缺血型糖尿病足诊疗规律回顾性研究

A Retrospective Study of Ischemic Diabetic Foot Treatment Rules

[主要目的]分析缺血型糖尿病诊疗规律。[资料来源]在辽宁中医药大学附属第一医院病案室选取2012年6月至2013年10月缺血型糖尿病住院病历。[选择文献量及依据]①研究类型:临床观察。②研究对象:符合缺血型糖尿病足诊断标准;中医四诊资料齐全;同一患者反复入院症状发生变化时重复纳入,无明显变化时仅纳入第一次入院情况。③诊断分型:湿热毒盛、血脉瘀阻。④评价指标:临床症状、双下肢多普勒血流图和踝肱比(ABI)、Wagner分级、血流量(ABI所取动脉血管:π(血管内径/2)^2*血流速度,cm^3/s),等。⑤干预方法:常规西药、四妙勇安汤合仙方活命饮、当归四逆汤合桃红四物汤、清脉康熏洗、一效膏,等。共51例住院病历。[数据提炼规则及应用方法]临床症状、双下肢多普勒血流图和踝肱比(ABI)、Wagner分级、血流量。疗效判定:参照《中医病证诊断疗效标准》。采用SPSS19.0统计软件,计量资料采用均值±标准差(sx±)表示,组间比较用单因素方差分析和t检验。使用Microsoft Excel2013建立数据库,分析预后结果。[数据综合得出结果与结论]预后结果:治愈12例,有效35例,无效4例,总有效率92.16%。ABI两组均有改善(P<0.05,P<0.01),湿热毒盛改善优于血脉瘀阻(P<0.05)。肢端缺血程度为影响治疗效果决定因素,是否存在感染不是影响治疗效果的主要因素。ABI不能反映下肢血流量,可能是因为侧支循环的形成,彩超测定血管内径和血流速度,计算得出每秒血流量更能反映下肢血流情况,因管腔狭窄而造成相同每秒血流量下血流速度相对加快,故不能采用血流速度,而采用每秒血流量能客观反映肢端有效供血量。[未来展望]扩大样本量,进一步调查研究,为缺血型糖尿病足的预防及辨证施治提供科学依据。

[Objective] Analysis the rule of diagnosis and treatment of ischemic diabetic foot.[Source] In the medical records department of the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from 2012 June to 2013 October ischemic diabetic foot inpatients. [the choice of literature and the basis] ①The research type：clinical observation. ②The object of study：conform to diagnostic criteria of ischemic diabetic foot;Chinese medical documents are complete;the same patients with recurrent symptoms during admission changes repeat into,no obvious change when only into the first admission condition. ③ Diagnosis：dampness heat toxic,blood stasis. ④The evaluation index：clinical symptoms,double lower limbs Doppler flow chart and the ankle brachial index（ABI）,Wagner score,blood flow. ⑤Intervention：routine western medicine,Simiaoyongan Decoction Xianfanghuoming Decoction,Dangguisini Decoction and Taohongsiwu Decoction,Qing Mai Kang fumigation effect,a paste,etc..[Data extraction rules and methods of application] clinical symptoms,double lower limbsDoppler flow chart and the ankle brachial index（ABI）,Wagner score,blood flow. Efficacy：according to ＂standards of TCM syndrome diagnosis and treatment＂. Using SPSS19.0 statistical software,measurement data using mean ± standard deviation said,compared with single factor analysis of variance and t test. Use the Microsoft Excel2013 to establish database,analysis of outcomes. Results and conclusion.[data] outcomes：12 cases were cured,35 cases effective,4 cases ineffective,the total efficiency of 92.16%. ABI two groups were improved（P 0.05,P 0.01）,dampness heat toxic is better than blood stasis（P 0.05）. The degree of limb ischemia for the therapeutic effects of decision factors,the presence of infection is not the main factors affecting the therapeutic effect. ABI does not reflect the lower limb blood flow,possibly because of the formation ofcollateral circulation,vascular diameter and blood flow velocity of color Doppler,blood flow calculations per second can better reflect the lower limb blood flow,blood flow velocity of blood flow the same per second relative speed caused by stenosis,so can not use blood flow velocity and blood flow,the second objective reflect the acraleffective blood volume. [Future] Combine traditional Chinese and Western medicine treatment of diabetic footischemic effect,prospect,worthy of promotion.