糖尿病足溃疡合并外周动脉病变患者运动处方的有效性及安全性研究

Study on the safety and effectiveness of an exercise prescription for patients with diabetic foot ulcer and peripheral arterial disease

目的探讨糖尿病足溃疡（diabetic foot uleer，DFU）合并外周动脉病变（peripheral arterial disease．PAD）患者的运动治疗处方对足部血流灌注、溃疡愈合的影响。方法选取60例DFU合并PAD患者分为运动组及对照组，运动组患者进行运动治疗培训，保证患者能遵循运动处方完成运动治疗，对照组无运动要求。治疗12周后，比较治疗前后2组患者的踝肱指数（ABI）、经皮氧分压（TcPO2）、皮温、HbA1c、体重指数（BMI）及12周溃疡愈合率，评价患者对运动治疗的满意度、依从性，并记录治疗中的不良事件。结果治疗12周后，2组患者ABI、足部TcPO2、皮温均升高，HbA1c均降低（P〈0．05或P〈0．01）。运动组TcPO2升高5．25mmHg（1mmHg=0．133kPa）、皮温升高0．45℃、BMI降低0．69kg／m^2；对照组TcP02升高2．59mmHg、皮温升高0．28℃、BMI升高0．02kg／m^2，2组患者3项指标变化值比较差异有统计学意义（P〈0．01）。运动组溃疡愈合率显著高于对照组（53．6％对25．9％，P〈0．05）。患者对于运动治疗的满意度为90％，依从性94％。运动组患者不良事件的发生与运动处方无直接因果关系。结论本研究的运动处方可以改善DFU合并PAD患者足部血流灌注、促进溃疡愈合，且具有较高的安全性，患者依从性及满意度较高。

Objective To investigate the effect of exercise prescription on foot perfusion and ulcer healing in patients with diabetic foot ulcer （ DFU ） accompanied with peripheral arterial disease （ PAD ）. Methods Sixty patients with DFU and PAD were divided into exercise group and control group. The patients in the exercise group took exercise therapy training, ensuring that they could follow the exercise prescription. The patients in the control group had no exercise requirements. After the treatment for 12 weeks, ankle brachial index （ABI） , transcutaneous oxygen tension （ TcPO2 ） , skin temperature, body mass index （ BMI）, HbA^c, and the ulcer healing rate in the two groups were compared, the satisfaction and compliance in the exercise group were evaluated, and the adverse events of the treatment were recorded. Results After the treatment for 12 weeks, the ABI, TcPO2 , and foot skin temperature in the two groups increased and HbAic decreased（ P〈0.05 or P〈0.01 ）. TcPO2 increased 5.25 mm Hg（ 1 mm Hg=0. 133 kPa） , skin temperature increased 0.45℃ , and BMI decreased 0. 69 kg/m2 in the exercise group, while TcPO2 increased 2.59 mm Hg, skin temperature increased 0.28℃ , and BMI increased 0.02 kg/m2 in the control group, showing significant differences in the three index changes between two groups （ P〈0.01 ）. The healing rate in the exercise group was higher than that in the control group （ 53.6% vs 25.9% , P 〈0.05 ）. The patients＇compliance and satisfaction to the exercise therapy were 90% and 94%, respectively. The incidence of adverse events in the exercise group had no causal relationship with the exercise prescription. Conclusion The exercise prescription in the study can improve the foot perfusion, and promote ulcer healing. It has the advantage of high safety, patients＇compliance and satisfaction.