护理干预对预防糖尿病足溃疡的作用

目的：探讨护理干预对预防糖尿病足溃疡的作用。方法：将188例发生足溃疡的低、中、高危患者根据教育阶段不同分为A、B、C3组，分别在足溃疡发生的前期、发生期和后期予以护理干预并随访12个月，观察干预前后足溃疡的发生率和血糖值。结果：血糖与足溃疡发生、发展密切相关。3组干预后血糖均明显下降，以A组最为显著，无1例发生足溃疡。高危者足溃疡发生率明显高于中、低危者，但干预后显著下降。结论：预防教育应从低危者着手，中、高危者列为重点防治对象，指导患者控制血糖和每目护足是有效预防足溃疡的关键。     

同伴支持健康咨询模式在社区糖尿病足溃疡预防中的应用效果观察

以2014年3月~2015年3月本社区就诊的70例住院的糖尿病患者为对象,经评估分为糖尿病足溃疡低、中、高危组,所有患者均采取同伴支持健康咨询模式,讨论其在社区糖尿病足溃疡预防中的应用效果。结果 70例患者中,低危足、中危足、高危足的发生率分别为45.8%、27.1%、27.1%。干预后患者皮肤干燥、皲裂、足癣、下肢、足麻木、疼痛状况及触觉、痛觉、震动觉异常发生率显著低于干预前(χ2=22.214、7.832、18.893、5.892、21.831、10.739,P0.05)。但干预前后的冷、热觉异常情况比较无明显差异(P0.05)。通过对社区糖尿病患者采取同伴支持健康咨询模式,能够进一步预防社区糖尿病足溃疡发生。     

彩色多普勒超声在妇科术后下肢深静脉血栓预防中的作用

目的 探讨彩色多普勒超声(CDU)在妇科手术后使用预防措施对下肢深静脉血栓(LEDVT)干预的价值.方法 因妇科疾患接受盆腔手术的患者219例,根据患者并发LEDVT的风险程度随机分为三组:对照组:无预防措施;预防组分别使用下肢间歇性气囊加压(IPC)预防(IPC组)和低分子肝素(LMWH)预防(LMWH组).应用彩色多普勒超声分别于术前1天、术后第二天开始扫查双下肢,若有血栓,则继续动态观察.结果 LEDVT发生率对照组为11.64%,IPC组为4.11%,LMWH组为0.68%,预防组较对照组发生率显著下降(P<0.0001),IPC组与LMWH组间发生率差异无统计学意义(P=0.06);对照组高危患者中血栓发生的比例为42.86%,中危患者为5.88%,低危患者为8.00%;IPC组高危患者中血栓发生的比例为14.28%,中危患者为6.06%,低危患者无血栓发生;LMWH组中危患者中血栓发生的比例为2.94%,低危和高危患者无血栓发生;预防组高危患者中血栓发生的比例较对照组显著下降(P=0.01).结论 盆腔手术后下肢IPC及LMWH均可有效预防盆腔手术后LEDVT的发生,后者疗效更为显著;高危患者术后应常规使用预防措施;彩色多普勒超声在妇科手术后应用预防措施时有重要价值.     

尿酸干预治疗对无症状高尿酸血症并糖尿病前期患者血糖的影响

目的探讨尿酸干预治疗对无症状高尿酸血症并糖尿病前期患者血糖的影响。方法无症状高尿酸血症并糖尿病前期患者112例分为3组,A组50例给予低嘌呤饮食联合降尿酸药物干预治疗,B组30例给予低嘌呤饮食干预,C组42例不予任何干预措施,A、B组疗程均为1a,比较3组治疗前、后血尿酸及空腹血糖水平。结果与治疗前及C组比较,A,B组血尿酸、空腹血糖水平降低(P<0.05),A组较B组降低明显(P<0.05)。结论血尿酸干预治疗可降低无症状高尿酸血症并糖尿病前期患者血糖水平。     

护理教育干预对糖尿病足预防的效果研究

目的通过系统的个体化糖尿病足预防护理教育方法的建立、实施与效果评价，观察足部护理教育干预对糖尿病足预防的中远期效果。方法220例糖尿病患者随机分为教育干预组86例（入组110例，失访24例）、对照组92例（入组110例，失访18例），评价教育前、教育干预后9个月时糖尿病足预防护理知识与行为、足部状况、足病发生情况。结果教育干预9个月后追踪观察发现：2组患者在基线人口学及足部病理改变相似的情况下，教育干预组患者对糖尿病足的认识、早期筛查知识、日常足部护理、合适鞋袜选择、修剪趾甲等知识显著提高、日常足部护理行为明显改善（P〈0．05）。教育干预组患者足部皮肤病理性损害明显减少：足部胼胝发生率、足部皮肤损伤率、足癣发生率、皮肤干燥、皲裂发生率均明显低于对照组（P〈0．05）。结论糖尿病足的预防护理教育干预在减少足病发生中有重要作用，个体化教育干预对足病预防的中远期效果显著。     

健康信念模式在社区高危压疮患者家庭中的应用

目的探讨健康信念模式在社区高危压疮患者家庭中的应用效果。方法将86例高危压疮患者及其主要照顾者,按照随机数字表法分为观察组和对照组,各43例。观察组采用健康信念模式进行教育。对照组采用常规健康教育。比较干预后两组主要照顾者的压疮预防信念及干预1个月后两组压疮发生率。结果干预后观察组主要照顾者压疮预防信念评分优于对照组(P0.01)。干预1个月后观察组压疮发生率低于对照组(P0.05)。结论健康信念模式教育能有效预防高危压疮患者发生压疮。     

持续胰岛素静脉注射治疗老年2型糖尿病疗效观察

目的观察短期持续胰岛素静脉注射对老年2型糖尿病患者血糖控制的作用。方法 64例老年2型糖尿病患者随机分为持续胰岛素静脉注射组32例、多次皮下胰岛素注射（MSII）治疗组32例,治疗3 d,评估治疗前后血糖控制及低血糖发生情况。结果治疗后静脉注射组血糖下降明显,低血糖发生率低。结论持续胰岛素静脉注射可以短期内降低老年2型糖尿病患者血糖,低血糖发生率低。     

不同剂型胰岛素强化治疗2型糖尿病的观察和护理

目的探讨采用不同剂型胰岛素强化治疗2型糖尿病的效果和护理。方法将102例新发2型糖尿病患者随机分为诺和灵R组和诺和锐组,采用胰岛素泵强化治疗1周,检测2组患者空腹血糖及餐后2h血糖下降情况、血糖达到强化治疗良好目标所需时间、低血糖发生率。结果2组患者血糖均明显下降,与诺和灵R组相比,诺和锐组餐后2h血糖下降更为显著(p<0.05),血糖控制达标所需时间更短(p<0.05),低血糖发生率更低(p<0.05)。结论诺和锐与诺和灵R在胰岛素泵临床应用中均安全有效。但诺和锐起效快,使用灵活方便,低血糖发生率低,方便了患者进餐,减少了护理工作量,提高了护理质量和患者满意度。     

不同管理模式对糖尿病足溃疡发生风险的效果分析

目的探讨不同管理模式对糖尿病足溃疡发生风险的效果分析。方法本研究对我科住院未发生足溃疡的2型糖尿病患者进行震动感觉阈值(VPT)测定,任足VPT>15V为糖尿病足溃疡中、高度风险的患者120例,随机分为实验组和对照组,各60例。对照组接受传统随访管理。实验组接受加强自我管理及随访与追踪管理。1年后两组进行比较,评估糖尿病足发生率、血糖变化情况。结果实验组与对照组糖尿病足的发生率分别为7.1%、23.1%,两组糖尿病足发生率比较有显著性差异(P<0.05)。与对照组比较,实验组空腹血糖及餐后2h血糖控制较好(P<0.05)。结论糖尿病足溃疡中、高度风险患者接受加强自我管理,早期采取一系列护理干预,血糖得到良好的控制,能有效防止或延缓糖尿病足溃疡的发生。     

保护动机理论在糖尿病高危足患者护理干预中的应用

目的探讨基于保护动机理论的护理干预提高糖尿病高危足患者的生活质量及预防糖尿病足的效果。方法 2011年3月至2012年3月,采用便利抽样法选取衡阳市某三级甲等医院内分泌科的糖尿病高危足患者80例作为研究对象,采用随机数字表法将其分为对照组及干预组各40例,两组患者均予糖尿病足常规健康教育及护理,干预组在此基础上给予基于保护动机理论的综合护理干预,干预时间为6个月。比较两组患者干预前后的生活质量、自我效能、血糖及血脂等实验室指标和踝-肱血压比值(ankle brachial index,ABI)。结果干预组患者自我效能及生活质量明显优于对照组,空腹血糖、餐后2h血糖、糖化血红蛋白、高密度脂蛋白和ABI也较对照组有明显改善,差异均有统计学意义(均P0.05)。结论运用保护动机理论的综合护理干预能有效提高糖尿病高危足患者的生活质量和自我效能、预防糖尿病足的发生。     

多学科团队管理对糖尿病足病人心理健康及生活质量的影响

[目的]探讨多学科团队管理对糖尿病足病人心理健康状况及生活质量的影响.[方法]将200例糖尿病足病人随机分为两组,实验组实施多学科团队管理,对照组给予常规治疗.比较两组病人血糖、血脂、疗效、心理健康及生活质量状况.[结果]两组病人血糖、血脂控制情况均较前有所改善(P＜0.05);实验组较对照组控制水平更佳;两组糖尿病足痊愈率比较差异有统计学意义(P＜0.05);实验组病人的心理健康及生活质量评分优于对照组.[结论]多学科团队管理能更好地控制糖尿病足病人的血糖水平,改善心理健康及生活质量,有效治疗糖尿病足.     

Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration

OBJECTIVE: To investigate the role of limited joint mobility (LJM) in causing abnormal foot pressures and foot ulceration. RESEARCH DESIGN AND METHODS: The subjects were recruited from a general diabetes clinic where patients were screened for neuropathy, retinopathy, and elevated plantar foot pressure. Sixty-four patients in five groups were matched by age and sex in the following groups: group 1, patients with LJM and neuropathy; group 2, nonneuropathic diabetic patients with LJM; group 3, patients with neuropathy and no LJM; group 4, diabetic control subjects; and group 5, nondiabetic control subjects. Joint mobility was assessed in the foot at subtalar and metatarsophalangeal joints; plantar foot pressures were assessed by optical pedobarography and neuropathic status by a Biothesiometer and electrophysiology. RESULTS: Joint mobility was reduced at both sites in groups 1 and 2 compared with groups 3, 4, and 5 (P less than 0.001). Plantar foot pressures were significantly higher in groups 1 and 2 compared with groups 3, 4, and 5 (P less than 0.001). No differences in plantar foot pressures were observed between groups 1 and 2. There were strong correlations between plantar foot pressures and joint mobility in the foot (r = -0.7, P less than 0.001). Previous foot ulceration was present in 65% of patients in group 1, none in group 2, and 5% in group 3. CONCLUSIONS: 1) LJM may be a major factor in causing abnormally high plantar foot pressures, 2) abnormal plantar foot pressures alone do not lead to foot ulceration, and 3) LJM contributes to foot ulceration in the susceptible neuropathic foot.     

Pattern of abnormal tangential forces in the diabetic neuropathic foot

OBJECTIVES: The role of tangential stress in neuropathic foot ulceration is yet unknown. The aim of this study was to investigate the tangential forces developed during gait by the whole foot and by selected subareas of it, namely the heel, the metatarsals and the hallux. METHODS: 61 diabetic patients have been evaluated: 27 without neuropathy, 19 with neuropathy and 15 with previous neuropathic ulcer. The patients were compared with 21 healthy volunteers. A piezo-dynamometric platform was used to measure the three components of the ground reaction force under the total foot and the selected subareas. RESULTS: A significant reduction was observed for the forward peak and the backward peak of the anteroposterior ground reaction force component measured under the whole foot. Patients with previous neuropathic ulcer showed a significant increase of the mediolateral stress under the metatarsals. CONCLUSIONS: Tangential stress is altered in diabetic neuropathic patients; the increased mediolateral component suggests that tangential stress could have a role in the high risk of recurrence observed in patients with previous ulceration. RELEVANCE: To assess the effectiveness of a non-invasive methodology for the estimation and the monitoring of significant alterations of the tangential stress with the increase of neuropathy.     

Use of the Semmes-Weinstein monofilament in the strong heart study. Risk factors for clinical neuropathy.

OBJECTIVE: We used the Semmes-Weinstein 5.07 monofilament to assess the prevalence of foot insensitivity and its relationship to potential risk factors. RESEARCH DESIGN AND METHODS: There were 3,638 American Indian participants from Arizona, North and South Dakota, and Oklahoma who attended a study clinic on two occasions: baseline and follow-up, 4 years later. Oral glucose tolerance tests were performed at the visits for those who had not previously been diagnosed as having diabetes. A total of 2,051 participants were diagnosed with diabetes before the study or at the subsequent study visits. At the follow-up visit, participants were tested for their ability to sense the 5.07 (10 g) monofilament at 10 sites of the foot. The prevalence of foot insensitivity was ascertained, and its relation to characteristics of participants was assessed in both univariate and logistic regression analyses. RESULTS: Diabetic participants had a much higher prevalence of foot insensitivity (defined as greater than or equal to five incorrect responses) than nondiabetic participants (14 vs. 5%, respectively). However, marked foot insensitivity was uncommon within the first few years of diagnosis of diabetes. Among the diabetic participants, those diagnosed before study entry had the highest prevalence of foot insensitivity. The prevalence of foot insensitivity was highest in the Arizona Indians (22 vs. 9% in the Dakotas and 8% in Oklahoma). In a logistic regression analysis, foot insensitivity was significantly and independently related to center (Arizona versus others), age, duration of diabetes, and height. CONCLUSIONS: Marked foot insensitivity is prevalent in the diabetic American Indian population, especially in Indians in Arizona; however, this insensitivity is apparently uncommon for several years after the diagnosis of diabetes. The data show that Indians with diabetes are particularly vulnerable to the risk of foot ulceration and that the diagnostic screening of diabetes may lead to better prevention of sensory neuropathy and subsequent foot ulceration.     

The diabetic foot

Diabetic foot lesions most commonly result from a combination of neuropathy and vascular disease in the lower extremity, and may be the presenting feature of diabetes in the older patient. Insufficient attention previously has been given to the careful clinical assessment of the foot, which enables the physician to recognize those patients who are at particular risk of ulceration. The high-risk patient requires education and frequent follow up to reduce the risk of lesions developing. If ulceration develops, healing is likely to occur if the vascular supply is adequate, infection and the blood glucose are controlled, and pressures that may have caused the ulcer are relieved. The ischemic foot requires full vascular assessment, involving colleagues from vascular surgery. The key to a future reduction in the incidence of diabetic foot ulceration is the setting up of a foot care team in which the skills of nurses, podiatrists, orthotists, physicians, and surgeons are combined. The most important members of the team, however, are the patients, who must be convinced that regular foot care will reduce their chances of developing ulceration and other catastrophic consequences, such as amputation.     

Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot

OBJECTIVE: To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes. RESEARCH DESIGN AND METHODS: A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation. RESULTS: Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001). CONCLUSIONS: The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.     

Use of liquid crystal thermography in the evaluation of the diabetic foot

Liquid crystal thermography (LCT) was used to determine temperature variations on the plantar surface of feet. The purpose was to identify thermal emission patterns associated with diabetic foot ulcers. Three population groups were screened: group I, 16 nondiabetic controls; group II, 21 diabetic patients with no history of pedal ulcers; and group III, 28 diabetic patients with active pedal ulceration or history of foot ulcerations. The results demonstrate a generalized increase in plantar foot temperature in group III compared with groups I and II. Temperature readings under metatarsal heads 1-5, great toe, heel, and lateral band were significantly increased (P less than .01) in group III. Additionally, the warm lateral surface displayed by group III patients was not significantly different in temperature from the medial arch of the foot. In groups I and II, the lateral band was significantly cooler (P less than .01) than the medial arch. In group III patients with active ulceration on only one foot, no significant difference in temperature was found between the foot with active ulceration compared with the contralateral nonulcerated foot. When patients with active pedal ulceration were compared with patients with a history of foot ulcers, no significant difference in temperature was seen at five of seven sites tested. A warm concentric color band surrounding active plantar ulcers was identified in group III. This pattern extended from the center of the ulcer to a distance of 8 mm. A significant change in temperature (P less than .01) was noted at 6- and 8-mm distances from the center of the ulcer. In addition, a mottled thermographic pattern was observed more frequently in group III patients than in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)     

The causes and management of foot ulceration

Managing foot ulceration is a challenge for all concerned. This article argues that the key to successful management of ulceration lies with the accurate identification of the underlying cause of the ulcer and consideration of the additional factors that are likely to impair healing. The common causes of foot ulceration are discussed, the means of evaluation and assessment are outlined and appropriate management strategies are identified. As with all care pathways, patient concordance is essential in reaching successful clinical outcomes and foot ulceration is no exception.     

The role of limited joint mobility in diabetic patients with an at-risk foot

OBJECTIVE: To assess the role of limited joint mobility (LJM) in causing abnormal high plantar pressures in the forefoot of diabetic patients with an at-risk foot. RESEARCH DESIGN AND METHODS: A total of 70 type 1 or type 2 diabetic patients and 30 control subjects participated in this cross-sectional study. Thirty-five diabetic patients with an at-risk foot, defined as a foot with neuropathy but without ulceration or previous ulceration, and 35 diabetic control subjects without neuropathy were selected for the subgroups. Joint mobility was assessed in the foot at the ankle and metatarsophalangeal I (first MTP) joints. Using the FastScan plantar pressure analyzer, the pressure-time integrals (PTIs) as dynamic variables were measured in each foot. The clinical assessment included standard measures of peripheral neuropathy. RESULTS: The mobility at the ankle and first MTP joint were significantly reduced in the foot-at-risk group compared with the diabetic control group and the control subjects (P < 0.0001). The PTIs were significantly higher in the foot-at-risk group compared with the two other groups (P < 0.0001). There was a strong inverse correlation between the mobility of the ankle or first MTP joint and the PTI of the diabetic patients (r = -0.67, P < 0.0001, and r = -0.71, P < 0.0001, respectively). The vibration perception threshold was positively correlated with the PTI of the diabetic patients (r = 0.44, P = 0.0001). CONCLUSIONS: Diabetic patients with an at-risk foot have reduced joint mobility and elevated PTIs on the plantar forefoot, placing them at risk for subsequent ulceration. Therefore, LJM may be a possible factor in causing high plantar pressures and may contribute to foot ulceration in the susceptible neuropathic at-risk foot.     

Plantar pressures are elevated in the neuroischemic and the neuropathic diabetic foot

OBJECTIVE: Clinical observation has noted that diabetic neuropathic ulcers occur frequently on the plantar surface, whereas neuroischemic ulcers seem to occur often on the foot margins. The reason for this difference in the site of ulceration is unknown, but it may be related to differences in pressure loading. The aim of the study was to compare vertical in-shoe foot pressures measured during walking (using the F-SCAN system) in four groups of patients whose degree of neuropathy was measured by vibration perception threshold (VPT). RESEARCH DESIGN AND METHODS: Subjects included 14 neuroischemic diabetic patients (VPT 29.3 +/- 13.5 V) with history of ulceration on the margins of the foot, 18 patients with neuropathy alone (VPT 38.7 +/- 12.7 V) and previous history of ulceration on the plantar surface, 10 diabetic control patients (VPT 9.9 +/- 2.7 V), and 15 nondiabetic control subjects (VPT 7.0 +/- 0.5 V). RESULTS: When compared with the other three groups, neuroischemic patients had higher foot pressures when measured as mean peak pressures and highest peak pressures under four areas of the foot: medial and lateral forefoot, hallux, and heel. Furthermore, when measuring the maximum pressures developed at any point under the plantar surface, the neuroischemic patients also had the most elevated pressures (757.6 +/- 135.9 kPa), significantly higher than those found in the neuropathic group (482.8 +/- 68.6 kPa, P = 0.04) and in both diabetic control patients (310.2 +/- 34.7 kPa, P = 0.008) and nondiabetic controls subjects (365.1 +/- 49.8 kPa, P = 0.007). CONCLUSIONS: Despite having increased plantar pressures and a comparable degree of neuropatny, the neuroischemic patients did not have a history of ulceration on the plantar surface. These observations may have relevance to different mechanisms of ulcer formation in the neuroischemic and neuropathic foot.