高压氧并足疡平软膏治疗糖尿病足

糖尿病足溃疡属于难愈性创面,治疗较为困难,严重者可发生局部或全足坏疽,需要截肢,是引起糖尿病患者残肢甚至死亡的主要原因之一[1].正确处理糖尿病足是降低糖尿病足溃疡发生和避免截肢的有效方法.我院对36例糖尿病足患者在局部应用中药复方膏剂--足疡平软膏(以下简称足疡平).的基础上加用高压氧(hyperbaric oxygen,HBO)治疗,取得了满意的效果.现报道如下.     

老年2型糖尿病合并外周感觉神经病变患者足护理行为水平调查

目的 了解老年2型糖尿病合并外周感觉神经病变患者足护理行为水平,以制定符合目标人群的教育计划和策略.方法 采用自行设计的足护理行为问卷对200例老年2型糖尿病合并外周感觉神经病变患者足护理行为进行评估.结果 老年糖尿病患者对于如何防止足部外伤、足部自我检查和皮肤保护的知识和行为尤为缺乏,仅在足部清洁行为方面有较好的表现.患者足护理行为与患者年龄、性别、病程、受教育程度和收入无明显相关性,但与曾经接受足护理教育的情况呈正相关(r＝0.328,P＜0.05).结论 足护理教育可以促进老年2型糖尿病患者采取健康的足护理行为,对于如何防止足部外伤、足部自我检查和皮肤保护的知识和行为教育应列入重点教育内容.     

慢性难愈合创面住院患者回顾性调查

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

中药复方足疡平软膏对糖尿病大鼠感染创面抗菌作用实验研究

目的观察局部外治复方中药足疡平的抗菌作用,为临床应用提供实验依据。方法30只大鼠随机分为3组,即足疡平组、血小板源性生长因子凝胶组、空白组,每组10只大鼠,将足疡平用于糖尿病大鼠感染创面,动态对照观察局部细菌总量和G-菌量变化及创面愈合指标。结果足疡平组实验第3、7天总菌量、G-菌量均显著低于第1天,亦低于对照组;其创面愈合速率快于对照组。结论中药复方制剂外治糖尿病创面具有良好的抗菌作用,值得临床应用。     

2型糖尿病不同尿白蛋白排泄率患者合并外周动脉疾病临床分析

目的 探讨2型糖尿病不同尿白蛋白排泄率（UAER）合并外周动脉疾病（PAD）的发生率及其相关性.方法 依据尿微量白蛋白排泄率将375例2型糖尿病患者分为对照组（UAER〈20μg/min）、A组（微量蛋白尿组,UAER 20～200μg/min）和B组（临床蛋白尿组,UAER〉200μg/min）,检测所有患者的尿白蛋白排泄率、糖化血红蛋门和踝肱指数（ABI）,并分析各组患者外周动脉疾病的发生率、踝肱指数与尿白蛋白排泄率及其它指标的相关性.结果 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病发生率均较对照组高,两者比较差异有显著性（P〈0.05,P〈0.01）,踝肱指数随尿白蛋白排泄率的增加而减低（P〈0.05）,外周动脉疾病发生率随尿白蛋白排泄率增加而增加（P〈0.05,P〈0.01）;踝肱指数与年龄、病程、尿白蛋白排泄率呈明显负相关（P〈0.05）.结论 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病的发生率较对照组明显增加,且尿白蛋白排泄率与踝肱指数显著相关,提示尿微量白蛋白不仅是肾脏病变的表现,同时伴有肾外血管病变发病率的增高,是全身血管病变的标志.     

应用负压封闭引流技术治疗糖尿病足溃疡的临床疗效观察

目的 探讨应用负压封闭引流（VSD）技术治疗糖尿病足溃疡的临床疗效.方法 将58例2型糖尿病足溃疡患者分为非缺血性组和缺血性组,均进行有效清创,应用负压封闭引流治疗,同时进行全身有针对性的综合治疗.结果 非缺血性组患者30例,其中显效26例,有效4例,总有效率100.00％,其中显效率86.70％.创面平均愈合时间为（65.63±14.53）天.缺血性组患者28例,其中显效17例,有效9例,无效2例,总有效率92.86％,其中显效率60.71％.创面平均愈合时间为（93.65±18.67）天.两组之间疗效比较,差异有统计学意义（P＜0.05）,创面愈合时间比较差异有统计学意义（P＜0.01）.结论 负压封闭引流能有效控制感染,促进创面肉芽生长,改善微循环,促进创面愈合,对非缺血性和缺血性足溃疡治疗均有效,非缺血性组优于缺血性组;非缺血性组创面愈合时间比缺血性组明显缩短.     

慢性难愈合创面住院患者回顾性调查

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed:397 out of 12 161 cases ( accounting for 3.3% ) were recognized as having chronic wounds. ( 1 ) The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% (238/397),15.6% (62/397), 10.8% (43/397), respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury (x 2 = 136.21, P = 0. 001 ). (2) Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups (x2 = 24.12, P =0. 025). There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury ( with x 2 values from 7.86 to 28.31, P values all below 0.05 ). ( 3 ) All patients with chronic wounds received traditional dressing. In 60. 5% (240/397) and 86.4% (343/397) of patients, operative treatment or antibiotics were given. (4)The average length of hospital stay in patients with chronic wound [( 38 ± 27 ) d] was longer as compared with that of all the inpatients in the same period [(15 ± 7) d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons ( F = 24.06, P = 0. 036) , in which burn injury resulted in the longest length of hospital stay [(47 ±27) d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.     

家庭支持对老年糖尿病患者足护理教育效果的影响

目的：评价纳入家庭成员的教育干预对老年糖尿病患者足护理行为水平的影响。方法随机选取42例门诊老年糖尿病患者,采用感受社会支持多面量表（MSPSS）的家庭支持亚量表对患者家庭支持水平进行评价,根据家庭支持水平进行分组,家庭支持水平分值≥3分的患者进入干预组22例,＜3分的患者进入对照组20例,两组患者均接受内容相同的一对一足护理教育,同时干预组患者家中1名照顾者同时参与教育干预的过程。在干预前和干预后1,3,6个月采用足护理行为调查问卷（ NAFF）和MSPSS进行足护理行为水平的评价及家庭支持水平的评价。结果教育前和教育后1个月两组患者的NAFF总分比较差异均无统计学意义（ P＞0．05）;教育后3个月和6个月干预组患者NAFF总分中位数分别为66．91,68．19分,均高于对照组63．60,59．50分,差异有统计学意义（ Z值分别为-2．782,-4．997;P＜0．01）;干预组患者教育前后MSPSS得分比较差异有统计学意义（Z＝41．932,P＝0．001）,而对照组患者教育前后MSPSS得分比较差异无统计学意义（Z＝1．228,P＝0．874）。结论家庭支持能强化老年糖尿病患者足护理教育的效果,同时纳入家庭成员的足护理教育能有效提高老年糖尿病患者的家庭支持水平。     

牛蒡子对糖尿病大鼠肾组织基质细胞衍生因子1表达的影响

目的:研究牛蒡子对糖尿病大鼠肾脏基质细胞衍生因子1(SDF-1)表达的影响。方法:建立糖尿病大鼠模型,利用荧光实时定量PCR和Western blot检测经牛蒡子治疗后糖尿病大鼠肾脏组织中SDF-1mRNA和蛋白表达水平的变化。结果:荧光实时定量PCR结果显示糖尿病大鼠组肾脏组织中SDF-1mRNA(1.499±0.03)明显较正常大鼠组(1.231±0.02)升高,而牛蒡子治疗组大鼠肾脏SDF-1的mRNA(1.27±0.01)较糖尿病大鼠组明显降低,组间比较差异均具有统计学意义(P<0.05)。Western blot结果显示牛蒡子治疗组大鼠肾脏中SDF-1蛋白的相对表达量为0.93±0.22,明显低于糖尿病模型组1.60±0.21(P<0.05),与正常组大鼠肾脏表达量接近(0.80±0.13)。结论:牛蒡子能够下调糖尿病大鼠肾脏组织中SDF-1的表达。