中国部分省市糖尿病足调查及医学经济学分析

A multicenter survey on the diabetic foot and medical economics in China

目的调查和分析2型糖尿病患者糖尿病足的分类分期和医疗费用.方法以统一的调查方法对全国11个省市、14家三级甲等医院2004年全年门诊和住院糖尿病足患者进行调查,包括病史回顾、体格检查、生化检查及医疗费用等,对足溃疡进行分类、分期和病因分析,以及采用踝肱动脉压比值确定下肢血管病变程度.结果共调查糖尿病足与周围血管病变患者634例.足病高发在年龄71～80岁、病程11～20年、文化程度初小及初中、月收入501～1 500元的糖尿病患者.足病患者合并糖尿病并发症或相关病变依次为神经病变(68.0%)、高血压(57.4%)、视网膜病变(42.8%)、肾病(40.4%)、血脂异常(30.0%)、下肢动脉病变(28.7%)、冠心病(28.5%)、脑血管病(24.3%),吸烟率为38.8%.足溃疡诱因以物理因素(77.7%)为主.足溃疡和(或)坏疽患者中,溃疡以单发(57.3%)、Wagner 1级和2级溃疡(63.2%)为主,合并坏疽者28.8%,部位多在足趾(88.0%),干性坏疽居多(49.1%).足溃疡以混合型溃疡为主(60.4%),67.9%的溃疡合并感染.糖尿病足溃疡患者平均住院日数为26天,住院总费用为14 906元.206例糖尿病足患者的主要费用的分布为药品费7 661元、检查费2 567元、治疗费1 548元、处置-换药费771元.结论糖尿病足患者多为高龄、文化程度低、收入低者;多已合并大血管及微血管病并发症.足溃疡中单发、表浅及缺血溃疡多见,合并感染率高;医疗花费大,以药品花费最多.

Objective To investigate the classification and the pathogenesis of diabetic foot and peripheral artery diseases （PAD） and the medical cost of these patients in both in-patient and out-patient facilities. Methods Diabetic patients with foot problems and/or PAD were surveyed from January 1 to December 31,2004 in 14 teaching hospitals located in 11 provinces in China, including demographic data, present and past history of the foot and PAD, the classification and phases of the foot ulcers based on the Wagner system and Texas system, control of the hyperglycemia and lipid disorder, medical cost in hospital and the diabetic complications and relative risk factors. All staff involved in the survey were trained before the study and the standard form was used for the purpose. Results In the study, 634 diabetic patients with foot problems and/or PAD were analyzed. Foot problems most frequently occurred in the elderly diabetic patients （71-80 years old） with long duration （11-20 years）, lower educational level and lower income. Most of these patients had diabetic complications or cardiovascular risk factors, including neuropathy （68.0%） , hypertension （57.4%） , retinopathy （42.8%） , nephropathy （40.4%） , smoking （38.8%） , lipid disorder（30.0% ） , PAD （28.7%） , coronary heart disease （28.5%） , cerebral vascular disease（24.3% ）. 63.2% of the ulcers were at the Wagner stage 1 or 2. In 57.3% of these patients, only one ulcer was detected. 28.8% of these patients were accompanied with gangrene, mainly gangrene of one toe or toes. 67.9% of ulcers were complicated with infection. The mixture of ischemic and neuropathic ulcers were most common （ 60.4% ）. The average direct medical cost in hospital for the diabetic patients with foot problems and/or PAD was RMB 14 906 yuan （about US $ 1850）, Conclusion Foot problems markedly increase the medical cost of the diabetic patients. The elderly diabetic patients with long duration, lower educational level and more diabetic complications or more cardiovascular risk factors should be paid more attention on intensifying foot care and preventing education of foot problems.