不同Wagner分级糖尿病足患者的临床及治疗特点

Clinical and therapy features of different Wagner classification diabetes foot patients

目的:探讨不同Wagner分级糖尿病足溃疡的临床特点及预后。方法:按Wagner分级糖尿病足溃疡2～4级患者62例,进行生化检测、局部换药及全身治疗,分析不同分级溃疡特点、愈合情况及影响愈合的因素。结果:随着Wagner分级增加,下肢血管病变逐渐加重,糖尿病足治疗时间逐渐增长,血胱抑素C、血同型半胱氨酸、血尿酸水平逐渐增加,差异有统计学意义(P<0.05);随着Wagner级别增加,病原菌谱由革兰阳性菌为主转变为以革兰阴性杆菌为主。结论:血胱抑素C、血同型半胱氨酸、血尿酸有利于病情严重程度的判断,改善下肢血供是治愈糖尿病足溃疡的基础,随着糖尿病足病情加重,革兰阴性菌为主感染比例逐渐增加,应注意抗生素的选择。

Objective: To investigate the clinical features and therapy of different Wagner classification diabetes foot patients. Methods: Sixty-two diabetic foot patients were classified into Wagner 2–4 grades according to the severity of diabetic foot ulcer. Biochemical test, medication and local treatment were taken. The features of ulcer and recovery and the factors influencing healing were assessed. Results: With the increase of Wagner’s grades, the peripheral artery disease was more serious, wound-healing times were longer, the levels of serum Cyst-C, homocysteine and serum uric acid were all increased significantly(P<0.05). The bacterial floras were transformed from gram-positive to gram-negative rods with rising Wagner’s grades. Conclusion: The levels of serum Cyst-C, homocysteine and uric acid regarded as indicators of the disease severity. Improving the blood supplying of the limbs is the basis of which cure diabetes foot. Proportion of gram-negative bacilli seems to increase in patients with severe diabetic foot ulcer and requiring appropriate application of antibiotics.