摘要
目的了解目前糖尿病足溃疡患者治疗延迟的现状,并探讨其相关预测因素。方法选择2013年1月至2019年2月于中国人民解放军战略支援部队特色医学中心糖尿病中心首次住院治疗的476例糖尿病足溃疡患者的病例资料进行回顾性分析。就诊延迟分别为患者延迟和专业延迟。患者延迟定义为发现溃疡至首次医疗机构就诊的时间,专业延迟定义为首次医疗机构就诊至转诊至我科就诊的时间。将患者延迟的最高四分位值32 d和专业延迟的最高四分位值40 d定义为严重患者延迟和严重专业延迟。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验或χ^(2)检验。采用logistic回归模型分析与严重患者延迟和专业延迟的可能预测因素。结果患者延迟中位数时间为14(1~354)d,33.2%(158/476)的糖尿病足患者能够在足溃疡发生后1周之内就诊,48.7%(232/476)的糖尿病足患者在2周后就诊。专业延迟中位数时间为16(1~359)d,74.3%(171/230)的患者在治疗1周后转诊至本中心进一步治疗,54.8%(126/230)的患者在治疗2周后转诊至本中心进一步治疗。年龄增长与严重患者延迟正相关(P=0.010),糖化血红蛋白升高则与严重患者延迟和严重专业延迟负相关(P=0.029,0.007)。结论目前我国糖尿病足溃疡患者从就诊到能够接受糖尿病足专科诊治过程中的诸多环节还存在延迟,需要建立标准化的诊疗时间框架来缩短就诊延迟。
Objective To investigate the treatment delay in the management of diabetic foot ulcers and its associated predictive factors.Methods Clinical data of 476 patients hospitalized for the first time in the diabetic center of our department due to diabetic foot ulcers between January 2013 and February 2019 were collected and retrospectively analyzed.Their treatment delays included patient delay(time interval between ulcer detection by the patient and the first consultation of a health care professional)and professional delay(time interval between the first consultation of a health care professional and admission to our hospital).The highest quartile of 32 d in patient delay and that of 40 d in professional delay were defined as severe patient delay and severe professional delay,respectively.SPSS statistics 25.0 was used for statistical analysis.Data comparison between 2 groups was performed using student′s t test or Chi-square test depending on data types.Logistic regression analysis was performed to identify the predictors for severe patient delay and severe professional delay.Results The median patient delay was 14(1-354)d,and 33.2%(158/476)of patients saw a doctor within 1 week after the occurrence of diabetic foot ulcer,and 48.7%(232/476)of them did so within 2 weeks.The median professional delay was 16(1-359)d,and 74.3%(171/230)of patients referred to our center after 1 week of treatment,and 54.8%(126/230)did so after 2 weeks.Age(P=0.010)was positively correlated and hemoglobin A1 c(P=0.029)was negatively correlated with patient delay,while hemoglobin A1 c was also negatively correlated with professional delay(P=0.007).Conclusion At present,there are still delays in many links in the process from treatment-seeking to receiving professional diagnosis and treatment for patients wity diabetic foot ulcer.It is necessary to establish a standardized time frame for its diagnosis and treatment to shorten the delays.
作者
李翔
许樟荣
陆祖谦
张美
孙丽慧
王爱红
LI Xiang;XU Zhang-Rong;LU Zu-Qian;ZHANG Mei;SUN Li-Hui;WANG Ai-Hong(Department of Endocrinology,Characteristic Medical Center of PLA Strategic Support Force,Beijing 100101,China)
出处
《中华老年多器官疾病杂志》
2022年第5期345-349,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
糖尿病
2型
糖尿病足溃疡
治疗延迟
预测因素
diabetes mellitus
type 2
diabetic foot ulcer
treatment delay
predictor