影响重症糖尿病足患者大截肢手术平面的因素分析

Factors Affecting the Surgical Level of Major Amputations in Patients with Severe Diabetic Foot

目的探讨影响重症糖尿病足患者大截肢平面的主要因素。方法用病例对照研究的方法,分析2020年7月–2022年7月于东部战区空军医院重症监护室(ICU)住院的重症糖尿病足大截肢患者临床资料,根据截肢平面高低分为经胫腓骨截肢(TT)组和经股骨截肢(TF)组。对患者的临床资料进行相关性分析,并筛选出影响患者大截肢平面的相关因素进行多因素logistic回归分析。结果共完整收集48例大截肢患者资料,其中TT组有15例,TF组有33例。TT组伴心脑血管并发症比例低于TF组〔26.67%(4/15)vs.57.58(19/33),P<0.05〕,TT组伴下肢血管介入史比例高于TF组〔40%(6/15)vs.9.09%(3/33),P<0.05〕,TT伴肌酐升高比例低于TF组(70.31±22.98 vs.127.98±108.38,P<0.05),且下肢动脉介入史可能是决定大截肢平面的独立保护因素〔比值比(OR)=0.17,95%可信区间(CI):0.03~0.91,P=0.038〕。结论心脑血管疾病史、血肌酐水平和下肢动脉介入史是影响重症糖尿病足患者手术大截肢平面的主要因素,其中下肢动脉介入史可能是一种独立保护因素。

Objective To investigate the main factors affecting the surgical level of major amputations in patients with severe diabetic foot.Methods A case-control study was conducted to analyze the clinical data of severe diabetic foot patients who had major amputations and were admitted to the Intensive Care Unit(ICU),Air Force Hospital of PLA Eastern Theater Command between July 2020 and July 2022.According to their surgical level of amputation,patients were divided into transtibial amputation(TT)group and transfemoral amputation(TF)group.Correlation analysis was performed with the clinical data of the patients,and multivariate logistic regression was performed to screen for relevant factors affecting the surgical level of major amputation.Results The data of 48 patients with major amputations were collected,including 15 patients in the TT group and 33 patients in the TF group.The proportion of patients who had cardiovascular and cerebrovascular complications in the TT group was lower than that in the TF group(26.67%[4/15]vs.57.58%[19/33],P<0.05),the proportion of patients who had lower extremity arterial intervention history was higher in the TT group than that in the TF group(40%[6/15]vs.9.09%[3/33],P<0.05),and the proportion of patients who had elevated creatinine level was lower in the TT group than that in the TF group(70.31±22.98 vs.127.98±108.38,P<0.05).Moreover,the history of lower extremity arterial intervention may be an independent protective factor for determining the surgical level of major amputations(odds ratio[OR]=0.15,95%confidence interval[CI]:0.03-0.72,P=0.018).Conclusion History of cardiovascular and cerebrovascular diseases,serum creatinine level and history of lower extremity arterial intervention are the main factors affecting the surgical level of major amputations in patients with severe diabetic foot,and the history of lower extremity arterial intervention may be an independent protective factor.