139例糖尿病足溃疡患者的死亡率及伴有并发症分析

目的 研究糖尿病足溃疡患者的死亡率和相关临床危险因素.方法 对2001年1月至2006年12月在解放军306医院内分泌科住院的163例糖尿病足溃疡患者进行随访,获得其截止2009年12月的生存状态及死亡时间.采用Kaplan-Meier生存曲线计算死亡率,并采用Cox风险比例模型判断死亡的预测因素.结果 163例患者中我们获得了139例患者(85.3%)截止2009年12月31日的随访资料,平均随访时间为(3.71±1.80)年.总共死亡55例(39.6%),其中男性39例,女性16例.5年死亡率为45.8%,平均生存时间为5.38年(95%CI 4.87～5.89),生存时间中位数6.83年.年龄、吸烟、高血压、冠状动脉疾病以及糖尿病肾病是死亡的独立预测因素.结论 足溃疡明显增加糖尿病患者的死亡率,而高龄、吸烟、合并高血压、冠心病、糖尿病肾病可以预测死亡.

Abstract：

Objective To determine the mortality and associated risk factors in the patients with diabetic foot ulcers. Methods One hundred and sixty-three patients with diabetic foot ulcers hospitalized from January 2001 to December 2006 were followed up until December 2009. Mortality rates were derived from Kaplan-Meier survival curves. The prognostic factors were evaluated with Cox proportional hazard model. Results Follow-up was successful in 139 out of 163 patients, with a mean follow-up period of(3.71 + 1. 80)years. 55 patients(39 males and 16 females)died during the follow-up. The 5-year mortality was 45.8% and mean survival time was 5.38 years(95% CI 4.87-5.89). The median survival time was 6.83 years. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were found to be independent prognostic factors for mortality. Conclusions Diabetic foot ulcers increased the mortality of diabetic patients. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were predictive risk factors for mortality.     

有严重出血倾向的患者血透时的抗凝方法

出血倾向是尿毒症的临床表现之一,随着血液透析患者的增多,合并出血的病例已不少见。若采用常规抗凝方法会诱发或加重出血。我们对9例肾衰伴出血的病人45次血透采取了几种抗凝方法,效果满意。 1 临床资料 本组男7例,女2例。年龄30～65岁。其中,肝癌上消化道大出血1例,多囊肾破裂出血1例,泌尿系统癌症血尿2例,肝硬化鼻及牙龈出血1例,产后出血1例,高血压眼底出血1例,血性胸水1例,外伤出血1例。肾功