糖尿病足患者的临床特点及住院费用分析

Clinical features and expense of hospitalization in diabetic patients with foot problems

目的 调查糖尿病足患者的临床特点以及影响住院费用的主要因素。方法 调查分析 6 3例因糖尿病足住院患者的临床特点、住院费用以及影响住院费用的主要因素。结果 6 3例患者平均年龄 6 5岁 ,糖尿病病程9年 ,三分之二的患者是小学以下文化程度 ,有一半的患者治疗顺应性差 ,38%的患者HbA1c >10 % ;分别有 39%、30 %和 2 6 %的患者血胆固醇 >5 .17mmol/L、甘油三酯 >1.7mmol/L和HDL C <0 .9mmol/L ;6 3%的患者有吸烟习惯。合并高血压病 31例 (5 0 % ) ,其中分别有 2 1%、2 0 %的患者血压 >16 0 /95mmHg、>180 /10 5mmHg ;冠心病2 8例 (4 5 % ) ,慢性心功能不全的 7例 (11% ) ;脑血管疾病的 2 2例 (35 % ) ;神经病变 6 1例 (97% ) ;视网膜病变 37例(5 9% ) ;肾病 2 7例 (4 3% ) ,其中慢性肾功能衰竭 2例 (3% )。 9例合并表浅的足溃疡 ,2 1例合并软组织感染和足溃疡 ,19例足溃疡合并深部感染 ,5例足趾局限性坏疽 ,9例足的广泛坏疽。住院天数和住院费用的中位数分别为2 3d和 830 1元。患者有否高血压史 (而不是现在的血压值 )、HDL C水平降低、心电图异常和微血管病变在住院费用方面存在明显的差异。结论 有足病变的糖尿病患者文化程度低 ,微血管和大血管并发症发生率高 ,住院费用高 ,治疗上更需要多学科?

Objective To investigate the clinical manifestatios of diabetic patients with foot problems and the main factors influencing the hospitalization expense. Methods Sixty-three Chinese diabetic patients with foot problems were analyzed for the relationship between diabetic complications and medical expense. Results Average age of the patients was 65 yrs and duration of diabetes was 9 yrs. Two thirds of the patients possessed very low educational level (less than 6-year education) and were smokers. The treatment compliance was poor in half of them. Fasting and postprandial blood glucose level were 9.3±4.7 and 12.9±6.4 mmol/L, respectively; HbA 1c was(8.9±2.4)%.Fifty percent,45% and 35% patients had uncontrolled hypertension (41% patients with blood pressure over 160/95 mmHg), ischemic heart disease and cerebrovascular disease respectively. Ninety eight per cent, 59% and 44% had neuropathy, retinopathy and nephropathy (including microalbuminuria, proteinuria and 2 cases with chronic renal failure)respectively. Wagner Classification System was applied to these patients, including 9 cases with Wagner 's 1,21 with Wagner 's 2,19 with Wagner 's 3,5 with Wagner 's 4 and 9 with Wagner 's 5. Median days and medical expense in hospital were 23 days and 8、301 RMB (about 1 000 USD). There were significant differences in the medical expense between the patients with and without hypertension history , abnormal ECG, microvascular diseases and decreased HDL-C level. Conclusion The patients with diabetic foot problems possess low education level, present poor treatment compliance, have more smokers, high prevalence of hypertension and high incidence of diabetic micro- and macro-vascular diseases, which are related to the high medical expense for these patients.