"偎脓长肉"是中医疮疡外科的特色治疗理念之一,临床广泛应用于各种慢性难愈合性创面,且临床效果显著.然而"偎脓长肉"在历史流传中记载较为散在,且出现了不同的文字表述,以致不同医家对"偎脓长肉"的中医内涵存在分歧.通过文献研究及临床工作,本文对"偎脓长肉"的历史源流、含义、应用时机、常用方药等方面进行梳理论述,以期为"煨脓长肉"的临床应用提供理论指导.

目的 探讨活血通脉方溻渍对糖尿病周围神经病变的影响.方法 选取2019年6月至2020年9月北京中医药大学东直门医院周围血管科收治的糖尿病周围神经病变患者60例,根据随机数字表法将其分为治疗组和对照组,每组30例.除糖尿病基础治疗及口服甲钴胺外,对照组给予安慰剂溻渍治疗,治疗组给予活血通脉方溻渍治疗,疗程为28 d.比较两组临床疗效;治疗前后腓总神经和胫神经感觉传导速度(SNCV)、运动传导速度(MNCV);比较两组治疗前后脑源性神经营养因子(BDNF)、髓鞘碱性蛋白(MBP)含量.结果 治疗组临床疗效优于对照组(P＜0.05).治疗后,两组腓总神经和胫神经SNCV、MNCV较治疗前升高,且治疗组高于对照组(P＜0.05).治疗后,两组血清BDNF水平较治疗前升高,MBP水平较治疗前下降(P＜0.05);治疗组血清BDNF水平高于对照组,MBP水平低于对照组(P＜0.05).治疗过程中未出现明显不良反应.结论 活血通脉方溻渍能提高糖尿病周围神经病变患者的神经传导速度,改善患者的临床症状,其作用机制可能与增加BDNF含量,降低MBP含量有关.

目的:系统评价中药溻渍法治疗糖尿病足溃疡的有效性和安全性.方法:计算机检索PubMed、Cochrane Library、中国知网、万方、维普数据库,检索时限为建库至2021年9月1日,搜集关于中药溻渍法治疗糖尿病足溃疡的随机对照试验(RCT)研究.采用Cochrane偏倚风险评估表对文献方法学质量进行评价,运用RevMan 5.3软件进行Meta分析,采用TSA 0.9软件对结局指标进行试验序贯分析.结果:最终纳入16项研究,涉及1404例患者.Meta分析结果显示,溻渍法的临床有效率显著高于对照组[RR=1.22,95％CI(1.12,1.33)].试验序贯分析显示,有效率的累计Z值在第3项试验穿过TSA界值,中药溻渍法治疗糖尿病足溃疡证据确切,结论可排除假阳性可能.结论:中药溻渍法是治疗糖尿病足溃疡有效安全方法,但存在发表偏倚,且无高质量的研究,亟需针对溻渍法开展高质量、大样本、多中心随机对照试验的临床研究.

目的 探讨糖尿病足溃疡(DFU)Wagner分级与炎性反应指标的关系.方法 收集2020年1月至2021年5月于北京中医药大学东直门医院住院治疗的106例DFU患者的临床资料,根据Wagner分级判断病变严重程度并将所有患者分为轻度病变组(n=32,Wagner分级<3级)和中重度病变组(n=74,Wagner分级≥3级).分析DFU患者Wagner分级与炎性反应指标[外周血白细胞(WBC)、中性粒细胞百分比(NEUT％)、C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)及白细胞介素-6(IL-6)]的关系及DFU患者Wagner分级的影响因素.结果 Wagner分级≥3级组患者的WBC、NEUT％、CRP水平、ESR水平、IL-6水平均高于Wagner分级<3级组患者,差异均有统计学意义(P<0.05).两组患者的PCT水平比较,差异无统计学意义(P>0.05).多因素分析结果显示,ESR、IL-6水平均是DFU患者Wagner分级的影响因素(P<0.05),模型拟合度良好(R2=0.447).结论 ESR、IL-6水平是DFU患者Wagner分级的影响因素,临床中可以结合DFU患者的Wagner分级及相关炎性反应指标进行综合分析与判断,有利于指导DFU的临床诊断及治疗.

目的 分析糖尿病足(DF)患者WIFi预测截肢风险分级与病原菌分布及药物敏感试验结果的关系.方法 收集2020年4月至2021年4月北京中医药大学东直门医院收治的109例DF患者的临床资料,根据WIFi预测截肢风险分级将患者分为极低风险组(n=6)、低风险组(n=18)、中风险组(n=13)、高风险组(n=72).收集4组DF患者的足溃疡分泌物培养结果及药物敏感试验结果进行分析.结果 109例患者中,14例患者的病原菌采取混合细菌培养的方式,共培养出122株细菌.122株细菌中,49株革兰阳性菌(40.16％),71株革兰阴性菌(58.20％),2株真菌(1.64％).以革兰阴性菌为DF患者的主要病原菌.在不同WIFi预测截肢风险分级中,高风险组、中风险组以革兰阴性菌为主要病原菌,低风险组、极低风险组以革兰阳性菌为主要病原菌.WIFi预测截肢风险分级中,革兰阳性菌中的主要葡萄球菌为金黄色葡萄球菌,革兰阴性菌中的主要病原菌为铜绿假单胞菌.革兰阳性菌中分布比例最高的病原菌为葡萄球菌,粪肠球菌及链球菌的比例较少.结论 WIFi预测截肢风险分级与病原菌感染相关.随着DF创面的扩大、缺血的加重及感染的加重,病原菌由革兰阳性菌转向革兰阴性菌,多次、反复的病原菌培养和药物敏感试验能够合理指导临床抗菌药物的使用.

Objective:To compare swab sampling method with tissue sampling method to determine whether diabetic foot (DF) were infected pathogenic bacteria and to determine the consistency of pathogenic microorganism by using Meta-analysis method.Methods:Relevant literatures were retrieved from PubMed, Embase, The Cochrane Library, CBM, CNKI, VIP and Wanfang Data until March 25, 2021. Two independent researchers evaluated the included literatures and extracted the data to analysis, RevMan5.3 and STATA13 software were used to calculate the sensitivity (Sen) and specificity (Spe) of the swab sampling methods to determine whether DF were winfected pathogenic bacteria and the consistence of the pathogenic microorganisms, and subgroup analysis was conducted according to the depth of infection. To compare the difference between the two methods, t test was used to analyze the number of pathogens and Chi-square test was used to analyze the classification of Gram stain typing. Results:A total of 725 samples from 6 studies were included. In the evaluation of swab sampling method to determine whether DF infected pathogenic bacteria, the combined SEN=0.94 [95%CI (0.82-0.98)], the combined SPE=0.59 [95%CI(0.33-0.81)]. While the combined SEN=0.71 [95%CI (0.46-0.87)], the combined SPE=0.28 [95%CI (0.14-0.49)], AUC=0.45 [95%CI (0.41-0.60)], when swab sampling method was used to determine pathogenic microorganisms. In the subgroup analysis, the sensitivity of the shallow infection group was higher than that of the deep infection group. There was no significant difference between the two sampling methods in the number of pathogens obtained by Gram stain typing.Conclusions:Swab sampling is of high diagnostic value in determining whether pathogenic bacteria are infected, but its accuracy in identifying DF infection of pathogenic microorganisms is poor. Swab sampling method cannot completely replace tissue sampling method.

目的 探讨壳聚糖凝胶对下肢深静脉血栓形成后溃疡的有效性及安全性.方法 收集2019年1月至2020年12月北京中医药大学东直门医院收治的72例下肢深静脉血栓形成后溃疡患者的临床资料,根据治疗方法不同将患者分为观察组和对照组,每组36例.两组患者均采取标准压力治疗,观察组患者外用壳聚糖凝胶后外敷凡士林纱布敷料治疗,对照组患者仅外敷凡士林纱布敷料治疗.治疗前、治疗1周后、治疗3周后,比较两组患者的溃疡面积、溃疡愈合情况、创面pH值.结果 治疗1周后、治疗3周后,观察组患者的溃疡面积均小于对照组患者,差异均有统计学意义(P<0.05).治疗3周后,观察组患者的溃疡愈合率为55.56％(20/36),高于对照组患者的30.56％(11/36),差异有统计学意义(P<0.05).治疗3周后,观察组患者的创面pH值低于对照组患者,差异有统计学意义(P<0.05).两组患者的安全性指标均无明显异常变化.结论 壳聚糖凝胶能够提高下肢深静脉血栓形成后溃疡的愈合率,降低创面pH值,且安全性较高.

目的 探讨单纯压力治疗、压力配合泡沫硬化剂(FS)、压力配合腔内激光治疗(EVLT)对伴交通支静脉功能不全(IPV)的下肢静脉性溃疡(VLU)患者的临床疗效.方法 收集2017年1月至2020年3月北京中医药大学东直门医院收治的90例伴有IPV的VLU患者临床资料,根据治疗方式的不同将患者分为单纯压力治疗组(n=27)、压力配合FS组(n=31)、压力配合EVLT组(n=32).观察3组患者的创面愈合时间及随访1年内的溃疡再发情况.观察压力配合FS组和压力配合EVLT组患者局部红肿、疼痛、麻木等术后并发症情况.结果 3组患者的溃疡愈合时间比较,差异有统计学意义(P<0.05).压力配合FS组与压力配合EVLT组患者溃疡的愈合时间均短于单纯压力治疗组患者,差异均有统计学意义(P<0.05).溃疡愈合后,对患者随访1年,从溃疡愈合后的第5个月开始,单纯压力治疗组患者的溃疡复发率明显高于压力配合FS组和压力配合EVLT组患者(P<0.05).压力配合FS组患者术后并发症的发生率为25.8％(8/31),低于压力配合EVLT组患者的53.1％(17/32),差异有统计学意义(P<0.05).结论 对于伴有IPV的VLU患者,处理IPV至关重要,且泡沫硬化剂治疗的术后并发症少于激光治疗.

目的:基于大数据分析总结古代溻渍方治疗疮疡的用药规律,为现代中医外用药研发提供传承依据,探索新药研发思路.方法:筛选《中医经典古方数据库》自春秋战国以来治疗疮疡的溻渍方,数据预处理以后,采用频次统计及关联分析的数据挖掘技术,对高频单味药、药对及新处方组合的使用特点及规律,从临床应用角度并结合现有市售治疗疮疡的外用中成药进行分析.结果:共筛选古方423首,涉及中药280味,单味药频次统计结果:药味以辛苦甘为主,归经以脾肝肾经为主,多用具有止痛、解毒、清热、燥湿的药物;关联分析结果:高支持度置信度用药组合为:黄芩-黄连、当归-甘草、黄芩-甘草等;新方组合有6个,包括黄芩-黄柏-苦参-金银花-蒲公英-白芍-蜈蚣-连翘、白芷-细辛-荆芥-金银花-露蜂房-当归等.结论:古代治疗疮疡溻渍方选用药物以止痛解毒、清热燥湿功效为主,同时重视活血、祛腐排脓药物的应用,结合目前市售治疗疮疡的外用药及临床需求,新药仍待进一步研发.

Objective:To research the clinical efficacy of negative-pressure wound therapy with instillation of Carboxymethyl Chitosan Biological Glue in diabetic foot ulcer.Methods:The study was prospective. A total of 60 patients with diabetic foot ulcers in Dongzhimen Hospital, Beijing University of Chinese Medicine were collected from February 2019 to March 2020. The patients were randomly divided into experimental group ( n=30) and control group ( n=30) according to the random number method. The control group was based on at the same time of treatment, normal saline drip irrigation was used for negative pressure therapy, and the experimental group was used for drip irrigation negative pressure therapy with carboxymethyl chitosan biological glue. The wound volume reduction value and the quantification and scoring criteria of the diabetic foot ulcer curative effect index were recorded in the two groups, and the t test and the rank sum test were used for statistical analysis. Results:In the control group, there was 1 case of leakage in the negative pressure treatment, and finally a total of 59 patients completed and were included in the statistical data. After 14 days of treatment, the wound volume of patients in the experimental group was significantly better than that of the control group [9.00 (7.75, 12.00) ml vs. 5.00 (3.00, 6.00) ml, P<0.01]; the quantification of diabetic foot ulcer curative effect index and scoring in the experimentalgroup was smaller than that in the control group (16.96±1.74 vs. 20.40±7.06, P<0.05). There was no serious adverse events and reactions in the two groups. Conclusion:Carboxymethyl chitosan bio-glue as a drip irrigation solution for negative pressure drip irrigation can promote diabetic foot ulcers, and the effect is better than normal saline.

Objective:To investigate the clinical characteristics and risk factors for major amputation in patients with diabetic foot.Methods:A retrospective study was performed on the clinical data of 2 210 patients with diabetic foot ulcer at the Department of Peripheral Vascular of Beijing Dongzhimen Hospital from January 2011 to June 2018. The patients were divided into two groups according to whether they received major amputation: the major amputation group ( n=93) and the control group ( n=2 117). Risk factors of major amputation in patients with diabetic foot were analyzed through multifactorial logistic regression combined with single factor analysis. Results:Logistic regression analysis showed that dialysis ( OR=2.78, 95% CI:1.10-7.51, P=0.027), rest pain ( OR=27.89, 95% CI: 6.89-112.83, P<0.001), heel ulcer ( OR=9.07, 95% CI:1.19-11.13, P=0.016), bone destruction ( OR=2.61, 95% CI: 1.07-6.32, P=0.033), low ABI ( OR=13.93, 95% CI:3.56-54.54, P<0.001) and moderate to severe infection under IDSA classification ( OR=7.12, 95% CI:1.44-29.37, P=0.035) were the independent risk factors of major amputation in patients with diabetic foot. Conclusion:Dialysis, rest pain, heel ulcer, bone destruction, low ABI and IDSA grade 3 to 4 are the independent risk factors of major amputation in patients with diabetic foot. Early identification of independent risk factors combined with aggressive intervention is the key to preventing major amputation

目的:观察复方黄柏液涂剂溻渍治疗糖尿病足感染耐甲氧西林金黄色葡萄球菌(MRSA)的临床疗效.方法:将2016年1月-2018年12月于东直门医院周围血管科住院且符合纳入标准的糖尿病足患者分为试验组和对照组,两组患者均采用标准化内科基础治疗及创面换药.在此基础上,试验组和对照组分别予复方黄柏液涂剂、莫匹罗星溶液溻渍治疗,qd,观察2周,比较两组的总有效率、创面面积、中医证候积分以及不良事件.结果:共104例患者完成试验,试验组和对照组各52例,总有效率分别为92％和77％.治疗后,在创面面积缩小及中医证候积分降低的对比上,试验组均优于对照组(P＜0.05),两组不良事件发生率无统计学意义.结论:针对糖尿病足MRSA感染,复方黄柏液涂剂溻溃法有良好的效果.

目的 观察象皮粉外掺治疗糖尿病足溃疡虚证患者的临床疗效.方法 将2018年6月-2019年6月于北京中医药大学东直门医院周围血管病科等10家单位住院且符合纳入标准的糖尿病足患者分为试验组和对照组,均采用标准化内科基础治疗及创面换药,分别予象皮粉、表皮生长因子外掺,每天1次,观察14天.结果 共180例患者完成试验,总有效率分别为95.5％、84.4％.治疗后创面面积、中医证候积分、治疗总费用,试验组均低于对照组(P＜0.05).结论 象皮粉外掺治疗糖尿病足溃疡虚证患者有良好的效果.

Objective To analyze the causes of failure of negative pressure wound therapy ( NPWT) in the treatment of diabetic foot wounds, and to explore preventive measures in order to improve therapeutic effects. Meth-ods The clinical data of 580 patients with diabetic foot who were treated with NPWT in Dongzhimen Hospital of Bei-jing University of Chinese Medicine from January 2012 to December 2016 were analyzed retrospectively. After one course of NPWT treatment, the patients who did not respond to therapies were included in the failure group and those with effective and markedly effective treatment as well as those with clinically healed wounds were included in the success group according to curative effect evaluation based on the Guiding Principles of Clinical Research on New Drugs of Traditional Chinese Medicine. The general conditions, wound-related indicators and indicators related to the whole body before treatment were compared between the two groups. Logistic multivariate regression analysis was used to analyze the factors that had statistical differences. Thus, the factors influencing the failure of NPWT in diabetic foot wounds were investigated. Results Of 580 patients, 36 cases failed in NPWT treatment, mainly due to the ag-gravation of wound infection. Multivariate Logistic analysis showed independent risk factors in treatment failure of dia-betic foot wound by NPWT, including ankle brachial index less than 0. 3, wound infection grade greater than or equal to grade 3, wound with active bleeding, wound granulation coverage less than 25% , and wound skin malignant trans-formation. Conclusion To improve the success rate of NPWT for patients with diabetic foot, it is the key to evaluate the degree of ischemia, infection and debridement as well as the general condition of the patients, and to prepare the wound bed accordingly before applying NPWT.

Objective We conducted a systematic review and meta-analysis to clarify risk factors for major amputation in patients with diabetic foot. Methods Observational studies of risk factors for major amputation in patients with diabetic foot published before September 2017 were searched on PubMed and EMBASE. Analysis was performed using Stata 12.0 statistical software and study quality was rated by Newcastle-Ottawa scale (NOS). Results Ten observational studies was identified with 659 major amputation patients and 4 905 controls. Across studies, the overall odds ratios (OR) and 95% confidence intervals (95%CI) of significant risk factors were the depth of ulcer involved bone (OR=11.80, 95%CI 6.90-20.15), dialysis (OR=5.19, 95%CI 2.69-10.04), peripheral arterial disease (PAD) (OR=4.80, 95%CI 2.22-10.36), gangrene (OR=4.67, 95%CI 1.62-13.48), hind foot position (OR=3.64, 95%CI 1.19-11.13), decreased ankle brachial index (ABI) (OR=3.36, 95%CI 1.51-7.52), lower albumin levels (OR=3.13, 95%CI 1.82-5.37), anemia (OR=2.66, 95%CI 1.22-5.79), infection (OR=2.52, 95%CI 1.71-3.71), elevated serum creatinine (OR=1.19, 95%CI 1.08-1.31), ischemic heart disease (IHD) (OR=1.39, 95%CI 1.05-1.84). While there were no significant difference in white blood cell (WBC), C reactive protein (CRP), diabetic peripheral neuropathy (DPN), glycated hemoglobin A1c (HbA1c), hypertension and Charcot foot (all P>0.05). Conclusion Factors associated with major amputation in patients with diabetic foot are the depth of ulcer involved bone, dialysis, PAD, gangrene, hind foot position, decreased ABI, lower albumin levels, IHD, there is no relation with WBC, CRP, HbA1c, DPN, hypertension and charcot foot. Key words: Diabetic foot; Risk factors; Meta-analysis; Major amputation

目的:观察中药对下肢静脉曲张微创治疗术后并发症的预防作用.方法:选择单纯大隐静脉曲张患者134例,按治疗方法分为中药干预组和对照组.两组均行大隐静脉根部结扎、主干剥脱术,小腿部泡沫硬化剂(1%聚多卡醇)注射/腔内光灼闭术治疗,术后弹力绷带加压包扎3天,后改用弹力袜3个月.中药组围手术期口服中药(自拟方),对照组不服中药.术后3天、1个月、3个月随访,比较两组术后疼痛、皮下瘀血、血栓性静脉炎、隐神经损伤、色素沉着、皮肤灼伤等并发症.结果:术后3天两组深静脉血栓形成发生率均较低,仅对照组有1例术肢治疗前后周径差值大于1 cm.中药组疼痛1~3分6例,4~5分9例,6~10分2例均少于对照组10例、11例、6例,差异有统计学意义;中药组血栓性浅静脉炎5例,对照组15例、P=0.10,色素沉着中药组4例,对照组12例,P=0.024,中药组具有明显优势,皮下淤血中药组20例,对照组30例,差异有统计学意义,隐神经损伤和皮肤灼伤中药组例数少于对照组,但无统计学意义;术后1个月疼痛、皮下淤血、皮肤灼伤并发症两组均消失.术后3个月静脉彩超提示中药组深静脉返流通畅,对照组有1例术肢出现小腿部陈旧性血栓.结论:凉血通络法对下肢静脉曲张术后并发症起到有效的预防作用,值得临床推广.

Objective: To conduct a meta-analysis to evaluate the clinical efficacy and safety of Compound Cortex Phellodendri Liquid for treatment of diabetic foot ulcer (DFU). Methods: Databases including Pub Med, EMBASE, The Cochrane Library, CBM, CNKI, Wanfang and VIP data were searched to collect randomized controlled trials (RCTs) about Compound Cortex Phellodendri Liquid in the treatment of DFU from inception to March 2018. Two reviewers independently evaluated the quality of the included studies and extracted the data.Meta-analysis was systematically reviewed by using Rev Man 5. 3 statistical software. Results: A total of 11 RCTs involving 2 147 patients were included. The result of meta-analysis showed that, compared with control group, Compound Cortex Phellodendri Liquid produced a statistically significant improvement for a higher effective rate in DFU (RR = 1. 28, 95％ CI: 1. 17 ～ 1. 41). Six trials revealed that no serious adverse event was related to the use of the drug. Conclusion: Compound Cortex Phellodendri Fluid is an effective and safe external preparation for treating DFU. More high-quality RCTs need to be carried out to confirm the present findings.

Objective To explore the action of Chinese herbal medicine of damp clearing and circulation promotion formula in the treatment of limb ischemia reperfusion injury.Methods 60 patients with ischemic reperfusion injury were selected and randomly divided into a treatment group and a control group,and each group had 30 cases.The control group was given Lipoic Acid Injection and Sodium Aescinate Injection for ⅣV;apart from the treatment for the control group,the treatment group also took damp clearing and circulation promotion granules orally;on treatment day 1,3,7 and 14,the activity of SOD and the concentration of tumor necrosis factor(TNF-α) in intravenous serum were analyzed.Results The symptom scores of the treatment group was significantly lowered than those of the control group on day 3,7 and 14 after treatment,the difference was statistically significant (P ＜ 0.05);TNF-a concentration of the treatment group was significantly lowered than that of the control group on day 3 and day 7,the difference was statistically significant (P ＜ 0.05);SOD activity of the treatment group was significantly higher than that of the control group on day 1 and 3,the difference was statistically significant (P ＜ 0.05).Conclusion Chinese herbal medicine of damp clearing and circulation promotion formula had obvious effects on limb ischemia reperfusion injury.

Objective To investigate clinical features, misdiagnosed causes and diagnosis and treatment strategy of cholesterol crystal embolization (CCE).Methods Clinical data of 3 misdiagnosed patients with CCE admitted in recent years was retrospectively analyzed.Results The 3 patients with lower limb arteriosclerosis occlusion underwent lower limb intracavity angioplasty treatment, all patients had postoperative lyons blue lesions in toe extremitates skin, and then all patients were misdiagnosed as having blue toe syndrome.Abnormally increased values of renal function level, c-reaction protein (CRP), erythrocyte sedimentation rate and eosinophils were found in 3patients, of whom 2 patients were timely confirmed the diagnosis of CCE, and were forbidden with anticoagulation and thrombolytic therapy, and the prognoses were good by follow-up;1 patient was continuously treated with anticoagulation and thrombolysis, and finally died of multiple organ failure.Conclusion If patients with atherosclerosis have increased eosinophils and inflammatory index levels, skin lesions, unexplained renal injury, gastrointestinal or neurological manifestations after vascular intervention, and CCE should be considered, and therefore histopathologic examination for many times can confirm the diagnosis.

目的:通过研究糖尿病溃疡患者踝肱比值及激光多普勒血流灌注量,来探讨两者与不同的中医辨证分型的关系。方法:通过临床辨证分型将糖尿病溃疡分为气虚血瘀型和湿热蕴结型,并设立正常对照组,检测血沉、胆固醇、血脂、低密度脂蛋白、高密度脂蛋白、踝肱比值、激光多普勒血流灌注量在不同组别中的变化。结果:糖尿病溃疡患者踝肱比值较正常对照组明显降低,且气虚血瘀组＜湿热蕴结组,组间差异有统计学意义（P＜0.01）;激光多普勒血流灌注百分比较正常对照组明显降低,且气虚血瘀组＜湿热蕴结组,组间差异有统计学意义（P＜0.01）;经Logistic回归分析得出糖尿病溃疡中医辨证分型与糖尿病病程、踝肱比值密切相关。结论:踝肱比值及激光多普勒血流灌注量与糖尿病溃疡患者的不同中医辨证分型具有一定相关性,对于不同的证型差异有统计学意义,说明糖尿病溃疡患者均存在不同程度的缺血,气虚血瘀型缺血程度更加明显,糖尿病病程及踝肱比值与糖尿病溃疡的中医辨证分型的相关性最大。