Portraying Diabetic Foot Ulcers: Comparative Evaluation of Diabetic Foot Infections versus Diabetic Foot Ulcers

Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers;no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.

Relationship of visual impairment and peripheral artery disease with the occurrence of diabetic foot ulcers in Dr. Moewardi Hospital

Objective: One of the diabetes mellitus (DM) complications is foot ulcers. Foot ulcers are influenced by many factors. DM puts patients at risk of injury because of visual impairment. Hyperglycemia can damage blood vessels, which results in peripheral artery disease (PAD). The purpose of this study was to find the relationship of visual impairment and PAD with diabetic foot ulcers. Methods: This research used observational analytic study with case–control methods. It used purposive sampling in 34 DM patients with foot ulcers and 34 DM patients without foot ulcers. The research instruments were an interview guide to assess visual impairment, physical examination to assess PAD, and documentation study, which was used to know the incidence of diabetic ulcers. Results: The results showed that the respondents who experienced ulcers with visual impairment were 44.1% and the respondents who had foot ulcers with PAD were 73.5%. The results of statistical tests showed that there was no relationship between visual impairment and the incidence of ulcers (P = 0.166). The respondents with PAD will have a chance to suffer from foot ulcers 5.808 times higher than those who do not have PAD. Conclusions: There is no relationship between visual impairment and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital, but there is relationship between PAD and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital. Suggestions of this study are to do foot screening and educate about the importance of foot care to prevent the occurrence of diabetic ulcers.

Effect of vacuum sealing drainage combined with intermittent insulin flushing on expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound

Objective: To discuss the effect of vacuum sealing drainage combined with intermittent insulin flushing on the expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound. Methods: A total of 48 patients with diabetic lower limb ulcer who were treated in the Endocrine Department of the hospital between January 2016 and January 2017 were divided into the control group and research group by random number table, 24 cases in each group. Control group received vacuum sealing drainage, and research group received vacuum sealing drainage combined with intermittent insulin flushing. The differences in the expression of inflammatory factors and apoptosis genes in the wound exudate were compared between the two groups before and after treatment. Results: Before treatment, the differences in the inflammatory factor contents and apoptsis gene expression in wound exudate were not statistically significant between the two groups of patients. After treatment, inflammatory factors IL-6, IL-1β, TNF-α, CRP, VCAM-1 and FGF2 contents in wound exudate of research group were lower than those of control group;apoptosis gene Bcl-2 mRNA expression in wound exudate of research group was higher than that of control group while Bax, p53 and Fas mRNA expression were lower than those of control group. Conclusions: Vacuum sealing drainage combined with intermittent insulin flushing can effectively reduce the local inflammatory response and promote the granulation cell proliferation in wound of patients with diabetic lower limb ulcer.

Effect of Shuxuening Injection Combined with Alprostadil on Healing of Diabetic Foot Ulcers and Hemodynamic Indexes of Dorsal Artery of Foot

OBJECTIVE: To observe the effect of Shuxuening Injection combined with alprostadil on healing of diabetic foot ulcers and hemodynamic indexes of dorsal artery of foot. METHODS: A total of 84 cases of diabetic foot patients treated in Wuhan Red Cross Hospital(from February 2016 to April 2017) were divided into treatment group(42 cases) and control group(42 cases) by the random digital table. The control group was given basic clinical treatment while the treatment group was given Shuxuening Injection combined with alprostadil on the basis of the treatment in control group. After 2 weeks of treatment, the improvement of TCM symptom scores(pain, numbness, swelling, claudication), conditions of foot ulcer healing(ulcer area, wound oxygen pressure, wound pH), the hemodynamics of the dorsum pedis artery(the blood flow velocity of the dorsum pedis artery, the blood vessel diameter, resistance index(RI), pulsation index(PI)) of both groups were compared, and the clinical efficacy of 2 groups were statistically analyzed. RESULTS: The scores of pain, numbness, swelling and claudication were significantly reduced in 2 groups after the treatment(P < 0.05), and the improvement of the above symptom scores in the treatment group were all significantly better than that in the control group(P < 0.05). The area of ulcer and the p H of the wounds in the 2 groups were significantly decreased after the treatment(P < 0.05), and the oxygen partial pressure in the wound was significantly increased(P < 0.05), and the improvements of the wound healing outcomes in the treatment group were significantly better than that in the control group(P < 0.05). The blood flow velocity of the foot, the blood vessel diameter, the level of RI and PI after treatment in both groups were significantly increased after the treatment(P < 0.05), and the improvement of the hemodynamic index of the foot back after treatment in the treatment group was significantly better than that in the control group(P < 0.05). The total effective rate of the treatment group was significantly higher than that of the control group(P < 0.05). CONCLUSION: The application of Shuxuening Injection combined with alprostadil can quickly improve the clinical symptoms of the patients, correct the abnormal hemodynamics of the dorsum pedis artery and promote the healing of foot ulcers, and the combination of the two medicines has a synergistic effect.

Lower extremity amputations and long-term outcomes in diabetic foot ulcers:A systematic review

BACKGROUNDDiabetes mellitus causes a large majority of non-traumatic major and minoramputations globally. Patients with diabetes are clinically complex with amultifactorial association between diabetic foot ulcers (DFU) and subsequentlower extremity amputations (LEA). Few studies show the long-term outcomeswithin the cohort of DFU-associated LEA.AIMTo highlight the long-term outcomes of LEA as a result of DFU.METHODSPubMed/MEDLINE and Google Scholar were searched for key terms, “diabetes”,“foot ulcers”, “amputations” and “outcomes”. Outcomes such as mortality, reamputation,re-ulceration and functional impact were recorded. Peer-reviewedstudies with adult patients who had DFU, subsequent amputation and follow upof at least 1 year were included. Non-English language articles or studiesinvolving children were excluded.RESULTSA total of 22 publications with a total of 2334 patients were selected against theinclusion criteria for review. The weighted mean of re-amputation was 20.14%,29.63% and 45.72% at 1, 3 and 5 years respectively. The weighted mean of mortality at 1, 3 and 5 years were 13.62%, 30.25% and 50.55% respectively withsignificantly higher rates associated with major amputation, re-amputation andischemic cardiomyopathy.CONCLUSIONPrevious LEA, level of the LEA and patient comorbidities were significant riskfactors contributing to re-ulceration, re-amputation, mortality and depreciatedfunctional status.

Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly.The development of foot ulcer in a diabetic patient has been estimated to be 19%-34%through their lifetime.The pathophysiology of diabetic foot ulcer consist of neuropathy,trauma and,in many patients,additional peripheral arterial disease.In particular,diabetic neuropathy leads to foot deformity,callus formation,and insensitivity to trauma or pressure.The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification,surgical debridement,dressing to facilitate wound healing,offloading,vascular assessment(status and presence of a chance for interventional vascular correction),and infection and glycemic control.Although especially surgical procedures are sometimes inevitable,they are poor predictive factors for the prognosis of diabetic foot ulcer.Different novel treatment modalities such as nonsurgical debridement agents,oxygen therapies,and negative pressure wound therapy,topical drugs,cellular bioproducts,human growth factors,energy-based therapies,and systematic therapies have been available for patients with diabetic foot ulcer.However,it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials.This review aims at evaluating diabetic foot ulcer with regard to all aspects.We will also focus on conventional and novel adjunctive therapy in diabetic foot management.

Assessing diabetic patients at risk of developing foot ulcers in Freetown, Sierra Leone

Introduction:Diabetes Mellitus is a global health issue,though current prevalence data is lacking Sierra Leone has an increasing number of diagnosed and undiagnosed diabetes.Lack of education and self-care,poor adoption of healthy lifestyle may be the main factors leading to an increased risk of diabetic foot ulcers.Objectives:To identify patients with diabetes at risk of developing foot ulcers,diabetic neuropathy,peripheral artery disease and to investigate the association between independent risk factors involved in development of foot ulcers and other clinically related factors.Methods:Study was done at two sites,Connaught hospital and a clinic in Freetown.A standardized questionnaire was administered for risk assessment of diabetic ulcers.A total of 231 participants(Ages 45-75 years)were recruited via systematic random sampling.Descriptive statistics was used to analyze data using SPSS.Results:Majority of participants(64.5%)were diagnosed with diabetes within 1-5 years,5.5%and 13.4%had eye and kidney disease respectively.Protective sensation evaluation revealed that 38.5%had loss of protective sensation and 19%had suspected peripheral arterial disease with absent pulse at the posterior tibial artery and dorsalis pedis.Age,occupation,years since diagnosis and type of diabetes was significantly associated with high risk of developing diabetic foot ulcers with a P value<0.005.Risk Categorization of participants revealed 76%at low risk while those at moderate,high and highest risks were 20%,17%and 3.5%respectively.Individuals with prior kidney disease,eye problems and previous history of amputation had greater loss of protective sensation,absent pulse,and tingling sensation at extremities.Conclusion:There’s great need for health care workers to become diabetes educators to offer proper services like diabetes foot examination to prevent diabetes ulcers which leads to amputation.Detecting diabetic patients at risk for diabetic foot ulcers will go a long way to prevent future amputations and other associated complications.

Diabetic foot ulcers:Classification,risk factors and management

Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection,amputation,and death,and is affecting increasing numbers of patients with diabetes mellitus.The pathogenesis of foot ulcers is complex,and different factors play major roles in different stages.The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate,which means that management and nursing plans need to be considered carefully.The importance of establishment of measures for prevention and management of DFU has been emphasized.Therefore,a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management.In the first part of this review,we list several commonly used classification systems and describe their application conditions,scope,strengths,and limitations;in the second part,we briefly introduce the common risk factors for DFU,such as neuropathy,peripheral artery disease,foot deformities,diabetes complications,and obesity.Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management;in the last part,we emphasize the importance of preventive education,characterize several of the most frequently used management approaches,including glycemic control,exercise,offloading,and infection control,and call for taking into account and weighing the quality of life during the formulation of treatment plans.Multidisciplinary intervention and management of diabetic foot ulcers(DFUs)based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs,and improve their prognosis.

Diabetic foot ulcer: Challenges and future

Diabetic foot ulcers(DFUs)have become one of the important causes of mortality and morbidity in patients with diabetes,and they are also a common cause of hospitalization,which places a heavy burden on patients and society.The prevention and treatment of DFUs requires multidisciplinary management.By controlling various risk factors,such as blood glucose levels,blood pressure,lipid levels and smoking cessation,local management of DFUs should be strengthened,such as debridement,dressing,revascularization,stem cell decompression and oxygen therapy.If necessary,systemic anti-infection treatment should be administered.We reviewed the progress in the clinical practice of treating DFUs in recent years,such as revascularization,wound repair,offloading,stem cell transplantation,and anti-infection treatment.We also summarized and prospectively analyzed some new technologies and measurements used in the treatment of DFUs and noted the future challenges and directions for the development of DFU treatments.

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Diabetes mellitus,a chronic disease of metabolism,is characterized by a disordered production or cellular utilization of insulin.Diabetic foot disease,which comprises the spectrum of infection,ulceration,and gangrene,is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients.The aim of this study is to provide an evidence-based overview of diabetic foot complications.Due to neuropathy,diabetic foot infections can occur in the form of ulcers and minor skin lesions.In patients with diabetic foot ulcers,ischemia and infection are the main causes of non-healing ulcers and amputations.Hyperglycemia compromises the immune system of individuals with diabetes,leading to persistent inflammation and delayed wound healing.In addition,the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance.As a further complicating factor,the warning signs and symptoms of diabetic foot problems can easily be overlooked.Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis;accordingly,the risk of these complications in people with diabetes should be assessed annually.Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections,if peripheral arterial disease is present,revascularization should be considered to prevent limb amputation.A multidisciplinary approach to the prevention,diagnosis,and treatment of diabetic patients,including those with foot ulcers,is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.

Overcoming ischemia in the diabetic foot:Minimally invasive treatment options

As the global burden of diabetes is rapidly increasing,the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances.A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue.Left untreated,chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality;prompt treatment is required.In this review,the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization,stem cells,and gene therapy are examined.

Detection,management,and prevention of diabetes-related foot disease in the Australian context

Diabetes-related foot disease(DFD)is a widely feared complication among people who live with diabetes.In Australia and globally,rates of disability,cardiovascular disease,lower extremity amputation,and mortality are significantly increased in patients with DFD.In order to understand and prevent these outcomes,we analyse the common pathogenetic processes of neuropathy,arterial disease,and infection.The review then summarises important management considerations through the interdisciplinary lens.Using Australian and international guidelines,we offer a stepwise,evidence-based practical approach to the care of patients with DFD.

Diabetes and peripheral artery disease:A review

Peripheral arterial disease(PAD)refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs.It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries.The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors.Nonhealing ulcers,limb amputation and physical disability are some of its major complications.Diabetes mellitus(DM)remains a major risk for PAD,with DM patients having more than two-fold increased prevalence of PAD compared with the general population.The clinical presentation in people with DM also differs slightly from that in the general population.In addition,PAD in DM may lead to diabetic foot ulcers(DFUs),which precipitate hyperglycaemic emergencies and result in increased hospital admissions,reduced quality of life,and mortality.Despite the epidemiological and clinical importance of PAD,it remains largely under diagnosed and hence undertreated,possibly because it is largely asymptomatic.Emphasis has been placed on neuropathy as a cause of DFUs,however PAD is equally important.This review examines the epidemiology,pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population.It also highlights recent innovations in the management of PAD.

Effect of Buerger’s Exercises on Improving Peripheral Circulation: A Systematic Review

The aim of this study was to systematically review the evidence for the effectiveness of Buerger’s exercise on the peripheral circulation or diabetic foot ulceration. A systematic search and 18 electronic databases were conducted. The intervention was predominantly focused on Buerger’s exercise as an outcome. Due to high heterogeneity, data were synthesized in a narrative format rather than by statistical methods. Nine studies that covered 592 participants were selected in the analysis, of which 8 of the 9 found an effect of Buerger’s exercise on peripheral circulation. The positive effects were indicative of improving blood flow, walking ability, reducing necrosis, reducing venous embolism, pain, swelling, cyanosis and the bed-rest times. However, the study design and quality appraisal were limited to Jadad score 2 and the sample size was small. Findings provide some evidence of the beneficial effects of Buerger’s exercises. It was seen as a low cost and low risk physical activity that most diabetic patients could undertake at home. This review highlighted a need for further investigation of standardized procedures of Buerger’s exercises. More high quality studies on the prevention of diabetic foot are required regarding Buerger’s exercises.

超声造影联合血清Ficolin-3,FOXM1对2型糖尿病下肢动脉病变的诊断价值分析

目的超声造影联合血清纤维胶凝蛋白-3(Ficolin-3)、叉头框蛋白M1(FOXM1)对2型糖尿病(T2DM)下肢动脉病变的诊断价值分析。方法选取2022年2月至2023年2月我院收治的T2DM患者114例,以下肢动脉血管造影检查为金标准,将患者分为下肢动脉病变组23例(病变组)和无下肢动脉病变组91例(T2DM组),另选取同期于本院进行体检的健康志愿者91例为对照组。对患者及健康志愿者进行血清Ficolin-3、FOXM1及超声造影检查;ROC曲线分析血清Ficolin-3、FOXM1对T2DM下肢动脉病变的诊断价值;采用四格表法分析血清Ficolin-3、FOXM1、超声造影及3项联合对T2DM下肢动脉病变的诊断价值。结果病变组、T2DM组血清Ficolin-3水平显著高于对照组,且病变组血清Ficolin-3水平显著高于T2DM组(均P<0.05);病变组、T2DM组血清FOXM1水平显著低于对照组,且病变组血清FOXM1水平显著低于T2DM组(均P<0.05);血清Ficolin-3诊断T2DM下肢动脉病变的曲线下面积为0.868,敏感度为86.96%,特异度为75.82%,最佳截断值为35.12μg/ml;血清FOXM1诊断T2DM下肢动脉病变的曲线下面积为0.854,敏感度为82.61%,特异度为78.02%,最佳截断值为0.57;血清Ficolin-3、FOXM1检查结果与金标准均具有中度一致性(Kappa=0.480、0.481,均P<0.001);超声造影检查结果显示,T2DM下肢动脉病变的阳性检出率为73.91%,与金标准具有较高一致性(Kappa=0.631,P<0.001);3项联合检测的敏感度、漏诊率均显著优于超声造影单独诊断,准确度显著优于Ficolin-3、FOXM1单独诊断,差异均有统计学意义(均P<0.05)。结论血清Ficolin-3、FOXM1联合超声造影检查在T2DM下肢动脉病变诊断中的应用价值较高,进一步提升了诊断的敏感度、准确度,减少了误诊率。

下肢动脉腔内血管成形术联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果研究

目的:观察下肢动脉腔内血管成形术(PTA)联合创面局部应用胰岛素治疗糖尿病足溃疡的临床效果。方法:选取2020年8月-2023年8月我院收治的糖尿病足溃疡合并下肢动脉硬化闭塞症患者65例,所有患者均接受下肢动脉PTA治疗,根据治疗方法不同,将患者分为对照组35例和观察组30例。对照组采用常规外科换药法,即局部清创、清洁换药;观察组在常规外科换药基础上应用局部注射胰岛素及胰岛素溶液湿敷。对比两组的踝肱指数(ABI)、创面愈合情况及治疗有效率。结果:两组患者性别、年龄、糖尿病足病程、糖化血红蛋白、空腹血糖水平、Wanger分级、Fontaine分期、Rutherford分级、疼痛分级无显著性差异(P <0.05);两组术前及术后ABI指数对比无显著性差异(P <0.05),术后第4周,观察组愈合情况优于对照组(P <0.05);观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);两组组内比较,术后4周ABI指数较术前明显提高,差异有统计学意义(P <0.05),术后创面面积较术前明显缩小,差异有统计学意义(P<0.05)。结论:下肢动脉PTA手术联合创面局部应用胰岛素治疗糖尿病足溃疡,可促进创面愈合,提高创面愈合率,同时下肢PTA手术可改善糖尿病足溃疡患者下肢血供,对创面愈合起到促进作用,临床效果确切。

血清碱性磷酸酶、同型半胱氨酸及半胱氨酸蛋白酶抑制剂C与糖尿病足下肢动脉粥样硬化的关系

目的分析糖尿病足患者血清碱性磷酸酶(ALP)、同型半胱氨酸(Hcy)、半胱氨酸蛋白酶抑制剂C(Cys-C)水平与糖尿病足及下肢动脉粥样硬化(AS)的关系。方法收集2021年1月至2021年12月于山东中医药大学附属医院住院治疗的80例糖尿病足患者和36例同期健康体检者的临床资料,分别设为观察组和对照组。根据彩色多普勒超声测定的下肢股动脉内-中膜厚度(FAIMT)测定结果将观察组患者分为FAIMT增厚组(n=39)和斑块组(n=41)。比较各组患者的临床特征、血液指标[ALP、Hcy、Cys-C、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及空腹血糖(FBG)],采用多因素Logistic回归模型分析糖尿病足发生的危险因素,通过受试者操作特征(ROC)曲线确定ALP、Hcy、Cys-C对糖尿病足的诊断价值。结果观察组的年龄大于对照组,ALP、Hcy、Cys-C、FBG水平均高于对照组,TC、HDL-C水平均低于对照组,差异均有统计学意义(P﹤0.05)。斑块组患者的Hcy水平高于FAIMT增厚组患者,差异有统计学意义(P﹤0.05)。多因素分析结果显示,年龄、FBG、ALP、Hcy、Cys-C均是糖尿病足发生的独立危险因素(P﹤0.05)。ROC曲线分析结果显示,ALP、Hcy、Cys-C诊断糖尿病足的AUC分别为0.724、0.640、0.895,对糖尿病足均具有较好的诊断价值。结论ALP、Hcy、Cys-C与糖尿病足的发生密切相关,且与下肢AS程度有关,对糖尿病足患者病情的诊断具有重要临床意义。

下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响

目的探讨下肢动脉病变程度对富血小板凝胶治疗糖尿病足溃疡的影响。方法选取糖尿病足溃疡患者129例为研究对象。根据踝肱指数和下肢动脉血管超声结果分为轻度组49例、中度组44例和重度组36例。3组患者均给予常规治疗联合富血小板凝胶治疗。比较3组患者治疗前后溃疡面积变化和肉芽面积变化。结果3组治疗前后的溃疡面积及其差值比较,差异有统计学意义(P<0.05);3组治疗前后的肉芽面积及其差值比较,差异有统计学意义(P<0.05)。溃疡面积差值与踝肱指数呈正相关(r=0.392,P<0.001),与糖尿病病程呈负相关(r=-0.420,P<0.001);肉芽面积差值与踝肱指数呈正相关(r=0.406,P<0.001),与糖尿病病程呈负相关(r=-0.375,P<0.001)。结论下肢动脉病变越严重,富血小板凝胶治疗糖尿病足溃疡的疗效越差。

糖尿病足的外科治疗进展

糖尿病足合并外周动脉疾病往往会导致足部溃疡加剧、易发感染甚至截肢。糖尿病足需要多学科的正确评估和综合诊治。外科手术重建下肢血运是促进糖尿病足溃疡愈合、降低患者截肢率的重要保障。在血运重建过程中,术者可根据糖尿病足下肢缺血特征以及溃疡严重程度合理选择手术方式。该文就糖尿病足的病变基础、外科准备及外科治疗做一总结和展望。

八珍汤联合黄油纱治疗糖尿病足溃疡气血两虚证的临床研究

【目的】观察八珍汤联合黄油纱治疗糖尿病足溃疡(diabetic foot ulcer,DFU)气血两虚证患者的临床疗效。【方法】将42例DFU气血两虚证患者随机分为对照组和观察组,每组各21例。对照组给予西医基础内科治疗及黄油纱外敷创面局部治疗,观察组在对照组的基础上加用八珍汤治疗,疗程为4周。观察2组患者治疗前后创面面积、中医证候积分、踝肱指数(ABI)及血清纤维蛋白原(FIB)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)水平的变化情况,并比较2组患者的临床疗效及治疗方案的安全性。【结果】(1)治疗4周后,观察组的总有效率为95.24%(20/21),对照组为85.71%(18/21),组间比较(秩和检验),观察组的临床疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的创面面积及中医证候积分均较治疗前明显改善(P<0.05),且观察组对创面面积及中医证候积分的改善作用均明显优于对照组(P<0.05)。(3)治疗后,2组患者的ABI均较治疗前升高(P<0.05),且观察组对ABI的升高作用明显优于对照组(P<0.05)。(4)治疗后,2组患者血清CRP、TNF-α、FIB水平均较治疗前降低(P<0.05),且观察组对血清CRP、TNF-α、FIB水平的降低作用均明显优于对照组(P<0.05)。(5)治疗过程中,2组患者均未发生明显不良反应,具有较高的安全性。【结论】八珍汤联合黄油纱治疗DFU气血两虚证患者疗效确切,可有效改善患者的凝血功能及下肢动脉缺血情况,降低炎症因子水平,减轻炎症反应,且无明显不良反应。