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Analysis of the Effect of MEBT/MEBO on Necrotic Diabetic Foot Ulcer
Author£ºAdmin  
Source:mebo
Add Time£º2011/8/11 16:14:29
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Li Chuanji, Ding Xiaohong£¬Wu Shaojun, Gao Hua
1 Burns Department of The 1st People¡¯s Hospital, Shizuishan City, Ningxia Autonomous Region, 753200
2 Department of Emergency Medicine of Shizuishan Traditional Chinese Medical Hospital, Shizuishan City, Ningxia Autonomous Region, 753200
 
¡¾Abstract¡¿ Objective: To further verify the efficacy of MEBT/MEBO in treating necrotic diabetic foot ulcer. Method: Incision and drainage surgery and douching were performed on the patients with finally diagnosed necrotic diabetic foot ulcer in the early stage. MEBO was applied with dressing change by perfusion method in combination with systemic combined therapy including anti-hyperglycemia, anti-infection and nutrition support. Result: All the 15 cases were cured with restored physiological function without one case of disablement or amputation. Conclusion: MEBT/MEBO is effective on necrotic diabetic foot ulcer, restoring the physiological function of the foot.
¡¾Key words¡¿ Diabetic foot ulcer; Necrotic; MEBT/MEBO
    
Diabetic foot ulcer is a common disease among middle-aged and senior population over 45 years. It is usually caused by delayed treatment after the epidermal injury by some stimulus and the sharply aggravated wound condition within a short period of time, even refractory ulcer resulted in. Severe redness and swelling of the foot and extensive ulcer and cacosmis are usually the manifestation of the necrotic diabetic foot ulcer. Since 2001, MEBT/MEBO has been applied on the necrotic diabetic foot ulcer in combination with systemic treatment on the primary disease and remarkable results have been attained as shown in the following report:           
     
1 Clinical data
Fifteen cases of necrotic diabetic foot ulcer in the group aged between 42-76 years with the average of 61.27y¡À8.78y, including 11 males (accounting for 73.33£¥) and 4 females (accounting for 26.67£¥) with the ratio being 2.75£º1; Diabetes history: 22-61 days, average of 34.87¡À11.50d; Cause of injury: 7 cases of scald by boiling water (accounting for 46.67£¥), 4 cases of abrasion by shoes or socks (26.67£¥), 4 cases of infection by panneuritis endemica (26.67£¥). All the 15 cases were diagnosed as non-insulin dependent diabetes, including 11 cases diagnosed as non-insulin dependent diabetes before admission (73.33£¥) and 4 cases of denial of diabetes (26.67£¥). The general data of the patients are as shown in table 1.  
 
 
 
 
Table 1 General Data of 15 Cases of Necrotic Diabetic Foot Ulcer
    
No.
Gender
Age 
 
Time of disease£¨Age£©
 
Fasting blood glucose when admission (mmol/L)
 
Healing duration (Day)  
1    
 Female
42 
22
22.67
94
2
Male 
46
24
21 .80
51
3
Male
46
24
19.80
56
4
Male
48
26
19.01
59
5
Female
55
26
20.61
60
6
Male
57
26
20.00
60
7
Female
57
31
21.20
64
8
Male
62
31
20.46
66
9
Female
68
34
18.42
66
10
Male 
70
34
20.06
66
11
Male    
70
45
21.61
70
12
Male    
72
45
20.43
70
13
Male   
74
47
18.41
94
14
Male 
76 
47
20.61
104
15
Male
76
61
19.82
110

2 Method
 
1) Systemic treatment: ¢ÙAnti-hyperglycemia treatment: Fasting blood glucose of the patients was measured and directional recheck of the blood glucose was then performed based on the measured value, and non-insulin dependent diabetes was diagnosed. Routine anti-hyperglycemia therapy was applied with the assistance of Endocrine Department to control the fasting blood glucose below 8mmol£¯L; ¢ÚAnti-infection treatment: The administration of antibiotics should be reasonable. It was indicated by the susceptibility test that bigeminy of drugs was required with the first choice being third-generation cephalosporium and metronidazole in full dosage by i.v. for one week based on the medical experience; ¢ÛSystemic nutrition supportive therapy: The excessive consumption of the diabetes requires the correction of water and electrolyte balance and acid-base balance disorder, proper supplement of albumin, and transfusion of fresh whole blood for multiple times with small amount for each time, in order to promote the restoration of the patients¡¯ physical condition and improve the regenerative potential of the wound tissue.
 
2) Local treatment: ¢ÙDebridement and drainage: During incision and drainage, the non-alive necrotic tissues should also be eliminated as possible, in order to make a thorough drainage. Sinus ulcer should be treated with contra-aperture windowing discussion; the 1.5£¥ hydrogen dioxide and physiological saline were used to do alternating douche of the wound and sinus in early stage; MEBO was then applied on the wound and sinus after the residual saline was absorbed out with sterile gauze.  ¢ÚDressing change of the sinus: MEBO oil gauze was filled in the sinus by perfusion method for drainage; bandage and change dressing twice a day. Necrotic tissues were eliminated thoroughly after two weeks¡¯ treatment, which indicated the coming of the stage of tissue regeneration. In this stage, douche was stopped and exposed MEBO application was performed with dressing change once every 4 hours till wound healing; the patient should be kept in bed throughout the treatment with raising movements performed on the diseased limb.
 
3 Result
 
All the 15 cases in the group achieved regenerative healing with the duration from
51¡«110d¡À16.20d (average of 72.67d). Follow-up was carried out on 13 cases 1 year
later with the rechecking rate being 86.67£¥, and all the 13 cases could take normal
walking and housework without functional disability of the diseased limb bearing the
similar skin color to the contralateral limb. The patients kept self-treatment on
diabetes after discharge from the hospital with improved consciousness of self
health-care. Recheck was not taken on the other two cases because of the unknown
home address and contact information.
 
Typical cases: Ms. Lv, female, 42 years, laid-off worker, was affected with left foot ulcer aggravated after 22 days¡¯ treatment in other hospital. After the patient refused the suggestion of amputation by that hospital, she was admitted in our hospital for MEBT/MEBO treatment on Jan. 23rd, 2005. Physical examination and diagnosis were made as non-insulin dependant diabetes though the patient denied having diabetes history during treatment in the former hospital. Admission and examination: morning fasting blood glucose of 22.67mmol£¯L£¬severe swelling of the left foot, extensive ulcer from the lateral dorsum to postmedian sole of the foot, sinus formed between sole and calcar pedis, calcaneus exposure, ulcer and necrosis with cacosmis in large area of fascia and muscle. After treatment of anti-inflammation, nutritional support and anti-hyperglycemia, fasting blood glucose was decreased to 8.60mmol£¯L after one week, and maintained between 5.30mmol£¯L-6.84mmol£¯L. Local contra-aperture windowing incision and douche were performed on the sinus in the early stage, and necrotic fascia and muscle tissues were removed; MEBO was then perfused in the sinus with MEBO oil gauze for two-way drainage; bandage the wound with dressing change twice a day. The necrotic tissues were eliminated thoroughly after two weeks¡¯ treatment, and the wound entered the stage of tissue regeneration and reparation, when exposed MEBO application was performed with dressing change once every 4 hours. The wound realized regeneration and reparation after 94 days¡¯ treatment with the restored physiological function and form of the left foot after discharge. (See figure 1, 2, 3, 4, 5)
   
Fig.1£ºMs. Lv£ºDiabetic foot ulcer£¨Necrosis£©
Fig.2: After MEBT/MEBO treatment for 3 weeks, the necrotic tissues were discharged thoroughly with infection under control, and the wound entered the stage of tissue regeneration and reparation.
Fig.3£ºThe wound healed basically after 75 days¡¯ MEBT/MEBO treatment.   
Fig.4£ºThe wound healed completely after 90 days¡¯ treatment with restored physiological function though small area of tissue loss left.
Fig.5£ºThe patient was discharged after 90 days¡¯ treatment with the restored physiological function and form of the left foot.
 
4 Discussion:
 
1)    Analysis of complications: Diabetes is a common disease in China. According to the census on 300,000 population in 14 provinces and municipalities in China in 1980, the diabetes patients accounted for 6.09£¥£¬no obvious difference in case rate observed between male and female. Case rate among patients over 40 years was high up to 30£¥-40£¥, patients in 40 years and below being less than 20£¥;the rate was only 3.88£¥ among non-overweighted population. Non-insulin dependant diabetes was the majority with pathological changes of systemic small vessels and capillaries observed in about 70£¥ of the total patients[1£Ý. The above statistics indicate the generality of diabetes in China with the possibility of incidence in various populations. There is an upgrading trend in the incidence rate with the improvement of the living standard.
 
Till now, diabetes is little known in its etiopathogenesis and no effective method has been found though the therapeutic tool is getting perfect [2]. No method for radical cure is found with the current aim of treatment being only anti-hyperglycemia, metabolic disorder correction, maintenance of normal physical strength and body weight, symptoms control, prevention and reduction of complications in its incidence and development as well as death rate reduction£Û1£Ý. For that low-incomed population who can not afford the regular physical examination in particular, most of them are usually alarmed with diagnosed diabetes in examination years after they have been affected with it. Four out of 15 cases in the group did not know their diabetes before admission (accounting for 26.67£¥).
 
Diabetes may involve nervous system and circulatory system, resulting in micro-circulation disorder and disesthesia of the skin tissue, which may cause skin injury due to scald by the hot water or compression by over-tight shoes or socks. Such injury slight for healthy people may lead to severe complications of the diabetes patients. Most of the patients in this group had such cause. Therefore, promoting science popularization, improving the consciousness of self health-care of the diabetes patients with reasonable treatment of primary diabetes are all crucial methods to improve the life quality and decrease complications of the diabetes patients.
 
2)      The advantage of MEBT/MEBO in treating diabetic foot ulcer: MEBT/MEBO belongs to an innovative medical system established by Professor Xu Rongxiang. Diabetic foot ulcer is in the field of ¡°wound and ulcer medicine¡± characterized by such pathological changes as wound exudation, infection and tissue necrosis. [3£ÝThe diagnosis and treatment of diabetic foot ulcer based on the system of ¡°wound and ulcer medicine¡± and the conception and therapy of ¡°MEBT/MEBO¡± conform to the traditional Chinese medicine and the new medical system by Prof. Xu¡¯s. The treating method of MEBT/MEBO goes with the basic theory of eliminating the necrosis and promoting granulation to realize tissue regeneration and reparation in traditional Chinese medicine. The basic effect of MEBO: inducing variation of the pathogenic bacteria, decreasing toxicity, alleviating pains, anti-inflammation, protecting cells by increasing the tension of cell membrane to save cells to its vigorous state from necrosis-approaching condition;£Û3£Ýin addition, it can initiate series of bio-chemical reactions, i.e. hydrolysis, enzymolysis, rancidity, saponification and lipofaction with necrotic tissues on one hand, and supply life regenerative nutrients necessary for cell growth of the wound on the other£Û4£Ý. With the unique pharmaceutical effect of MEBO, the necrotic tissues of the necrotic diabetic foot ulcer can be discharged thoroughly, local microcirculation improved with increased regional blood flow volume, local immunity and anti-infection ability strengthened with the necrosis development under control, and the regeneration and reparation of the wound promoted, thus the ulcer foot can be saved from amputation.
 
Reference:
£Û1£ÝZhu Huimin, Internal Medicine£ÛM£Ý. People¡¯s  Health Publishing House. The third edition of National Medical Teaching Materials,383-387£®
£Û2£ÝChen Haozhu, Internal Medicine£ÛM£Ý. People¡¯s  Health Publishing House. The third edition of National Teaching Materials for High Medical College, 724£®
£Û3£ÝXu Rongxiang, Chinese Burns Wounds & Surface Ulcers Medicine£ÛM£Ý£¬Chapter of Local Treatment, 1. Wound and ulcer; 2 Wound and ulcer treating technique
£Û4£ÝXu Rongxiang, Blue Book for Burns Medical Technique£ÛM£Ý£®Chinese Medicine Technology Publishing House:41¡«46£®
 
Brief Introduction of the Authors:
Li Chuanji£¨1954¡«£©£¬male£¬director of burns department, associate chief physician, bone in Feixian County, Shandong Province, graduating from Ningxia Medical University in 1958.
Ding Xiaohong£¨1966¡«£©, female£¬attending physician, bone in Shizuishan City, Ningxia Autonomous Region, graduating from Department of Medical Treatment of Northwest University for Nationalities in 1990.
Wun Shaojun £¨1975¡«£©£¬male£¬resident physician, bone in Pingluo County, Ningxia Autonomous Region, graduating from Department of Medical Treatment of Ningxia Medical University in 1996.

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