足部反射区按摩与中药浴足防治糖尿病足的效果研究

[目的]探讨足部反射区按摩与中药浴足对糖尿病中高危足的临床疗效。[方法]选择本院2007年6月-2008年12月90例糖尿病足病人,随机分为3组,在糖尿病常规治疗基础上,A组给予常规健康教育;B组在A组基础上加穴位按摩;C组在B组的基础上加中药浴足。3组病人护理干预2个月后比较症候改善情况和踝肱指数的变化。[结果]护理干预2个月后3组病人的症候积分和踝肱指数的变化差异均有统计学意义（P〈0.05）。[结论]足部反射区按摩配合中药浴足可减轻糖尿病足病人下肢缺血情况,从而改善下肢疼痛、麻木等症状效果明显。     

中药熏洗配合按摩对糖尿病高危足干预研究

[目的]探讨中药熏洗及穴位、反射区按摩对糖尿病高危足的干预效果.[方法]将45例糖尿病高危足病人随机分为试验组和对照组,两组均给予糖尿病饮食和降血糖治疗,同时配合活血化瘀类药物治疗.试验组在此基础上行中药熏洗及穴位、反射区按摩；对照组以温水泡足,15d为1个疗程,共6个疗程.[结果]试验组病人临床症状明显缓解,总有效率91.30％；试验组病人治疗后双侧踝/肱指数明显改善；两组治疗后疗效及踝/肱指数比较差异有统计学意义(P＜0.01).[结论]应用中药熏洗配合穴位、反射区按摩,对糖尿病高危足病人进行积极干预,可预防足部溃疡、感染和/或深层组织破坏的发生,避免截趾或截肢.     

足部反射区按摩和中药浴足对中、高危糖尿病足患者生存质量的影响

目的探讨足部反射区按摩和中药浴足综合中医方法对糖尿病中、高危足生存质量的影响。方法2006年9月～2008年9月在我院住院治疗的60例DM中、高危足患者,按入院顺序随机分为实验租和对照组,两组在中西医药物基本治疗相同的基础上,对照组给予常规健康教育,并强化足部护理教育;实验组在常规健康教育基础上给予足部反射区按摩和中药浴足。分别于护理干预前和护理干预2个月后采用2型糖尿病人生活质量评定量表(DMQLS)评价患者的生存质量。结果护理干预2个月后,试验组与对照组DMQLS各维度的得分与干预前有明显的下降,但实验组DMQLS各维度得分显著低于对照组(P0.05)。结论足部反射区按摩和中药浴足较常规的健康教育能明显改善糖尿病中、高危患者的下肢症状,从而提高患者的生存质量。     

早期糖尿病足中医护理综合干预的效果观察

目的:通过踝肱指数(ABI)对早期糖尿病足进行筛查并采取中医护理综合干预,观察其效果。方法:将60例有早期糖尿病足患者随机分为2组各30例,相同治疗条件下实验组30例糖尿病人在实施常规护理的同时,运用足部中药浸泡联合足底反射区及重点穴位按摩对早期糖尿病足患者进行护理干预;对照组按传统的经验进行糖尿病足部护理并予以温水泡足,以14d为1个疗程,28d为目标。结果:第1个疗程结束后2组治愈、显效比较差异无显著性;第2疗程结束实验组的有效率96.67%,明显高于对照组66.67%。治疗后2组踝肱指数间差别有统计学意义(P<0.05)。结论:中药足浴及足底反射区及重点穴位按摩治疗早期糖尿病足是安全、有效的,从而杜绝或延缓糖尿病足进一步发展,提高病人生存质量。并且随着疗程的增加,疗效越明显。     

中药足浴、足底穴位按摩及护理干预对早期糖尿病足的疗效观察

目的观察中药足浴、足底穴位按摩及护理干预对早期糖尿病足的疗效。方法将70例有早期糖尿病足的患者随机分为观察组和对照组,每组35例,相同治疗条件下观察组35例糖尿病人在实施常规护理的同时,应用中药浸泡足部联合足底反射区穴位按摩,对早期糖尿病足患者进行护理干预;对照组按传统方法进行糖尿病足部护理并予以温水泡足,两组均在28d(两个疗程)观察疗效。结果观察组的总有效率为97.14%,明显高于对照组(74.29%)。治疗后两组患者踝肱指数间差异有显著意义(P0.05)。结论中药足浴及足底穴位按摩治疗早期糖尿病足是安全、有效的。     

糖尿病足高危因素分析

[目的]分析糖尿病足发病的高危因素,指导糖尿病病人预防足部并发症的发生.[方法]调查2009年9月-2012年10月住院和门诊糖尿病病人280例,其中非糖尿病足病人247例,糖尿病足病人33例.采用自行设计的调查问卷,收集糖尿病病人的临床资料、Gavin＇s足危险因素加权值积分和糖尿病足自我护理能力情况,采用Logistic回归分析筛选糖尿病足的高危因素.[结果]两组病人病程、体重指数、收缩压、糖化血红蛋白、尿白蛋白/肌酐比值、空腹及餐后2h血糖、血脂、踝肱指数比较、Gavin＇s足危险因素加权值和糖尿病足知识问卷得分比较差异均有统计学意义;Logistic回归分析显示：并发症、低密度脂蛋白胆固醇、糖尿病足知识问卷行为得分、收缩压进入回归模型（P＜0.05）,而性别、年龄、文化程度、收入、医疗费用、病程、体重指数、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿白蛋白/肌酐比值、糖化血红蛋白、空腹及餐后2h血糖、踝肱指数、舒张压、脉搏和Gavin＇s足危险因素加权值评分均未进入回归模型（P＞0.05）.[结论]严格控制血糖、减少并发症的发生、提供自我护理足部的能力是降低糖尿病足发生的关键.     

中药熏洗对于合并脑卒中的2型糖尿病患者处于0级糖尿病足的延续性护理的效果研究

目的:探讨中药熏洗对于合并脑卒中的2型糖尿病患者处于0级糖尿病足的延续护理的效果研究。方法:将2015年7月~2016年3月经本院治疗出院的60例合并脑卒中的且处于0级糖尿病足的2型糖尿病患者随机等分为对照组与观察组,对照组采用常规护理,观察组在对照组基础上对足部进行中药熏洗,两组均随访至6个月,观察两组患者疗效。结果:观察组的踝/肱指数高于对照组(P0.05),疗效优于对照组(P0.05)。结论 :在合并脑卒中的2型糖尿病患者的延续护理中采用中药熏洗进行足部护理能有效减轻患者的疼痛,提高患者踝/肱指数,降低糖尿病足发生率,为预防糖尿病足提供了简单有效、经济实惠的方案。     

热敏灸联合血管神经治疗仪对糖尿病高危足的干预研究

[目的]探讨热敏灸联合血管神经治疗仪干预糖尿病高危足的影响。[方法]选择在本院内分泌科住院的糖尿病高危足病人120例,按照编号随机分为对照组和观察组,每组60例。两组病人均给予糖尿病常规治疗护理,观察组在此基础上给予热敏灸联合血管神经治疗仪,连续治疗2周。比较两组干预前后感觉神经功能、踝肱指数(ABI)以及足背动脉血流量情况。[结果]治疗后观察组感觉神经功能得分明显低于对照组(P0.05),踝肱指数均明显高于对照组(P0.05),足背动脉血流量得分显著优于对照组(P0.05)。[结论]热敏灸联合血管神经治疗仪治疗糖尿病高危足有一定的优势,能在一定程度上改善病人的感觉神经及血管功能,延缓糖尿病足的发展,为糖尿病高危足提供早期有效的治疗方法。     

中医护理健康教育用于0级糖尿病足病人的效果评价

[目的]观察对0级糖尿病足病人实施中医护理健康教育的临床效果。[方法]将0级糖尿病足病人80例,随机分为干预组和对照组;对照组40例,采用常规护理及健康教育,包括口服降糖药、胰岛素注射、内服中药、健康教育大讲堂等;干预组40例,在对照组方法基础上,采用中医护理健康教育;两组均干预、随访至3个月。[结果]干预3个月后两组比较,病人的糖尿病足中医症候积分评价、代谢指标评价差异均有统计学意义（P〈0.05或P〈0.01）,干预组疗效优于对照组。[结论]中医护理健康教育应用于0级糖尿病足病人,能够改善病人日常足部护理行为及代谢指标,提高疗效,延缓糖尿病足的进展。     

常规方法联合中药口服并外敷治疗糖尿病足的临床观察

目的:探讨常规治疗和常规治疗联合中药口服并外敷治疗糖尿病足的溃疡面愈合情况和踝肱指数。方法 :选取2008年5月~2015年5月我院收治的糖尿病足患者90例,按随机数字表法分为常规治疗组(A组)和常规治疗联合中药治疗组(B组),对比两组溃疡面愈合情况和踝肱指数。结果:83例患者完成随访,A组41例,B组42例,平均随访12.3个月。B组溃疡愈合总有效率和踝肱指数均高于A组,P0.05。结论:常规治疗联合中药口服并外敷治疗糖尿病足,临床疗效显著。     

足部护理对糖尿病足的预防作用

BACKGROUND: With developing of economics and improve-ment of living level, development of health education and preventionof diseases has lagged behind. If blood sugar can' t be controlled andpatients with diabetes is lack of self-protection awareness, diabetesfoot is often caused, even trauma at foot progressed to ulcer infec-tion, gangrene and amputation of extremities.     

Charcot foot

Charcot joint is the painless, degenerative, progressive neuropathic destruction of the bony architecture of one or more joints of the feet. Diabetes mellitus is the most common cause of Charcot joint in North America, although the exact etiology is uncertain. The classic presenting complaint involves unilateral painless swelling of the lower extremity or foot. Charcot joint is often mistaken for cellulitis or deep vein thrombosis and may result in significant foot or ankle deformities. There are several treatment options for the patient presenting with Charcot joint. Medical management often includes immobilization and maintaining nonweightbearing status. Surgical intervention, often a final attempt at managing Charcot foot, involves careful patient selection and is not recommended for all patients. The postoperative phase can be challenging for both patient, nursing staff, and the surgeon.     

糖尿病足的防治

糖尿病足(diabetic foot，DF)是与局部神经异常和下肢远端外周血管病变相关的足部感染、溃疡和或深层组织破坏，是糖尿病常见慢性并发症之一，严重影响病人生活质量，甚至危及病人生命，其防治研究是当今糖尿病领域的热点之一。     

Incorporating foot care education into diabetic foot screening.

Rehabilitation nurses care for patients with diabetes who have strokes, orthopedic surgery, and spinal cord injuries; therefore, they should be knowledgeable about foot screening technique and foot care education so that they can identify patients who are at risk for foot skin breakdown. The objectives of diabetic foot screening are to identify foot problems, determine a foot risk category and management category for patients, and to instruct patients with diabetes and their families in proper foot care. The screening technique is simple and can be used in clinic settings or at the bedside. Incorporating foot care education into the foot screening process increases or reinforces patients' knowledge of self-care. Such knowledge empowers patients to join with their healthcare teams to decrease the incidence of ulceration and amputation.     

Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot

We hypothesized an association between foot type, foot deformity, and foot ulceration and conducted an analysis of a well-characterized, high-risk diabetic population of 398 subjects. The average age was 62 years of age and 74% of the study population were males. Foot-type distributions were 19.5% pes cavus (high arch), 51.5% neutrally aligned (normal arch), and 29.0% pes planus (low arch). We quantified the presence of hallux valgus (23.9%), hammer/claw toes (46.7%), and hallux limitus (24.4%). A significant association was found between foot type and hallux valgus (p = 0.003); pes planus feet had the highest prevalence as compared with neutrally aligned feet (odds ratio [OR] = 2.43, p = 0.0006). Foot type was also significantly associated with fixed hammer/claw toes (p = 0.01); pes cavus feet had the highest prevalence as compared with neutrally aligned feet (OR = 3.89, p = 0.001). Foot type was also significantly associated with hallux limitus (p = 0.006) with pes planus feet having the highest prevalence as compared with neutrally aligned feet (OR = 2.19, p = 0.003). However, foot type was not significantly related to any ulcer outcome (p = 0.7). Fixed hammer/claw toes (OR = 3.91, p = 0.003) and hallux limitus (OR = 3.02, p = 0.006) were associated with increased risk of any ulcer occurrence. This study affirms that foot type and foot deformity are related and that foot deformities are associated with ulcer occurrence.     

Mid foot kinetics characterize structural polymorphism in diabetic foot disease

BACKGROUND: Diabetic foot disease is characterized by progressive foot deformities that lead to amputation and disabling morbidity. The purpose is to investigate the classification of two distinct phenotypes of mid foot structural polymorphism in individuals using plantar kinetic and pressure distribution and tarsal bone density assessments. METHODS: Twenty-two individuals (26 ft) with diabetes mellitus, peripheral neuropathy and at least one mid foot deformity were compared to 29 age-, gender- and race-matched healthy controls (58 ft). Eleven subjects with diabetes mellitus and peripheral neuropathy (11 ft) had lateral deformity; 11 subjects (15 ft) had medial deformity. Each subject had calcaneal bone mineral density and plantar force and pressure assessments walking barefoot over an EMED-ST P-2 platform. FINDINGS: Control subjects had lower mid foot vertical forces and pressures despite significantly higher preferred walking speed. In subjects with diabetes and neuropathy, maximum vertical force was 6-fold greater, force-time integral 9.5-fold greater, peak pressure 6.7-fold higher, pressure-time integral was 9.7-fold greater, contact area 2-fold greater and contact time 1.9-fold higher than controls. Pressure values were larger in involved vs uninvolved (P0.05). During stance in the mid foot, subjects with medial column phenotype showed greater pressure in the medial mask; subjects with lateral column phenotype had greater pressures in the lateral mask (P<0.05). Calcaneal bone density was lower for the deformity foot vs the non-deformity foot; bone mineral density was lower in medial column phenotype vs lateral column phenotype (P=0.02). INTERPRETATION: Diabetic foot disease can be classified as stereotypical, structurally-distinct phenotypes of deformities of the medial and lateral columns of the mid foot. Assessments of pedal bone density and plantar mid foot force and pressure during barefoot walking can characterize the structural polymorphic phenotypes and may assist the foot care specialist in clinical decision making.