区，有52块骨头，60余条肌肉，被誉为“人体第二心脏”。有关临床研究中指出，对于糖尿病足患者而言，在通过中药足浴进行治疗的过程中，药物起效不以胃肠道为途径，而是直接作用于皮肤，在疗效确切的同时也表现出了较高的安全性，且水温本身对皮肤、经络、穴位的刺激和药物的透皮吸收进入血液，达到治疗疾病的目的，故而认为中药足浴对糖尿病足有相当确切的治疗效果。为进一步研究中药足浴联合百多邦软膏外敷治疗早期糖尿病足的临床效果与价值，本研究选取婺源县中医院近期所收治的早期糖尿病足患者共计60例作为研究对象，在随机分组下探讨常规西药干预方案与中药足浴联合百多邦软膏外敷治疗方案的干预效果。

1 资料与方法

1.1 一般资料

根据陈灏珠主编，2005年5月人民卫生出版社出版的《实用内科学》第12版糖尿病足的分级方法，早期糖尿病足为诊断标准中0～Ⅱ级分级，具体评估指标如下。①0级：皮肤完整，无开放性病灶，常表现为肢端供血不足，皮肤凉，伴麻木、刺痛，可有感觉迟钝或消失；②Ⅰ级：皮肤有开放性病灶，但未累及深部组织，如水疱、血疱、鸡眼或胼胝、冻伤及其他皮肤损伤所致的皮肤浅表性溃疡；③Ⅱ级：感染病灶已侵犯深部肌肉组织，脓性分泌物较多，但无肌腱、韧带破坏。

选取婺源县中医院2011年6～12月收治的早期糖尿病足患者共计60例作为研究对象，所有患者均符合《实用内科学》诊断标准中有关糖尿病足0～Ⅱ级的诊断要求。排除足部溃疡因非糖尿病因素所引发以及就诊前7 d内接受过其他相应治疗，且可能对效应观测指标产生影响的患者，所有患者均自愿参与本次临床研究，签署知情同意书。

将60例患者按照随机数字表法进行分组，对照组30例患者中，男性18例，女性12例；年龄48～75岁，平均（55.6±1.7）岁；病程3～20年，平均（12.5±2.3）年；空腹血糖10.0～29.0 mmol/L，平均（18.2±2.5）mmol/L。治疗组30例患者中，男性20例，女性10例；年龄45～76岁，平均（54.1±2.3）岁；病程4～25年，平均（13.6±1.8）年；空腹血糖12.0～27.0 mmol/L，平均（17.6±1.8）mmol/L。两组患者的年龄、性别、病程、血糖等差异无统计学意义（P＞0.05），具有可比性。

1.2 方法