共查询到18条相似文献,搜索用时 140 毫秒
1.
糖尿病足患者医疗费用分析 总被引:4,自引:0,他引:4
Wang AH Zhao S Li Q Wang PH Yan L Du YM Bian RW Wang ZJ Mao JP Xiao ZH Ma XY Lin SD Chen GC Zhou YS Xu ZR 《中华内科杂志》2007,46(6):471-474
目的 调查和分析糖尿病足医疗费用及其影响因素。方法 前瞻性地对全国14家三级甲等医院的2004年全年门诊和住院糖尿病足患者的足局部情况进行Wagner分级、Texas分期和溃疡性质分析及住院天数、医疗费用等调查。结果 573例患者的平均费用(14906±7072)元;其中药品费占56%、检查费占19%;患者职业、糖尿病病程对住院天数及费用有显著影响,合并糖尿病肾病患者住院费用显著增加,随着溃疡深度的加重,住院天数及费用明显增加;随足溃疡数量增加,住院天数无明显增加,但住院费用显著增加;合并感染及缺血的足病患者住院天数及住院费用均明显增加;缺血性溃疡较神经性和混合性的住院天数及住院费用均明显增加;合并坏疽足患者住院天数延长、住院费用增加。结论 糖尿病足医疗费用高。糖尿病足医疗费用与合并肾病、溃疡、缺血和感染的严重程度明显正相关。 相似文献
2.
糖尿病足病变诊断与治疗的临床思考 总被引:30,自引:1,他引:29
许樟荣 《中国实用内科杂志》2005,25(4):375-377
糖尿病足的定义是发生于糖尿病患者的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。患者从皮肤到骨与关节的各层组织均可受累,严重者可以发生局部的或全足的坏疽,需要截肢。糖尿病足处理不当会导致病情急转直下,严重致残,甚至死亡。国外的资料说明,所有因糖尿病有关问题住院的原因中,糖尿病足占到其中的 47%。糖尿病足溃疡和截肢所带来的医疗耗费巨大,在美国此项费用几乎相当于其他糖尿病并发症的医疗花费的总和 [1, 2]。国内部分综合性医院糖尿病内分泌专科报告,糖尿病足患者占了门诊患者的 2%,住院… 相似文献
3.
4.
为寻找糖尿病足诊疗规律,本文对比研究了国内外糖尿病足指南。本文从指南制定使用的方法学、内容划分、高危足预防、糖尿病足溃疡减压、糖尿病足溃疡周围血管病变、糖尿病足感染、糖尿病足溃疡愈合、糖尿病足溃疡分类这几个部分,比较了国际糖尿病足工作组2019年糖尿病足指南和中华医学会糖尿病学分会2019年糖尿病足指南。糖尿病足预防非常重要,溃疡减压以不可拆卸支具为主;存在外周动脉疾病时,要掌握手术适应证并采取合理治疗方法;有感染时,要根据严重程度不同选择不同的抗感染方法(含手术清创)。促进创面愈合的方法很多,但证据等级多不高;溃疡分类多,但无一能涵盖诊治全部需求。我国医护人员应当将国内外指南与当地医疗条件相结合、规范化地诊治糖尿病足。 相似文献
5.
糖尿病足的定义是发生于糖尿病患者的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。国外的资料说明,所有的因糖尿病有关问题的住院中,糖尿病足占到47%。糖尿病足溃疡和截肢所带来的医疗耗费巨大,在美国此项费用几乎相当于其余糖尿病并发症的医疗花费的总和。 相似文献
6.
糖尿病足是指糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏。其临床特点为早期肢端麻木、疼痛、发凉和《或)有间歇性跛行、静息痛,继续发展则出现下肢远端皮肤变黑、组织溃烂、感染、坏疽。糖尿病足溃疡使患者生活质量严重下降,且治疗相当困难,治疗周期长,医疗费用高。本病属中医“筋疽”、“脱疽”等范畴。 相似文献
7.
糖尿病足是指糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏。其临床特点为早期肢端麻木、疼痛、发凉和《或)有间歇性跛行、静息痛,继续发展则出现下肢远端皮肤变黑、组织溃烂、感染、坏疽。糖尿病足溃疡使患者生活质量严重下降,且治疗相当困难,治疗周期长,医疗费用高。本病属中医“筋疽”、“脱疽”等范畴。 相似文献
8.
许樟荣 《中国实用内科杂志》2007,27(7):483-484
糖尿病足病是常见的糖尿病慢性并发症之一。其治疗困难,医疗费用高,预后差,所造成的社会负担沉重。糖尿病足病医疗花费巨大。美国资料显示,1997年每位足溃疡患者平均住院的医疗费用为10831美元,平均住院日8.9d;下肢截肢医疗费用为17302美元,平均住院日12d,其平均住院日分别超过了心肌梗死(6.9d)和冠心病的冠状动脉旁路移植术(9.9d)[1]。美国糖尿病足病的直接医疗费用每年高达40亿美元[2]。糖尿病患者的截肢率约是非糖尿病患者的25倍。因此,对糖尿病足病的预防与治疗已是当务之急。随着人们生活方式的改变以及人均寿命的延长,糖尿病发病率以… 相似文献
9.
糖尿病足是由于糖尿病血管、神经病变引起下肢异常的总称,因合并感染引起肢端坏疽者称糖尿病肢端坏疽,是糖尿病足发展的一个严重阶段[1].据报道,在美国1600万糖尿病患者中,有近25%的患者并发过足部溃疡;糖尿病足部溃疡多发于糖尿病病程10年以上者,病程超过20年以上者,45%患者存在有足部神经障碍性病变[2];在德国,Gulan等报道,糖尿病足部溃疡的发生率占糖尿病总数的15%,需要截肢(趾)者高达33%,而且不管截肢与否,糖尿病足部溃疡患者的死亡率高达29%,而在Wagner分级中4级上而未行手术治疗严重患者,死亡率达54%[3],由此造成的经济和社会负担也相当大,Benotmane报道,在1779名糖尿病住院患者中,有163例(占9.16%)因足部损害而住院,这163名患者总的住院天数为7247天,平均45天,总的住院费用达914,534.39美元,无论是住院天数,还是住院费用均随足部病变的严重程度而增加[4].因此,早期预防,早期治疗糖尿病足部溃疡,阻止病变向严重情况发展,不仅能减少糖尿病患者的足部溃疡的发病率,及其死亡率,而且还能减少治疗所带来的沉重的经济和社会负担. 相似文献
10.
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 相似文献
11.
《Diabetes research and clinical practice》2014,103(2):286-294
AimsTo identify risk factors and clinical biomarkers of prevalent diabetes foot complications, including foot ulcers, gangrene and amputations among patients with diabetes in Jeddah, Saudi Arabia.Methods598 diabetes patients from Jeddah participated in the current study. Patients were considered to have diabetes foot complications if they reported diagnosis of foot ulcers or gangrene or amputations in a questionnaire administered by a physician and confirmed by clinical exams. Information on socio-demographic and lifestyle variables was self-reported by patients, and several clinical markers were assessed following standard procedures.ResultsThe prevalence of diabetes foot complications in this population was 11.4%. In the multivariable model without adjustment for PAD (peripheral artery disease) and DPN (diabetes peripheral neuropathy), non-Saudi nationality, longer diabetes duration and insulin use was significantly associated with higher diabetes foot complications prevalence. Each 1 g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. In the multivariable model adjusting for PAD and DPN, the previously observed associations except for nationality were no longer significant. Patients with both DPN and PAD had 9.73 times the odds of diabetes foot complications compared to the patients with neither condition.ConclusionIn this population, longer diabetes duration, insulin use, lower hemoglobin levels and non-Saudi nationality were associated with higher prevalence of foot complications. These associations were largely explained by the presence of DPN and PAD except for non-Saudi nationality. Diabetes patients with both DPN and PAD had nearly 10-fold increased risk of foot complications than those with neither condition. 相似文献
12.
严重下肢动脉病变与糖尿病足的相关性研究 总被引:3,自引:1,他引:2
目的 调查住院病人糖尿病足(DF)和下肢动脉病变(PAD)的发病情,分析两者之间的相关性.方法 测定523例住院糖尿病病人空腹及餐后血糖、HbA_(1C)血脂分析和尿微量白蛋白浓度等.应用多普勒超声技术评估所有糖尿病住院病人PAD病情,检查股动脉、股浅动脉、胭动脉、胫前动脉、胫后动脉和腓动脉.根据检查结果分为3组:无病变组、轻度病变组(血管狭窄<50%)和重度病变组(血管狭窄≥50%).糖尿病足诊断按照Wagner标准.结果 在凶糖尿病住院523例病人中,DF 95例(18.2%).PAD 311例(59.5%),其中重度PAD 131例(25.0%).95例DF病人中重度PAD 55例(57.9%).Log9istic回归分析显示,严重PAD(OR=5.00)是DF的独立危险因素.其他危险因素包括吸烟、高血压和糖尿病神经病变.结论 严重PAD是DF最主要的危险因素. 相似文献
13.
Magdy H. Megallaa Azza A. Ismail Mohammed H. Zeitoun Mai S. Khalifa 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2019,13(2):1287-1292
ContextDiabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group.Subjects and methodsThis cross-sectional study included 180 type 2 diabetic patients (aged 30–70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects.ResultsThe prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD).ConclusionChronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD). 相似文献
14.
Prompers L Huijberts M Apelqvist J Jude E Piaggesi A Bakker K Edmonds M Holstein P Jirkovska A Mauricio D Ragnarson Tennvall G Reike H Spraul M Uccioli L Urbancic V Van Acker K van Baal J van Merode F Schaper N 《Diabetologia》2007,50(1):18-25
Aims/hypothesis Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were
performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate
the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries.
Methods The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October
2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease
was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection:
A: PAD −, infection −; B: PAD −, infection +; C: PAD +, infection −; D: PAD +, infection +.
Results PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface
of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease.
Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and
more serious comorbidity.
Conclusions/interpretation According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously
reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially
in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease.
Further research is needed to obtain insight into the clinical outcome of these patients. 相似文献
15.
Elderly diabetic patients are particularly burdened by foot disease. The main causes for foot disease are peripheral neuropathy, foot deformities and peripheral arterial disease (PAD). Other risk factors include poor vision, gait abnormalities, reduced mobility an medical co-morbidities. The risk of major amputations increases with age, along with the increased prevalence of these risk factors. Th true risk of amputation and other burdens of foot disease in the elderly are likely underestimated by current epidemiological data. Th prevalence of neuropathy, foot deformities and PAD as well as the risk of amputation all increase with age even in non-diabetic patients. The principles of prevention and management of diabetic foot disease may also apply to large segments of the elderly non-diabetic population. Foot ulcer prevention relies on the identification of high risk patients and avoidance of triggering events, such as ill-fitting shoes, walking barefoot or poor self-care. PAD is a major cause of amputation and should be prevented by lifelong attention to glycaemic control, treatment of hypertension and dyslipidemia, and avoidance of smoking. The treatment of foot ulcers relies on pressure relief (off-loading), wound debridement, and treatment of infection and ischemia. It requires an individualized approach considering the patient's co-morbidities and functional status. Off-loading remains essential, but devices such as total contact casts or crutches can only rarely be implemented. However, providing adapted standard foot-wear and insisting on its consistent use even at home is often effective. The benefits of aggressive vascular or orthopaedic surgery should be weighed against the risks of prolonged hospitalisation and resulting functional decline. Greater attention to prevention and individualized care are needed to reduce the burden of diabetic foot disease in the elderly. 相似文献
16.
Lawrence A 《EDTNA/ERCA journal (English ed.)》2004,30(3):153-156
Foot complications are said to be the primary cause of hospitalization for patients with diabetes, resulting in enormous personal and financial costs. It is reported that end-stage renal disease (ESRD) diabetic patients with peripheral vascular disease have a much higher incidence of foot complications and increased risk for amputation. However, despite the serious financial burden caused by diabetic foot ulcers and their complications, the importance of diabetic foot care is still not fully recognised or supported. There is increasing evidence to suggest that education on foot care is essential for patients with diabetes. Studies have shown that simple techniques such as identifying those at risk of developing foot ulcers, educating patients about foot care that is tailored to meet the requirements of individual patient needs, educational background and learning ability can be of obvious benefit to people with diabetes and is cost-effective. 相似文献
17.
《Journal of diabetes and its complications》2020,34(9):107622
Diabetic foot ulcers are among the most serious complications of diabetes. If left untreated, these ulcers can lead to severe infection and gangrene; in some instances, they may result in death. Thus, timely treatment of diabetic foot ulcers is extremely important. However, timely patient treatment during the COVID-19 pandemic is particularly challenging, because of the higher volume of patients and the need to ensure safety of medical personnel. This article describes a proposed strategy for diagnosis and treatment of diabetic foot ulcers, based on experiences with infection and control strategies during the COVID-19 pandemic in China. 相似文献
18.
目的 通过对糖尿病足溃疡住院患者进行心理评估,探讨抑郁情绪对患者预后的影响.方法 对2010年6月至2011年5月因糖尿病足病住院的168例Wagner 3级足溃疡患者应用抑郁自评量表进行评估,按照抑郁程度分为不伴抑郁组和伴抑郁组,采用logistic回归分析抑郁情绪对糖尿病足患者足溃疡愈合以及对足溃疡愈合的患者行截肢手术的影响.结果 Wagner 3级患者中伴抑郁症者95例(56.5%),不伴抑郁症者73例(43.5%).卡方检验证实伴抑郁者溃疡不愈合率较不伴抑郁者显著增加(分别为18.9%和6.8%,OR=2.779,95% CI:1.120 ~9.023),logistic回归分析发现,在依次调整了与足溃疡预后密切相关的感染程度与动脉病变程度以及年龄、糖化血红蛋白、合并症Charlson评分等因素后,抑郁仍是患者溃疡不愈合的危险因素(OR=3.569,95%CI:1.220~10.442).进一步对溃疡愈合组患者进行logistic回归发现,在依次调整上述因素后,抑郁情绪的存在也是溃疡愈合组患者截肢的危险因素(OR=2.793,95% CI:1.361 ~ 5.732).结论 糖尿病足溃疡患者普遍存在抑郁情绪并对患者预后产生不利影响.对其进行筛查并给予必要的心理治疗,可降低住院糖尿病足溃疡患者的手术风险. 相似文献