腹膜透析患者糖尿病足护理行为调查及新发足部溃疡等复合终点的影响因素

nvestigation on nursing behavior of diabetic foot and new foot ulcer in peritoneal dialysis patients and study on the influencing factors of composite end point

目的了解腹膜透析患者的糖尿病足护理行为,随访新发足溃疡等复合终点的发生率,探索其影响因素。方法单中心队列设计,入选在2014年1月~6月期间北京大学第一医院肾内科肾内科腹膜透析中心接受规律随访的临床稳定的糖尿病腹膜透析患者。记录其基线数据,包括一般资料、生化指标、患者的足部护理行为发生频率,所有患者随访至2018年12月31日。复合终点事件包括新发足部溃疡,因足部溃疡或坏疽导致的截肢、下肢血管的血运重建术。结果共纳入108例患者,平均随访时间为26.0(15.0,45.0)月。共17例(15.7%)患者发生足部溃疡等复合终点,发病率为71.9次/1000患者年。患者糖尿病足护理高危行为发生率最高的为穿凉鞋或拖鞋(66.7%),之后依次为穿鞋时从未检查异物(23.1%),赤脚行走(20.4%),赤脚穿鞋(17.6%)。经过年龄、性别、糖尿病年限、糖化血红蛋白、左或右脚踝肱指数<0.9、白蛋白、超敏C反应蛋白等多因素校正,赤脚行走和穿凉鞋或拖鞋为独立危险因素(HR值分别为7.533,3.198;95%CI分别为2.073~27.370,1.212~8.436;P值分别为0.002,0.019)。结论本组患者共17例(15.7%)发生足部溃疡等复合终点,赤脚行走和穿凉鞋或拖鞋是预测新发足溃疡等复合终点的独立危险因素,提示需加强腹膜透析患者糖尿病足教育,避免高危行为。

Objective To understand the nursing behavior of diabetic foot in peritoneal dialysis(PD)patients,to follow up the incidence of new foot ulcer and other composite end points,and to explore the influencing factors.Methods A single center cohort design was conducted to enroll the clinical stable diabetic PD patients who received regular follow-up in our peritoneal dialysis center from January to June 2014.Their baseline data,foot care behavior and frequency were recorded.All patients were followed up to December 31,2018.Composite end points included new foot ulcers,amputations due to foot ulcers or gangrene,and revascularization of lower extremity vessels.Results A total of 108 patients were included.The average follow-up time was 26.0(15.0,45.0)months.Seventeen patients(15.7%)had a composite end point,with an incidence rate of 71.9/1,000 patients.The highest incidence of high-risk behavior in diabetic foot care was wearing sandals or slippers(67.6%).After adjustment of age,gender,diabetes years and other factors,walking barefoot HR:7.533,95%CI 2.073~27.370,P=0.002 and wearing sandals or slippers HR:3.198,95%CI 1.212~8.436,P=0.019 were the independent risk factors.Conclusion Seventeen patients(15.7%)in this group had foot ulcer.Walking barefoot and wearing sandals or slippers were the independent risk factors for predicting new foot ulcer,suggesting that diabetic foot education should be strengthened in PD patients to avoid the high-risk behaviors.