| Part Ⅰ:Clinical Study ObjectiveTo retrospectively study the clinical dialectical classification of diabetic foot infected by multiple drug-resistant bacteria,and to observe the difference of blood routine,CRP,FIB,PCT and other inflammatory indexes and symptom scores between the routine treatment group and the conventional treatment group,so as to explore its feasibility in order to reduce the pain of patients,reduce the cost of hospitalization and the use of antibiotics,and compare the differences of clinical syndrome types and multiple drug-resistant infections.MethodsA retrospective analysis selected in April 2013 to December 2020,the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine hospital patient records,who were mainly diagnosed as "type 2 diabetic foot" and the results of wound secretion culture showed multiple drug-resistant bacterial infection,aged from 18 to 85 years old,with diabetic foot ulcer.After excluding the short hospitalization time,incomplete clinical test data and patients who died of cardiovascular and cerebrovascular diseases during treatment,123 cases were finally selected and divided into treatment group and control group according to whether oral traditional Chinese medicine was taken or not.In addition,on the basis of the syndrome type of Chinese Diabetic foot Prevention and treatment Guide(2019 Edition),Combined with Tianjin University of Traditional Chinese Medicine,Second Affiliated Hospital of conventional surgical treatment and data collection review.After merging some syndrome types,they were mainly divided into 1 damp-heat toxin accumulation,2 dampness and blood stasis nostalgia,qi-yin deficiency syndrome 3 spleen and kidney yang deficiency,vein stasis syndrome.In the treatment group,in addition to clinical routine hypoglycemia,anti-infection,improving circulation and local debridement,the main prescriptions were Tuoli disinfection powder combined with Simiaoyong’an decoction,Buyang Huanwu decoction and Jinkui Shenqi pills combined with Buyang Huanwu decoction.The control group for clinical routine treatment group,not taking decoction.The data of the above treatment group and control group were analyzed and studied by selecting individual indexes at admission and 14 ±2 days,and describing symptom score scale at admission and 14 ±2 days.SPSS22.0 statistical software was used for statistical analysis,and α = 0.05 was used as the test standard.Results1.Clinical data and efficacy of the two groups showed no significant difference between treatment and control groups were comparable.2.After 2 groups hospitalization related to inflammation were significantly improved,the results of the two groups were significantly different differences.The decrease of inflammatory indexes such as WBC,NEUT% and CRP slightly higher treatment groups,but no significant difference between the two groups(P>0.05.No significant difference before and after treatment group).There was no significant difference in the control group before and after treatment(P > 0.05).Treatment group differences before and after treatment significantly.3 The differences of all indexes between the two groups before and after treatment were compared,except for d-FPG,all the other items conformed to normal distribution.Statistics showed that there was no significant difference in treatment difference between WBC,NEUT%,PCT and FGP.The FIB of the treatment group was significantly different than that of the control group(P <0.05).3.groups of symptom scores before and after treatment are decreased,but the score of the treatment group decreased more significantly,effective treatment group was higher(P <0.05).4.There were significant differences in lower limb vascular condition,antibacterial cost,ALB,Hb A1 c,FGB,WBC,NEUT%,FIB and PCT among different syndrome types.Treatment should have its own emphasis.ConclusionThe main foot infection flora of multi-drug resistant diabetes were Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Proteus mirabilis and Acinetobacter baumannii.There was no significant difference in the distribution of microflora among different syndrome types.Oral administration of traditional Chinese medicine combined with routine treatment of multiple drug-resistant bacteria infected diabetic foot is effective,there is no significant difference with the control group,the symptom score of the treatment group is better than the control group,with statistical difference to further improve the symptoms of patients.At the same time,the cost of antibiotic use is better than that of the control group,which can reduce the clinical use of antibiotics and reduce the occurrence and progress of drug resistance.Part Ⅱ:Systematic Analysis ObjectiveIn order to further evaluate the therapeutic effect of internal and external treatment of traditional Chinese medicine in diabetic foot ulcer infection,provide more sufficient evidence of evidence-based medicine for clinic,and supplement the indicators that were difficult to be included in previous retrospective studies,Meta analysis was carried out.MethodTaking "diabetic foot ulcer" OR,"diabetic foot","integrated traditional Chinese and western medicine" and "infection" as key words,the database of China knowledge Network,Wanfang and VIP was searched by computer from January 2014 to December 2020.According to the inclusion criteria,14 literatures were obtained.The selected literature was evaluated by Cochrane system evaluation,the literature quality was evaluated by jade score,and the analysis software Revman5.3 recommended by Cochrane collaboration network was used for analysis.ResultThe related indexes were grouped and analyzed,and the results showed that the combination of traditional Chinese and western medicine was more effective than western medicine in reducing C-reactive protein and interleukin-6 and improving the wound healing rate in the treatment of diabetic foot infection.The effect on ABI is not obvious.ConclusionThe combination of internal and external use of traditional Chinese medicine can play a synergistic effect to accelerate the regression of inflammation to a certain extent.There is no significant improvement in ABI,analysis of its possible reasons,the shorter treatment cycle because the elimination of inflammation can improve some symptoms,but can not change the vascular state in a short time,longer-term experiments are needed to provide solid evidence.Evidence-based medicine can summarize the research results and expand the sample size,so as to provide more reliable results and provide some guidance for the choice of clinical treatment. |
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