糖尿病足深部感染患者临床特点分析与研究

Research on the clinical features and effective factors of diabetic patients with deep foot infection

目的本研究通过回顾性分析糖尿病足深部感染患者临床特点,分析影响伤口愈合的因素。方法选取我院收治的220例糖尿病足深部感染患者作为研究对象,根据患者截肢与否及伤口愈合情况将其分成三组,分别用A、B、C表示,A组患者98例、B组患者96、C组患者26例。A组表示未截肢愈合组,B组表示截肢后愈合组,C组表示截肢后未愈合组,详细比较与分析患者临床资料、临床参数及伤口特征。结果 A、B、C三组血浆蛋白分别为(31±8)g/L、(28±6)g/L、(26±4)g/L,差异有统计学意义(P<0.01);A组病程(11±5)年短于B组患者病程(18±9)年,差异有统计学意义(P<0.01);伤口特征比较A组优于B组(P<0.05)。通过多因素Logistic回归分析,创面愈合的保护因素为hs-CRP、血红蛋白,而危险性因素有高龄、水肿、恶臭味、坏死及下肢严重缺血等。结论深部足部感染的糖尿病患者很难在早期诊断。即便是有一个完善的糖尿病足多学科治疗团队,但患者中一半以上仍需要截肢。患者的伤口愈合与多种因素有关,包括年龄、糖尿病持续时间、hs-CRP、血浆白蛋白、WBC计数、肢体缺血水平和伤口特征。

Objective To study the clinical features and effective factors related to wound healing in patients with diabetic. Methods Two hundred and twenty-two cases of diabetic patients with deep foot infection were selected and divided into 3 groups. Group A： patients healed without amputation （n=98）, group B： patients healed after amputation （n=96）, and group C： patients didn＇t heal after amputation （n=26）. The patients＂ clinical features, lab examinations and foot wound features were compared. Results The plasma protein of group A, B, C were （31＋8）g/L, （28_＋6）g/L and （26＋4）g/L respectively, with statistical significance （P〈0.01）. The duration of group A was （1 l＋5）years, which was shorter than （18＋9）years of group B, with statistical significance （P〈0.01）. The wound characteristics of group A were better than those of group B （P〈0.01）. Hs-CRP and plasma albumin were protective factors for wound healing. Age, possibility of probing bone, purulent secretion, necrosis, bone exposure, cacosmia, edema and critical limb ischemia were risk factors for wound healing. Conclusion Diabetic patients with deep foot infection are difficult to be diagnosed in early stage. Though muhidisciplinary team manages these patients, more than half of them need amputation. Wound healing in the patients is related to multiple factors, including age, duration of diabetes mellitus, hs-CRP, plasma albumin, WBC count, level of limb ischemia and wound features.