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1.
目的:探讨中西医结合治疗糖尿病肢端坏疽的有效方法。方法:在控制血糖、血脂等基础上采用山莨菪碱穴位注射,脉络宁静滴,中药洗剂外用,局部清创等综合治疗措施。结果:治愈129例,占85%,好转12例,占7.9%,无效11例,占7.2%,截肢10例,占6.6%,死亡25例,占16.4%,均死于糖尿病严重并发症。在治疗过程中患者的甲皱微循环明显改善,患肢血管多普勒检查见局部血管内径增宽,血流量增加。结论:中西医综合治疗糖尿病肢端坏疽疗效确切肯定。  相似文献   

2.
据《中华医学杂志》1994年74卷第6期报道中国人民解放军空军总医院糖尿病研究中心李仕明等,应用山莨菪碱改善患者全身和患肢微循环、局部清创换药及控制糖尿病等综合措施,对351例糖尿病肢端坏疽进行了治疗。  相似文献   

3.
目的观察多种方案联合治疗糖尿病肢端坏疽的疗效。方法按照随机平行原则将糖尿病肢端坏疽患者分为多元治疗组32例(36肢)和西药组31例(35肢),在相同的降糖基础治疗之上,多元治疗组采用中药辨证内服外治+抗生素+抗凝+654—2+局部处理治疗,西药组采用抗生素+局部处理。10d为1个疗程,共4个疗程。结果治疗后,疮面愈合情况多元治疗组优于西药对照组(P〈0.01或P〈0.05),足背动脉搏动差异无统计意义(P〉0.05),两组治疗前后对照血糖稳定,血流变指标改善显著(P〈0.01或P〈0.05),治疗后多元组全血比黏度低于单纯西药组(P〈0.01),血浆比黏度、纤维蛋白原差异无统计意义(P〉0.05),治愈、显效、有效和无效多元治疗组为60.00%、25.71%、8.57%、5.71%。西药组为33.33%、36.36%、21.21%、9.09%,两组比较P〈0.05,差异具有统计意义。结论多元治疗组疗效优于西药组。  相似文献   

4.
OAKLEY于1956年首先提出了“糖尿病足”(DF)的概念,1972年,CATTERALL将糖尿病足定义为因神经病变而失去感觉,或因缺血而失去活力同时感染的足。1995年,我国第一届糖尿病足学术会议对其进行了新的注释,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称糖尿病足肢端坏疽,是糖尿病足发展的一个重要阶段,糖尿病足作为糖尿病的一种严重并发症,具有很强的致残性,最终的结局是溃疡、截肢和死亡,糖尿病足的患病率占到糖尿病人数的90.8%~96%,针对糖尿病足肢端缺血,微循环障碍的病理改变,重新恢复足部循环是治疗的重要一环,我科在近几年采用川芎嗪联合高压氧治疗糖尿病足,在56例治疗分析中,发现治疗效果较好,现报道如下。  相似文献   

5.
于淑芹  李东梅  朱相珍 《吉林医学》2008,29(20):1758-1759
糖尿病足是导致糖尿病患者致残、致死的严重慢性并发症之一,主要为下肢中小血管及微循环障碍、周围神经病变而导致下肢感染、溃疡形成和(或)深部组织的破坏。由于此病多发生在四肢手足末端,因此,又称为肢端坏疽。其危害性极大,据报道全球约1.5亿糖尿病患者中15%以上将在其病程中发生足部溃疡或坏疽。因糖尿病足造成截肢者是非糖尿病患者的15倍,每年的截肢患者中约50%发生于糖尿病患者,而这些糖尿病截肢患者中85%以上是因足部溃疡恶化导致深部感染或坏疽所致。  相似文献   

6.
糖尿病肢端坏疽20例临床分析许道盛朱筠(第一附属医院内分泌科)糖尿病肢端坏疽是糖尿病严重并发症之一。随着糖尿病患病率增加,糖尿病肢端坏疽往院人数也增多,而且由于患者住院时间长,费用昂贵,给病人及家属带来极大的痛苦和经济负担。为总结糖尿病肢端坏疽的诊治...  相似文献   

7.
目的探讨系统性红斑狼疮(SLE)患者合并肢端坏疽的临床表现、危险因素及预后。方法回顾性分析1997年12月至2007年8月北京协和医院住院的2684例SLE患者及其中合并肢端坏疽者的病历资料,统计其临床表现、实验室检查及治疗情况;并对18例SLE坏疽患者进行随访。结果SLE合并肢端坏疽患者平均发病年龄(33±12)岁,平均病程(99±60)个月。长病程(≥4年)、雷诺现象、C反应蛋白升高及抗SSA抗体与SLE发生坏疽有关[P值分别为0.012、0.004、0.037及0.087,OR值分别为1.03(95%CI1.01~1.05)、39.05(95%CI3.31~460.13)、17.99(95%CI1.19~271.29)及7.01(95%CI0.75~65.12)]。15例坏疽患者接受≥1mg·kg^-1·d^-1泼尼松治疗,18例接受环磷酰胺治疗,8例患者截肢。坏疽发生3周内积极给予≥1mg·kg^-1·d^-1泼尼松治疗能降低坏疽截肢风险[P=0.081,OR=0.135(95%CI0.01—1.28)]。结论长病程、雷诺现象、C反应蛋白升高及抗SSA抗体是SLE合并坏疽的危险因素,早期积极治疗能够阻止坏疽进展、改善预后。  相似文献   

8.
糖尿病肢端坏疽重症者临床治疗较困难,传统治疗多采用高位截肢手术.我院于1994年应用山莨菪碱(654—2),通过改善微循环来治疗重症肢端坏疽患者,收到了较好的疗效,避免了高位截肢.现将护理体会总结如下.  相似文献   

9.
糖尿病是由于体内绝对缺乏或相对胰岛素分泌不足引起的疾病。糖尿病性肢端坏疽是较为常见并发病之一。常称"糖尿病足病"。糖尿病足病发展严重者,多采用截肢处理。现将我们遇到的一例糖尿病合并下肢坏疽及末梢神经炎,经用降糖药物局部清创、消炎、金银花、654-2改善微循环等综合治疗后痊愈,现将病情及治疗体会报告如下。患者,女,65岁,患糖尿病4年,右下肢麻痛半年,右足坏疽2个月,既往体胖。1个月来用长效胰岛素及口服降糖药和局部换药治疗。查体情况:消瘦,两下肢肌肉萎缩,皮肤刺痛感,右下肢关节以下发凉,呈紫红色。2~5趾已于…  相似文献   

10.
刘慧 《中国伤残医学》2009,17(5):137-138
糖尿病是老年人常见病之一,并发症较多,如感染、皮肤损害是最常见的并发症,足坏疽是糖尿病后期血管、神经并发症之一,该病是由于糖尿病血管病变使肢端缺血,且合并周围神经病变而失去知觉继发感染而导致坏疽。我国糖尿病患者并发足坏疽者占2.8%~4.5%,60%为神经性,20%为缺血性,血管及神经性占20%。2007年1月~2008年6月,我们对30例老年糖尿病足患者实施健康教育,经临床观察,取得满意效果。报告如下。  相似文献   

11.
蒋国民  赵进委  田丰  李绍钦  王云 《当代医学》2009,15(11):144-146
目的探讨膝下动脉成形术治疗严重下肢缺血的安全性和疗效。方法回顾性分析自2007年8月~2008年7月采用膝下动脉成形术治疗16例患者共26条严重缺血患肢的结果。糖尿病下肢动脉闭塞性硬化11例(18条患肢),占69.2%,非糖尿病下肢动脉闭塞性硬化5例(8条患肢),占30.8%。有19条患肢静息痛,7条患肢伴有溃疡或足趾坏疽,踝肱指数(ABI):0.1~0.3有11条患肢,0.31~0.5有15条患肢。结果技术成功率为96%(25/26),15条患肢(15/19)疼痛明显缓解,2条患肢(2/19)疼痛减轻,2条患肢(2/19)疼痛无缓解而分别行膝上和膝下截肢;踝肱指数增加了0.5以上有16条,增加0.31一0.5有7条,增加0.1一0.3有2条。随访4~12个月,平均为8.6个月,坏疽足趾脱落、溃疡愈合的5条患肢(5/7);4条(4/24)复发。ABI平均值为0.70。结论应用球囊导管行膝关节以下动脉成形术治疗严重下肢缺血具有较高的成功率,短期有较好疗效,可减少截肢率;中长期疗效有待进一步观察。  相似文献   

12.
急性重症下肢深静脉血栓形成的外科治疗   总被引:2,自引:1,他引:1  
目的 探讨急性重症下肢深静脉血栓形成(DVT)的外科治疗方法 与效果.方法 回顾性分析了2002年1月至2008年12月首都医科大学宣武医院血管外科治疗18例急性重症DVT患者,均有肿胀和肢体疼痛;16例伴有皮肤颜色青紫(1例小腿皮肤坏疽),2例伴有皮肤苍白;10例出现下肢足背动脉搏动减弱,8例足背动脉搏动正常;血管彩色多普勒超声显示:下肢深、浅静脉均有血栓形成.1例因患肢坏疽行膝上截肢手术.17例采用手术切开取栓,仅3例单纯采用手术切开取栓术,5例加用大隐静脉耻骨上转流术,6例加用人工血管耻骨上转流术,3例采用髂静脉松解成形术.结果 手术死亡1例(5.6%).下肢肿胀消失7例(41.2%),明显减轻10例(58.8%).除截肢的1例外其余患者皮肤颜色均基本恢复正常,动脉搏动也恢复正常.16例患者被随访,随访率为94.1%;随访时间为3~82个月,平均为34个月.患肢肿胀完全消失5例,占31.3%;肿胀明显减轻者8例,占50%;肿胀复发3例,占18.7%.复发的3例中,1例于术后9个月死于晚期恶性肿瘤,2例分别于35个月和48个月后因移植血管桥内膜增生导致闭塞而复发.结论 外科手术取栓是治疗急性重症DVT的有效方法 ;当髂静脉受压,耻骨上转流是一种可选择的有效方法 .  相似文献   

13.
A prospective study was made of 40 consecutive patients who presented with peripheral arterial embolism to the Vascular Surgical Service in UKM. Atrial fibrillation was the most common source of the embolus. Twelve patients did not present until the affected limb(s) were in established gangrene. Thirty-two embolectomies were performed on 25 patients. Only 10 of these patients were discharged well with their limbs intact. Four patients required amputation because embolectomy did not restore viability of the limbs. Eleven patients died following embolectomy. The overall mortality for arterial embolism was 50%. Among the survival (n = 20), only 11 patients were discharged with their limbs intact. The cause of the poor result was related to the delay in definitive treatment and the poor general state of the patients. It was concluded that the prognosis for arterial embolism was very poor. This result needs to be improved and recommendations are made to achieve this.  相似文献   

14.
重症下肢缺血的血管腔内治疗   总被引:12,自引:0,他引:12  
目的评价血管腔内治疗下肢动脉硬化闭塞症重症下肢缺血的临床效果。方法2005年4月-2006年5月采用血管腔内治疗重症下肢缺血24例共29条肢体,主要临床症状均为静息痛,其中合并溃疡或肢端坏疽12例(50%)。本组29条肢体均接受血管腔内治疗,其中有4条肢体行单纯球囊扩张,4条肢体术中同时行股胭动脉人工血管旁路术联合膝下胭胫动脉血管腔内球囊扩张成形术,21条肢体行支架植入。结果股胭动脉球囊扩张和支架植入技术成功率为100%,膝下动脉球囊扩张成功率为88%,术后患者临床症状明显好转,静息痛消失,溃疡愈合。围手术期膝下截肢1例,截肢率为3.4%。结论血管腔内治疗下肢动脉硬化闭塞症重症下肢缺血是一种安全有效的治疗方法。  相似文献   

15.
目的探讨自体外周血干细胞移植联合置管溶栓术重建血栓闭塞性脉管炎(TAO)患者的下肢血供并降低截肢平面的效果。方法回顾性分析2013 年10 月-2016 年6 月该中心收治的36 例拟截肢TAO患者(36 条患肢),采用自体外周血干细胞移植联合置管溶栓术治疗。结果干细胞移植4 周后27 例患者下肢疼痛、冷感评分、皮温及踝肱指数(ABI)均优于移植前(p <0.05),肢体溃疡、坏死处得到控制,呈干性坏疽;9 例患者无明显好转行截肢手术,移植前9 例截肢患者拟截肢平面:大腿下段2 例,膝关节4 例,小腿中上段3 例;实际截肢平面:膝关节4 例,小腿中上段2 例,小腿中段3 例。截肢率25%(9/36),降低截肢率75%,降低截肢平面率77.8%(7/9)。术后3 个月36 例患者行下肢DSA 检查,均形成不同程度的新生侧支血管,27 例保肢患者坏死范围局限,且呈干性坏疽;9 例截肢患者截肢处已愈合。36 例患者随访6~20 个月(平均12.2 个月)病情平稳;其中3 例保肢患者移植6 个月后因患肢疼痛、溃疡坏死加重,再次行自体外周血干细胞移植术,术后3 个月患肢症状好转。结论自体外周血干细胞移植联合置管溶栓术治疗TAO 患者可促进新生侧支血管形成并降低截肢平面。  相似文献   

16.
负压疗法治疗肢体缺血   总被引:4,自引:2,他引:2  
宁莫凡  马中 《医学争鸣》1998,19(4):424-425
目的:评价负压疗法对肢体缺血的治疗效果,方法:1985-07 ̄1995-03,我们应用自行研制的治疗机,对167例(231个肢体)肢体缺血患者进行了负压治疗,其中动脉硬化性闭塞症62例(91肢),血栓闭塞性脉管炎75例(93肢),雷诺综合征30例(47肢),治疗时将患肢置入密闭舱内,压力范围为-8.66kPa ̄-17.3kPa,一般上肢为-10.7kPa,下肢为-13.3kPa。结果:显效117肢  相似文献   

17.
Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus. This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients (type 2) with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene (PTFE) and graft-tibial autologous grafts was performed on 31 limbs (32.3%). Popliteal-tibial artery bypass alone was performed on 22 limbs (22.9%). Combined lilac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs (12.5%), and femoro-tibial artery graft bypass was performed on 10 limbs (10.4%). Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs (7.3%). Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs (3.7%) died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% (79/82). Graft patency rate of patients on discharge was 95.8% (92/96). The short-term total effectiveness rate was 83.3% (80/96). Foot ulcer healing rate was 35.7% (10/28). 97.4% (75/77) patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% (71/88). The total amputation rate was 4.5% (4/88). Mortality was 4.5%. The total graft patency rate was 90.9% (80/88). Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient's quality of life.  相似文献   

18.
Background We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. Methods The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions above the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. Results The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively ( P&lt; 0.05). Four patients died of heart attack (2), stroke (1) and multiple organ failure (1) after reoperations. Among them, only 1 patient underwent occluded bypass, and others, patent bypass. Five patients after patent bypass are still alive. The accumulative patent rate was 28.6% (8/28). The average duration of patency in groups T and C was (4.16 ± 5.68) (0.13 - 24) months and (7.14 ± 6.37) (0.26 - 21) months, respectively ( P&gt; 0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) ( P&lt; 0.01) . Nine patients had limb amputated (10/28 limbs, 35.71%) because of graft infection (2 limbs), pseudo aneurysm at anastomosis (1 limb), and gangrene caused by failed grafts (7 limbs). The amputation was performed on 6 limbs within 1 month and on 4 limbs 1 month after reoperation ( P&gt; 0.05). The rate of limb salvage was 64.29% (18/28). Conclusions The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass. Chin Med J 2006; 119 (2): 91-94  相似文献   

19.
目的:观察龟象膏外敷治疗糖尿病肢端混合性坏疽的临床疗效。方法:将2006年9月——2009年4月几年来糖尿病肢端坏疽住院患者入院时随机分成两组,治疗组40例,对照组40例。两组在常规治疗相同的情况下治疗组采用龟象膏,对照组采用生肌玉红膏外用,隔日换药1次,30天为1个疗程。结果:治疗组总有效率90%,对照组总有效率62.5%,两组总有效率比较差异有统计学意义(P〈0.05),两组平均住院时间、平均住院费用比较均有统计学意义(P〈0.05)。结论:龟象膏治疗糖尿病肢端坏疽疗效确切,能显著缩短坏疽的治疗周期、降低治疗费用,提供创面一个湿润环境。  相似文献   

20.
目的 评价糖尿病膝下动脉病变经皮腔内血管成形术(PTA)的临床短期疗效.方法 本组35例糖尿病合并缺血性下肢动脉病变患者,男20例,女15例,年龄50~81岁,中位年龄为69岁.Rutherford-Becker分级Ⅰ级6例,临床表现为中度以上间歇性跛行;Ⅱ级10例,临床表现为缺血性静息痛;Ⅲ级19例,为不同程度的溃疡和坏疽.所有患者术前均行患肢CT三维重建(CTA)及数字减影血管造影(DSA)检查,术后定期门诊随访,观察记录临床症状和体征变化,并测定1、3、6和12个月患肢踝肱指数(ABI).结果 35例患者53侧肢体共60支膝下动脉存在狭窄或闭塞,其中51支动脉通过球囊扩张得以开通,PTA成功率为85.0%.所有患者的疼痛症状均明显缓解,32例患者单位时间步行距离和固定距离步行时间均恢复正常.术后12个月ABI为0.65,与术前(0.49)的差异无统计学意义(P0.05).结论 PTA是治疗糖尿病膝下动脉病变安全有效的方法.  相似文献   

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