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.

不同Wagner分级糖尿病足患者自我管理行为现况评分比较

目的:比较不同Wagner分级糖尿病足(Diabetic Foot,DF)患者自我管理行为现况评分。方法:连续选择近期来诊及住院治疗的DF患者83例,他们分别接受了DF足溃疡Wagner分级(严重度)和"糖尿病自我管理行为量表(DSCS)"评估。结果:83例DF患者中,Wagner分级0级28例(33.73%)、l级21例(25.30%)、2级15例(18.07%)、3级16例(19.28%)和4级3例(3.6%)。高级别DF(3～4级)患者DSCS各维度分及自我管理行为总分均明显少于低级别(1～2级)和0级别DF患者(P均<0.05～0.01)。结论:高级别的Wagner分级DF患者自我管理行为现况评分较差。

城市与农村的糖尿病足临床特点比较分析

目的探讨分析城市与农村糖尿病足的临床特点差异。方法回顾性收集该院2012年6月—2015年10月82例住院诊治的糖尿病足临床资料,按居住地的不同分为城市组31例、农村组51例,并按不同Wagner分级进行统计白细胞、白蛋白、纤维蛋白原、肌酐、尿素氮、糖化血红蛋白以及住院天数等7项指标,对比分析其两组间、组内不同级别间的差异。结果 7项指标在两组间均差异有统计学意义(P<0.05);白细胞在组内不同级别间有差异,其中,Wagner5期与其他级别均差异有统计学意义(P<0.05)。结论城市的糖尿病足病患较农村病患血糖控制差、肾脏损伤重。

分级护理干预在糖尿病高危足病人中的应用

[目的]探讨基于国际糖尿病高危足分级管理系统分级干预在糖尿病高危足的应用效果。[方法]将100例糖尿病高危足病人随机分为对照组和观察组各50例,对照组给予常规护理,观察组基于糖尿病高危足分级管理系统评估,制定分级护理干预方案并实施1年的干预,观察比较两组病人并发症发生率、干预前和干预1年时高危足分布状况。[结果]干预1年后观察组足部损伤、足部溃疡和足部感染等足部并发症发生率低于对照组,观察组低危足、中危足、高危足病人分布情况优于对照组(P<0.05)。[结论]基于糖尿病高危足风险评估分级系统的分级干预能降低糖尿病高危足病人并发症的发生,促进高危足向中、低危足转化,降低发展成糖尿病足的风险。