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| 足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用 | |
| 引用本文： | 王秀红,李炳辉,李军,梅燕,裴红兵,龙飘,张艳,张文涛,杜烨,邝莉雯,张晨晨,李恭驰. 足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用[J]. 中华损伤与修复杂志, 2023, 18(1): 53-58. DOI: 10.3877/cma.j.issn.1673-9450.2023.01.008 |
| 作者姓名： | 王秀红 李炳辉 李军 梅燕 裴红兵 龙飘 张艳 张文涛 杜烨 邝莉雯 张晨晨 李恭驰 |
| 作者单位： | 1. 430080 武汉钢铁（集团）公司第二职工医院足病科2. 430077 武汉，华中科技大学同济医学院附属梨园医院创面修复科3. 430081 武汉市青山区钢都花园社区卫生服务中心4. 430080 武汉市青山区疾病控制中心5. 430022 武汉，华中科技大学同济医学院附属协和医院手外科 |
| 基金项目： | 武汉市卫生健康委医疗卫生科研项目(WG18D01); 国家重大疾病多学科合作诊疗能力建设项目(国卫办医函【2019】542号); 湖北省科技创新平台专项资助建设项目(2018BCC340); 国家自然科学基金青年科学基金项目(81801922); 湖北省重点研发计划项目(2020BCB029); 湖北省科技厅面上项目(2020CFB696) |
| 摘 要： | 目的探讨足病修复师足部综合干预在降低糖尿病足高危因素发生率中的作用。 方法对2016年7月至2017年7月武汉钢铁(集团)公司第二职工医院足病科收治的符合入选标准的387例糖尿病患者进行足部综合干预。由足病修复师对糖尿病足高危人群进行筛查、宣教及专人干预，对患者足部外观、足部周围神经及周围血管等情况进行检查，通过微信群、复诊、回访加强对患者及家属的足部相关知识教育，提高患者的自我防护意识；收集患者的相关信息，建立患者管理档案，开展糖尿病足分级管理；对糖尿病足高危因素进行筛查，依据患者的年龄、基础状况确定血糖的控制目标并将其控制在目标范围内，调节患者血压和血脂，戒烟，制定合适的饮食、运动及生活方式方案。根据以上内容对患者进行为期1年的干预，对筛查发现有足部疾病的患者，及早采取相应的治疗及预防措施。分别于患者入院时、足部综合干预1年期间每个月对患者足部外观异常情况(有无足癣、甲癣、胼胝、鸡眼及足部畸形的发生)，足部周围神经(触觉、温度觉、震动觉、痛觉、跟腱反射)以及周围血管情况(皮肤温度、足背动脉搏动、胫后动脉搏动、足部水肿、足部青紫、足部溃疡及足部麻木或疼痛)进行检查并记录，对患者入院时及足部综合干预1年后末次检查时的上述指标情况进行比较。数据比较采用χ2检验。 结果末次检查时，患者足部的足癣、甲癣、胼胝的发生率分别为35.66%(138/387)、59.17%(229/387)、24.81%(96/387)，均明显低于入院时[77.52%(300/387)、72.35%(280/387)、53.23%(206/387)]，差异均有统计学意义(χ2＝138.081、14.974、65.754，P<0.05)；末次检查时，患者足部周围神经检查结果中10 g尼龙丝触觉、温度觉、震动觉、痛觉、跟腱反射检查异常发生率分别为14.47%(56/387)、37.73%(146/387)、13.70%(53/387)、14.47%(56/387)、17.05%(66/387)，均明显低于入院时[60.72%(235/387)、81.91%(317/387)、29.20%(113/387)、40.31%(156/387)、42.64%(165/387)]，差异均有统计学意义(χ2＝176.503、157.235、27.658、65.015、60.530，P<0.05)；末次检查时，患者足部周围血管检查结果中皮肤温度改变、足背动脉搏动异常、胫后动脉搏动异常、足部水肿、足部青紫及足部麻木或疼痛发生率分别为12.40%(48/387)、28.17%(109/387)、34.11%(132/387)、28.94%(112/387)、30.23%(117/387)、11.11%(43/387)，均明显低于入院时[32.30%(125/387)、64.34%(249/387)、62.53%(242/387)、77.00%(298/387)、78.30%(303/387)、17.83%(69/387)]，差异均有统计学意义(χ2＝44.188、101.918、62.655、118.143、180.159、7.106，P<0.05)，而患者足部溃疡发生率末次检查时为6.72%(26/387)，低于入院时[9.82%(38/387)]，比较差异无统计学意义(P>0.05)。 结论足病修复师综合干预可以通过安全有效地降低足癣、甲癣、胼胝的发生率以及降低足部周围神经和周围血管检查相关项目结果异常的发生率，从而延缓糖尿病足高危因素对糖尿病患者的损伤，进一步防止糖尿病足溃疡的发生。 |
| 关 键 词： | 糖尿病足 糖尿病 足病修复师 高危因素 |
| 收稿时间： | 2022-12-20 |
Effect of foot comprehensive intervention by podiatrist in reducing the incidence of high-risk factors for diabetic foot |
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| Xiuhong Wang,Binghui Li,Jun Li,Yan Mei,Hongbing Pei,Piao Long,Yan Zhang,Wentao Zhang,Ye Du,Liwen Kuang,Chenchen Zhang,Gongchi Li. Effect of foot comprehensive intervention by podiatrist in reducing the incidence of high-risk factors for diabetic foot[J]. Chinese Journal of Injury Repair and Wound Healing, 2023, 18(1): 53-58. DOI: 10.3877/cma.j.issn.1673-9450.2023.01.008 | |
| Authors: | Xiuhong Wang Binghui Li Jun Li Yan Mei Hongbing Pei Piao Long Yan Zhang Wentao Zhang Ye Du Liwen Kuang Chenchen Zhang Gongchi Li |
| Abstract: | ObjectiveTo investigate the effect of foot comprehensive intervention by podiatrist in reducing the incidence of high-risk factors for diabetic foot. MethodsComprehensive foot intervention was performed on 387 diabetic patients who met the inclusion criteria and were admitted to the Department of Podiatry, Second Staff Hospital of Wuhan Iron and Steel (Group) Corporation from July 2016 to July 2017. The podiatrists screened, educated, and managed the diabetic foot high-risk group with dedicated interventions, examined the appearance of the patient′s feet, peripheral nerves, and blood vessels in the feet, and strengthened the education of foot-related knowledge to patients and their families through WeChat groups, follow-up consultations and return visits to improve the patient′s awareness of self-protection; collected relevant information from patients, established patient management files and carried out graded management of diabetic foot. The high risk factors of diabetic foot were screened, blood sugar control targets were determined and controlled within the target range according to the age and basic condition of patients, regulated the patient′s blood pressure and blood lipids, quit smoking, and appropriate diet, exercise and lifestyle programs were formulated for patients. Based on the above, the patients were given a 1-year intervention, and those patients with foot diseases detected by screening were given early treatment and preventive measures. The abnormal foot appearance (tinea pedis, onychomycosis, callus, corns and foot deformities), peripheral nerves (touch, temperature, vibration, pain, Achilles tendon reflex) and peripheral vascular conditions (skin temperature, dorsalis pedis artery pulsation, posterior tibial artery pulsation, foot edema, foot bruising, foot ulcers and foot numbness or pain) were examined and recorded at the time of admission and every month during the 1-year period of the comprehensive foot intervention, and the above indices were compared between the patients at the time of admission and at the time of the last examination 1 year after the comprehensive foot intervention. Data were compared with chi-square test. ResultsAt the last examination, the incidences of tinea pedis, onychomycosis, and callus on the patient′s foot were 35.66% (138/387), 59.17% (229/387), and 24.81% (96/387), respectively, all significantly lower than those at admission [77.52% (300/387), 72.35% (280/387), and 53.23% (206/387)], the differences were statistically significant (χ2=138.081, 14.974, 65.754; P<0.05); at the last examination, the incidences of abnormalities in the 10 g nylon wire tactile, temperature, vibration, pain, and achilles tendon reflex examinations in the patients′ peripheral nerve examination results were 14.47% (56/387), 37.73% (146/387), 13.70% (53/387), 14.47% (56/387) and 17.05% (66/387), which were significantly lower than those at admission [60.72% (235/387), 81.91% (317/387), 29.20% (113/387), 40.31% (156/387), 42.64% (165/387)], the differences were statistically significant (χ2=176.503, 157.235, 27.658, 65.015, 60.530; P<0.05); the incidences of skin temperature changes, abnormal dorsalis pedis artery pulsation, abnormal posterior tibial artery pulsation, foot edema, foot bruising and foot numbness or pain in the patients′ peripheral foot vascular findings at the last examination were 12.40% ( 48/387), 28.17% (109/387), 34.11% (132/387), 28.94% (112/387), 30.23% (117/387) and 11.11%(43/387), respectively, which were significantly lower than those at admission [32.30% (125/387), 64.345% (249/387), 62.53% (242/387), 77.00% (298/387), 78.30% (303/387), 17.83%(69/387)], the differences were statistically significant (χ2=44.188, 101.918, 62.655, 118.143, 180.159, 7.106; P<0.05), while the incidences of foot ulcers in patients at the last examination was 6.72% (26/387), which was lower than [9.82% (38/387)] at admission, the difference was not statistically significant(P>0.05). ConclusionComprehensive interventions by podiatrists can further prevent diabetic foot ulcers by safely and effectively reducing the incidence of tinea pedis, onychomycosis, and callus as well as reducing the incidence of abnormal results of items related to peripheral nerve and peripheral vascular examinations of the foot, thereby delaying damage to diabetic patients from high-risk factors of the diabetic foot. |
| Keywords: | Diabetic foot Diabetes mellitus Podiatrist High risk factors |
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