临床病例讨论——糖尿病足溃疡合并缺血性肠病

Diabetic foot ulcer combined with ischemic bowel disease

目的总结糖尿病足溃疡合并缺血性肠病治疗的临床经验。方法对1例糖尿病足坏疽患者的临床特征、治疗经过进行回顾分析。结果患者60岁,因左足底破溃3个月入院。既往有2型糖尿病、左下肢动脉支架植入术病史,足背动脉及胫后动脉未触及,下肢动脉CTA提示右股动脉闭塞。住院期间出现腹胀、便血,诊断为缺血性肠病,给予禁食水、抗凝、抗血小板、改善微循环等内科治疗,肠道功能恢复。结论糖尿病足溃疡合并缺血性肠病死亡风险较高,其早期识别、准确评估、治疗方案选择十分重要,动态观察临床表现、实验室指标是内科治疗成功的重要保证。

Objective To summarize the medical treatment for a patient of diabetic foot ulcer combined with ischemic bowel disease. Methods The clinical features, treatment procedure of diabetic foot ulcer combined with ischemic bowel disease were retrospectively analyzed. Results The patient was 60 years old, complained of left foot bottom broken for 3 months. He had a history of type 2 diabetes, surgical history of left leg artery stent implantation. The dorsalis pedis artery and posterior tibial artery pulses disappeared. Lower extremity arterial CTA showed occlusion of the right femo- ral artery. The patient was finally diagnosed as ischemic bowel disease. The intestinal function recovered after treatment of diet resistance, anticoagulants, antiplatelet drugs and prostaglandin El. Conclusion The risks of death are high in patient of diabetic foot ulcer combined with ischemic bowel disease. Therefore early identification, accurate evaluation and therapeutic scheme are critical. Dynamic observations of clinical manifestation and laboratory indicators are important to successful medical treatment.