35例感染性糖尿病足的治疗与护理

总结了本院内分泌科2008年1月～2010年5月共收治的35例感染性糖尿病足的治疗与处理.包括:整体治疗:控制血糖、控制感染、改善微循环、营养神经治疗.局部创面处理.采取的护理措施:体位护理、患足局部护理、心理护理、饮食调理.认为以上的治疗和护理措施,可以使感染性糖尿病足患者致死致残率大大降低.     

内治法与外治法联合应用治疗感染性糖尿病足

糖尿病足是糖尿病常见的致残性并发症.目前我国糖尿病患者约3 000万,居世界第2位,糖尿病足发病率为0.9%～14.5%,这就意味着我国将有27～435万糖尿病足病患者:糖尿病足截肢率是非糖尿病患者的15～20倍,而其中85%的截肢患者是由"清洁的"溃疡继发感染而最终截肢的[1-2],感染是糖尿病足截肢的重要因素.虽然目前治疗糖尿病足溃疡的方法有抗感染、周围血管腔内治疗、开放性血管重建术等多种方法,然而溃疡不愈合依然是突出的临床难题,中医以内治法与外治法联合治疗具有较好的治疗效果.     

糖尿病足的临床分析及综合性治疗

目的:探讨糖尿病足的临床特点及有效的综合性治疗方法.方法:对21例糖尿病足患者的临床资料进行回顾性总结;有效控制高血糖、高血脂、高血压;根据细菌培养和药敏使用抗生素;改善局部血供、抗凝、扩张血管,药物湿敷等综合治疗.结果:0～3级糖尿病足总有效率为87%,4～5级无一例治愈.结论:糖尿病足应早期发现、早期全面综合治疗.     

糖尿病足的发病机制

糖尿病足(diabetic foot,DF)是糖尿病综合因素引起的足部疼痛、皮肤深溃疡、肢端坏疽等病变的总称,是与下肢远端神经异常和不同程度的周围血管病变相关的足部感染、溃疡和深层组织破坏,属于祖国医学"脉痹"、"脱疽"的范畴,是糖尿病严重慢性并发症之一,具有很高的致残率和致死率,是临床上棘手的足部综合征.糖尿病足可能与很多因素有关,其中主要包括:周围神经病变及血管病变.     

20例糖尿病足的护理体会

目的 探讨糖尿病足的护理方法.结果 对20例糖尿病足患者进行有效的护理措施与健康教育.结果经医护人员的密切配合,精心护理,糖尿病足患者16例愈合.结论 加强糖尿病足知识宣教,控制血糖,足部护理,提高治愈率,降低致残率,取得了良好的效果.     

糖尿病足的护理

回顾性分析43例糖尿病足病人的临床资料,总结了糖尿病足的预防及护理措施,包括避免诱因、培养良好生活习惯、注意健康教育、进行全方位护理,认为重视足部预防和护理对抑制糖尿病足的发生与发展,减少致残率,提高病人的生活质量有重要意义.     

糖尿病足的预防与护理要点

糖尿病足是一类在糖尿病周围神经病变和外周血管病变基础上,由于足应力、外伤、感染等因素引起的严重下肢病变的总称.近年来,随着人口不断老化、生活方式的不断改变和生活水平不断的提高,糖尿病患病率明显上升,糖尿病足发病率也越来越高,严重威胁着人们的身体健康,有时甚至无法愈合而截肢,因此预防和护理糖尿病足非常重要.     

糖尿病足病的预防及护理

糖尿病足是指糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏.临床上,由于糖尿病患者长期受到高血糖的影响,下肢血管硬化、血管壁增厚、弹性下降,血管容易形成血栓,并集结成斑块,而造成下肢血管闭塞、支端神经损伤,从而造成下肢组织病变.随着糖尿病发病率的逐年升高,糖尿病足患者人数也在逐年增多,甚至已达到糖尿病患者的49.5%[1].通过对糖尿病足患者加强足部护理,防止外伤,健康教育等手段,使其降低了并发症的发生率.     

肤痔清软膏换药治疗30例糖尿病足的护理体会

糖尿病足(糖尿病合并肢端坏疽)是由于局部周围神经病变和下肢远端外周血管病变导致的足部感染、溃疡或深层组织破坏,是一种慢性、进行性以肢端缺血、溃烂、坏死为临床表现的疾病,主要原因是大血管、微血管及周围神经病变.糖尿病足作为糖尿病血管并发症之一,具有病程长,不易愈合且易复发的特点,是糖尿病患者致死致残的重要原因.本院从2004年起采用苗药肤痔清软膏换药治疗糖尿病足30例,取得了满意效果.现报告如下.     

糖尿病足的临床观察与护理

糖尿病足是指患者踝关节以下部位的溃疡坏疽或感染,是糖尿病的严重并发症.我院自2006年-2010年共收治糖尿病足36例,经胰岛素控制血糖、抗生素控制感染、抗凝改善微循环及局部换药清除坏死组织等治疗,取得了满意效果,全部病人均治愈出院.现将护理体会报告如下.     

The diabetic foot]

The role of strain differences in cadmium tissue distribution was studied using sensitive (129/J) and resistant (A/J) mice. These murine strains have previously been shown to differ in their susceptibility to cadmium-induced testicular toxicity. Cadmium concentration was measured in testis, epididymis, seminal vesicle, liver, and kidney at 24 h after cadmium chloride exposure (4, 10, and 20 micromol/kg CdCl2). The 129/J mice exhibited a significant increase in cadmium concentration in testis, epididymis, and seminal vesicle at all cadmium doses used, compared to A/J mice. However, cadmium concentrations in liver and kidney were not different between the strains, at any dose, indicating that cadmium uptake is similar in these organs at 24 h. These murine strains demonstrate similar hepatic and renal cadmium uptake but significantly different cadmium accumulation in the reproductive organs at 24 h. The mechanism of the protective effect of zinc on cadmium toxicity was studied by assessing the impact of zinc acetate (ZnAc) treatment on cadmium concentrations in 129/J mice after 24 h. Zinc pretreatment (250 micromol/kg ZnAc), given 24 h prior to 20 micromol/kg CdCl2 administration, significantly decreased the amount of cadmium in the testis, epididymis, and seminal vesicle of 129/J mice, and significantly increased the cadmium content of the liver after 24 h. Cadmium levels in the kidney were unaffected at this time. Zinc pretreatment also prevented the cadmium-induced decrease in testicular sperm concentration and epididymal sperm motility seen in 129/J mice. These findings suggest that the differences in the two murine strains may be attributed partly to the differential accumulation of cadmium in murine gonads. This may be caused by strain differences in the specificity of cadmium transport mechanisms. The protective role of zinc in cadmium-induced testicular toxicity in the sensitive strain may be due to an interference in the cadmium uptake by susceptible reproductive organs.     

Haemorheology in diabetic foot

Have the 1990 NHS and community care reforms totally divorced the national health service from its founding principles? Is commercialism compatible with public service? In the following extracts from a paper presented at the HVA 1993 annual professional conference Reg Pyne, in a presentation of his personal views, highlights short-comings in the organisation and delivery of both health and social care since the reforms were introduced. He calls on nurses and their managers to stand by their professional principles to defend standards and equity in NHS services.     

Salvage of the diabetic foot with exposed os calcis

Fifty consecutive heel ulcers were managed in three groups by debridement, split-thickness skin graft (STSG), bypass procedures, and orthotics. Group I consisted of 24 ulcers in patients with diabetes (DM) and peripheral vascular disease (PVD), 14 patients in Group II with DM only, and 12 patients with PVD only (Group III). Healing occurred in 56.5%, 64.3%, and 83.3%, respectively. An average of 2.2 procedures were performed per patient. Follow-up periods were for a minimum of two years or until amputation. Time for complete healing and the number of amputations performed were similar in all groups. Of the diabetics (combined from Groups I and II), a subgroup of 27% required partial excision of the os calcis to facilitate closure. After saline dressing changes, STSG was accomplished over thin granulation tissue. Forty percent of this subgroup healed, 30% remained open, and 30% were amputated. Aggressive management, soft-tissue coverage, and orthotic use can lead to a functional weight-bearing extremity.     

Factors associated with methicillin resistance in diabetic foot infections

Methicillin-resistant staphylococcal infections often present a challenge to physicians treating patients with pedal wounds. Most methicillin-resistant Staphylococcus aureus infections have been thought of as nosocomial in origin. Several studies have identified specific modes of transmission via hospital reservoirs such as the anterior nares of the patient, inanimate objects within close proximity of the patient, and direct contamination from health care providers. Exposure of patients to these reservoirs through hospitalization has been shown to increase the patient's risk of obtaining a methicillin-resistant S. aureus infection. Diabetic patients with a high risk for foot complications may be in greater danger of developing a methicillin-resistant S. aureus infection in that repeated hospitalizations, lengthier hospital stays, and the presence of open wounds facilitate exposure to these reservoirs.     

Role of neuropathy and high foot pressures in diabetic foot ulceration

OBJECTIVE: High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population. RESEARCH DESIGN AND METHODS: We studied a cross-sectional group of 251 diabetic patients of Caucasian (group C) (n=121), black (group B) (n=36), and Hispanic (group H) (n=94) racial origins with an overall age of 58.5+/-12.5 years (range 20-83). There was an equal distribution of men and women across the entire study population. All patients underwent a complete medical history and lower extremity evaluation for neuropathy and foot pressures. Neuropathic parameters were dichotomized (0/1) into two high-risk variables: patients with a vibration perception threshold (VPT) > or =25 V were categorized as HiVPT (n=132) and those with Semmes-Weinstein monofilament tests > or =5.07 were classified as HiSWF (n=190). The mean dynamic foot pressures of three footsteps were measured using the F-scan mat system with patients walking without shoes. Maximum plantar pressures were dichotomized into a high-pressure variable (Pmax6) indicating those subjects with pressures > or =6 kg/cm2 (n=96). A total of 99 patients had a current or prior history of ulceration at baseline. RESULTS: Joint mobility was significantly greater in the Hispanic cohort compared with the other groups at the first metatarsal-phalangeal joint (C 67+/-23 degrees, B 69+/-23 degrees, H 82+/-23 degrees, P=0.000), while the subtalar joint mobility was reduced in the Caucasian group (C 21+/-8 degrees, B 26+/-7 degrees, H 27+/-11 degrees, P=0.000). Maximum plantar foot pressures were significantly higher in the Caucasian group (C 6.7+/-2.9 kg/cm2, B 5.7+/-2.8 kg/cm2, H 4.4+/-1.9 kg/cm2, P=0.000). Univariate logistic regression for Pmax6 on the history of ulceration yielded an odds ratio (OR) of 3.9 (P=0.000). For HiVPT, the OR was 11.7 (P=0.000), and for HiSWF the OR was 9.6 (P=0.000). Controlling for age, diabetes duration, sex, and race (all P < 0.05), multivariate logistic regression yielded the following significant associations with ulceration: Pmax6 (OR=2.1, P=0.002), HiVPT (OR=4.4, P=0.000), and HiSWF (OR=4.1, P=0.000). CONCLUSIONS: We conclude that both high foot pressures (> or =6 kg/cm2) and neuropathy are independently associated with ulceration in a diverse diabetic population, with the latter having the greater magnitude of effect. In black and Hispanic diabetic patients especially, joint mobility and plantar pressures are less predictive of ulceration than in Caucasians.     

Quality of care of patients with diabetic foot problems in Barbados

In Barbados diabetics with foot problems account for 80% of the patients in the female and 50% of those in the male general surgery wards, and many patients have major amputations for preventable problems. A six month prospective study was undertaken of all cases admitted with foot problems to the general surgical wards of the Queen Elizabeth Hospital (QEH) in order to determine the quality of foot care, particularly among diabetics. 67.5% of the 195 patients (55% female) admitted to the study were diabetic, most of whom were diagnosed 10 to 19 years previously. Most of the patients were 70 to 80 years old, but significantly more diabetics than non-diabetics were 40 to 70 years old. Foot problems in diabetics were precipitated by events that are considered trivial in non-diabetic patients. 87 (58%) of 150 responding patients had their feet inspected by health personnel in the previous year. 47 (63.5%) of the 74 who responded about the care of their nails said that they took care of their nails themselves. Nearly 40% of diabetic and non-diabetic patients had no reported source of care before their admission. 14 patients (10 diabetic) sought care the same day and 11 (nine diabetics) the day after noticing foot problems. Most patients presented with infection as part of their problem; recognition of the early signs of infection should be an integral part of the education of the diabetic patient. Educational efforts for patients must be continually reinforced because many patients said they had had no education about the care of their feet in the previous year.