应用湿性愈合换药方法治疗4例糖尿病足的体会

目的通过对糖尿病足湿性愈合换药的4个典型病例的总结、分析，探讨湿性换药处理的应用条件及具体方式。方法分析总结本院于2011年1-9月收治的4例糖尿病足典型病例的临床资料。结果第1例经积极内科综合治疗，全身情况改善的同时给予分步去痂、加强换药得到治愈；第2例经局部彻底清创、抗感染治疗，创面床准备行持续负压吸引（VSD）、局部皮瓣移植术后痊愈；第3例局部扩创引流使用银离子抗菌敷料换药后保趾痊愈。第4例局部清创处理后，因足底深部感染，感染症状没有改善反而加重，行扩创术无效而截肢。结论在综合内科治疗中采取积极外科干预很重要，是减少截肢率、提高治愈率的必要保证，故治疗应采取全身和局部治疗相结合，全身治疗贯穿始终，局部治疗应强调个体化——根据溃疡的分级和炎症的不同阶段或表现作相应处理。

Report and experience of four cases diabetic foot with moist healing dressing method

Objective To discuss the applied conditions and detailed way of moist dressing through analyzing and sum- marizing treatment of 4 typical cases diabetic foot. Methods Analyzed and summarized the clinical data of 4 typical diabetic foot inpatients admitted to our hospital from January 2011 to September 2011. Results In the 1st case, the patient＇s condition improved with our positive internal comprehensive treatment. At the same time, the patient fully recovered with step-by-step scab removing and strengthened dressing. In the 2nd case,the patient got cured after local complete debridement.anti-infection treatment,wound bed preparation for continuous negative pressure aspiration （VSD） and local skin flap grafting surgery. The 3rd ease applied local opening drainage and Silver ion antimicrobial dressings to preserve feet,then the patient recovered. In the 4th case, after local debridement, the symptoms of infec- tion worsened rather than improved due to the presence of deep feet infections, thus debridement was ineffective and amputation was applied. Conclusion Active surgical intervention played an important role in the comprehensive medical treatment, and was a necessary guarantee for decreasing amputation rate and improving healing rate. Therefore, Systemic and local treatment should be combined, and systemic therapy must be provided through the whole process, local therapy should focus on individualization-specific treatment must be based on grades of ulcer and stages of inflammation.