华西医院住院糖尿病足的流行率及临床疗效

The trend of prevalence rate and clinical therapeutic efficacy of patients with diabetic foot in West China Hospital

目的探讨华西医院住院糖尿病足的流行率及临床疗效,为临床治疗提供科学依据。方法利用病案查询系统检索华西医院1996～2009年糖尿病足病患者的总出院人数,记录各年度糖尿病足的患病率及临床疗效。结果在1996.01～2009.12期间,我院共收治糖尿病患者16340人,其中糖尿病足(DF)患者662人(男370例,女292例),DF的流行率4.05%(1996～2006年为3.37%,2006～2009年为6.5%),DF的流行率随糖尿病患者的增加而逐渐增加;DF的发生无性别差异;14年间我院DF患者的总治愈率为61.9%,好转率23.7%,无效率为14.4%;糖尿病足诊治中心成立后其总治愈率为70.2%,远高于成立前的42.3%,尤其是在既往治愈率较低的Wagner 3、4级患者;随着Wagner分级的增高,DF治愈率逐渐降低。在662例患者住院期间共死亡27例,病死率4.07%。死亡组的糖尿病肾病(diabeticnephropathy,DN)、糖尿病周围血管病变(peripheral vascular disease,PVD)、胃肠植物神经病变、冠心病(coronaryheart disease,CHD)、高血压(hypertension,HTN)、尿路感染和肺部感染的发生率高于未死亡组,死亡原因主要为心血管疾病和呼吸系统疾病所导致的心源性猝死和呼吸衰竭。结论糖尿病足患者多为高龄且糖尿病病程长者,常合并糖尿病神经及外周动脉病变;DF的流行率随糖尿病患者的增加而逐渐升高;DF的发病无性别差异;DF患者随着Wagner分级的增高,其治愈率逐渐降低;通过多学科合作综合治疗,可提高DF的治愈率;DF患者的死亡率较高,死亡原因多为心脑血管疾病和肺部感染所导致的心源性猝死和呼吸衰竭。

Objective To investigate the prevalence rate and clinical therapeutic efficacy of diabetic foot（DF）,and provide a scientific basis for clinical treatment.Methods All of the medical records of DF inpatients admitted in West China Hospital（WHC） from Jan 1,1996 to Dec 31,2009 were retrieved.Available information including prevalence rate and clinical effective were collected and analyzed.Results There were 16340 diabetic inpatients admitted in WCH from 1996 to 2009.662 of them（male： female=370：292） suffered from DF.The prevalence of DF was 4.05%（3.37% during 1996～2006 and 6.50% during 2007～2009,respectively）,The prevalence mcveased along with the increase of the number of DM patients.The morbidity and mortality in the males was similar to the females.The total cure rate,improvement rate,inefficacy rate of DF patients was 61.9%,23.7% and 14.4%,respectively during the past 14 years.The total cure rate increased to 70.2% after 2005（especially in patients with Wagner 3,4 grade）,more than 42.3% that before 2005.It was clear that the Wagner＇s grades of DF was higher,the cure rate was lower.26 patients died in hospital and the mortality was 4.07%.The rate of DN,PVD,gastrointestinal autoneuropathy,CHD,HTN,decubitus and pulmonary infection,etc.in death group were more than that in non-death group.The major causes of death were respiratory failure and sudden death induced by cardiovascular and cerebrovascular diseases.Conclusion Foot problems most frequently occur in the diabetic patients with advanced age and long diabetic duration and more diabetic complications.The prevalence of DF in WCH is increased form Jan 1st,1996 to Dec 31,2009.The morbidity and mortality in the males is similar to the females.The cure rate is improvement by full multidisciplinary treatment.The mortality of DF is high.The major causes of death are respiratory failure and sudden death induced by cardiovascular and cerebrovascular diseases.