彩色多普勒超声评价糖尿病足患者下肢动脉病变

目的 探讨下肢动脉病变与糖尿病足之间的关系。 方法 超声检查糖尿病足、糖尿病不合并糖尿病足息者和健康对照组各30例，将下肢动脉分为8个节段，二维超声评价管径、内一中膜厚度（IMT）和管径狭窄率，彩色多普勒显像观察血流充盈并测量流速。 结果 糖尿病足组息侧与对侧下肢动脉IMT及狭窄程度无明显差异（t检验，P〉0．05）。与对照组相比，糖尿病足组IMT厚，管径狭窄程度重（方差分析，P〉0．05）。 结论 糖尿病足患者下肢动脉硬化明显，患侧与对侧病变程度无显著差异。     

糖尿病下肢动脉病变诊治现状

糖尿病大血管并发症是糖尿病患者的首要死亡原因,糖尿病下肢动脉病变是糖尿病的大血管并发症之一。本文就糖尿病下肢动脉病变流行病学和诊治现状等作一综述。     

糖尿病合并下肢动脉血管病变诊治进展

糖尿病下肢血管病变是糖尿病较常见的大血管并发症,是糖尿病患者下肢难愈合溃疡及截肢的主要原因,并且国内外研究表明糖尿病合并下肢血管病变发生率较高,因此下肢血管病变的早期防治具有重要价值。目前,随着科技的进步,糖尿病下肢血管病变的诊治方法也在不断探索中前进,现将糖尿病合并下肢动脉血管病变最新诊治进展作一综述。     

糖尿病下肢动脉病变的观察及中药治疗的临床评价

糖尿病下肢动脉病变是糖尿病常见的大血管并发症之一 ,国内老年糖尿病人并发肢端坏疸高达 2 .8%～ 14 .5 % [1] ,并因此造成截肢 ,丧失行走能力 ,故早期诊断并及时治疗非常重要。本文应用彩色多普勒对 5 6例糖尿病患者进行双下肢动脉检测并尚试应用中药对下肢动脉病变的患者进行治疗 ,现总结如下。1　对象与方法1.1　对象　按 1985年ＷＨＯ糖尿病诊断标准确诊的Ⅱ型糖尿病病人 5 6例 ,男 2 1例 ,女 3 5例 ,年龄 2 9～ 85 (平均 5 8)岁 ,病程0 .5～ 3 2年。其中合并有高血压病 2 3例 ,冠心病 15例 ,脑血管病 3例 ,周围神经炎 11例 ,糖尿病足 …     

糖尿病足下肢动脉彩超与造影的对比分析

目的:分析糖尿病足(DF)患者下肢动脉病变的特点及探讨彩色多普勒超声(彩超)与数字减影血管造影(DSA)诊断的差异.方法:对27例DF患者进行DSA及彩超检查,并将检查得到结果进行比较.结果:DF下肢动脉病变广泛,呈对称性、多节段性改变,尤以胫前动脉、胫后动脉及腓动脉严重狭窄或闭塞为主.彩超与DSA总检出率比较无统计学差异.彩超检查的血管分级和病变程度不同,检出的灵敏度、特异度不同.结论:彩超可作为DF筛查、评估下肢血管病变的手段之一,但DSA因其准确度、灵敏度、特异度高仍是最重要的指标.     

彩超对糖尿病下肢动脉病变的诊断价值

目的:探讨彩色多普勒血流显像对糖尿病(DM)下肢动脉病变的诊断价值。方法:175例DM患者与82例非DM患者进行下肢动脉彩色多普勒超声检查对照,观察其管壁、管腔、彩色血流及频谱特点。结果:DM所致下肢动脉硬化为弥漫性或多节段病变,单纯动脉硬化多为血管分叉处局灶性病变,DM患者下肢动脉管腔的硬化斑块、狭窄、闭塞的发生率明显高于非DM组,有显著差异(P＜0．01)。硬化斑块发生在股动脉最常见,而管腔狭窄、闭塞发生在腘动脉远侧动脉多见,胫动脉受累最为明显(P＜0．05)。结论:CDFI对DM患者下肢动脉病变的早期诊断、预防及治疗有重要的临床价值。     

糖尿病足患者下肢动脉彩色多普勒血流动力学变化的临床观察

糖尿病足是由于糖尿病患者长期血糖控制不良,继发血管和神经病变,出现以足部表现为主的麻木、疼痛、冷感,感觉障碍和或在诱发因素作用下引起坏疽的一种跨学科疑难病症。我院于１９９６年以来应用彩色多普勒超声检测３０例糖尿病足患者和正常人及排除大血管并发症的糖尿病患者各３０例,结果报告如下：１　资料与方法病例共分三组,即正常人组３０例（男１６例,女１４例）,年龄３８～６８岁,平均５５３７±８１２岁;糖尿病组３０例（男１７例,女１３例）,按１９８６年ＷＨＯ诊断为非胰岛素依赖型糖尿病（ＮＩＤＤＭ）,年龄４４…     

糖尿病足患者下肢血管病变分析

目的调查和分析糖尿病足下肢血管病变特点及相关因素。方法对2005年至2009年门诊和住院糖尿病足患者进行调查,包括病史回顾、体格检查、生化检查及下肢血管检查和周围神经检查;对足溃疡进行分类、分级,进行下肢病变特点的分析及足溃疡影响因素的相关分析。结果纳入本研究的糖尿病足患者共258例,缺血性溃疡179例(69.38%),其中单纯性缺血性足部溃疡患者92例(35.66%),合并神经性溃疡的混合性溃疡患者87例(33.72%);单纯神经性溃疡79例(30.62%)。足部缺血性溃疡患者足病中位病程〔6(1,95)个月〕明显长于神经性溃疡患者〔3(1,63)个月〕(P<0.01),混合性溃疡患者足病中位病程〔13(1,106)个月〕长于单纯神经性溃疡患者及缺血性溃疡患者(P均<0.01)。缺血性足病组及混合性足病组溃疡深度明显较深。缺血性足病患者截肢(趾)率明显高于神经性溃疡足病患者(31.84%vs13.92%,P<0.01)。多元逐步回归分析显示影响足部溃疡程度W agner分级的较显著因素为左足踝肱指数(AB I)、右足AB I及经济收入。结论糖尿病足溃疡患者中缺血性溃疡及混合性溃疡多见,下肢血管病变发病率高;缺血性溃疡溃疡深,愈合慢,截肢(趾)率高,预后差。足部神经病变与缺血病变相互影响加重足病病情。AB I检查是糖尿病足下肢血管病变简单实用的检查方法。     

糖尿病足介入治疗中下肢动脉造影方法探讨

目的：探讨对比剂跟踪数字减影血管造影（DSA）技术在糖尿病下肢动脉闭塞性病变检查中的应用。方法：对28例患者进行36例次对比剂跟踪DSA检查，通过造影床的两次移动，先摄取注射对比剂前的下肢影像，再摄取注射后的血管图像，两者相减，得到整个下肢连续的动脉减影图像，并同7例次传统对比剂分段DSA检查比较，对其方法及结果进行分析。结果：全部DSA检查均获得成功，对比剂跟踪DSA检查结果中，34例次造影图像优良，2例次采集的图像有移动性伪影；全部患肢均存在胭动脉以下血管不同程度的狭窄或闭塞，其中23例合并股浅动脉重度病变。结论利用对比剂跟踪DSA技术，可以全面地观察糖尿病下肢多发性动脉疾病，了解病变的程度和范围，具有快捷、准确而且有效的优点。     

护理支持对糖尿病足患者心理健康及预后的影响

目的探讨护理支持对糖尿病足患者心理健康及预后的影响。方法将60例糖尿病足患者随机分为观察组和对照组各30例,分别实施护理支持和常规护理两种模式,采用糖尿病和足部防护知识问卷、焦虑问卷（STAI）、医学应对问卷（MCMQ）、足部症状体征评分表,对两组患者实施前后进行调查,比较护理支持的效果。结果干预1个月后,观察组患者焦虑状态（S-AI）评分（42．51±7．82）,焦虑习性（T-AI）评分（40．23±6．56）,医学应对问卷中面对积分（22．34±2．43）、屈服积分（6．33±2．12）,与对照组比较差异均有统计学意义（t分别为2．645,2．858,1．697,0．683;P〈0．01）;对糖尿病和糖尿病足防护、部分足部症状体征评分等方面高于对照组,差异均有统计学意义（P〈0．01）。结论护理支持对糖尿病足患者心理健康及预后有改善作用。     

踝肱指数对糖尿病血管合并症的预测和诊断意义

目的:探讨踝肱指数诊断糖尿病患者血管并发症的效力,初步探讨不同踝肱指数界点对合并症预测的差异。方法:分析277例2型糖尿病患者的踝肱指数检测值,分别进行常规标准分组[≤0.90设为外周动脉疾病(PAD)组,0.91～1.30为非PAD组,>1.30为动脉硬化组]与自定标准分组(≤1.0为PAD组’,1.10～1.40为非PAD组’,>1.40为动脉硬化组’),比较不同程度踝肱指数分组间临床参数及血管并发症发生率的差异。结果:与其他组患者比较,踝肱指数≤0.9的糖尿病患者,其年龄大,病程长,餐后血糖、收缩压较高,心血管、肾脏疾病和糖尿病足发病率均明显增高;而踝肱指数≤1.0和>1.4均可能与糖尿病足的发生有关系。结论:踝肱指数与糖尿病大血管并发症的发生密切相关;临床在应用其预测糖尿病足发生时可能宜放宽诊断标准至≤1.0,以利早期预防。     

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.     

Related factors associated with exercise behavior in patients with peripheral arterial disease

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.     

糖尿病足病治疗进展

糖尿病足病是糖尿病的严重并发症之一,是糖尿病患者致残、致死的重要原因。鉴于该病危害极大,人们对其关注提高,相关的治疗理论和新治疗技术不断涌现,诸如“湿性愈合理论”和“创面床准备理论”、创面负压治疗、蛆清创、自体富血小板凝胶治疗技术、高压氧治疗及干细胞移植术等。同时,糖尿病足病处理和预防必须体现多学科协作理念,以提高其治愈率,降低死亡率与截肢率。本文就糖尿病足的治疗进展做一综述。     

Patients' experiences of living with peripheral arterial disease awaiting intervention: a qualitative study

The aim of this study was to investigate patients’ experiences of living with peripheral arterial disease (PAD) and the influence on activities of daily living. Twenty-four patients with various degrees of PAD were interviewed. The transcribed texts were analysed using manifest and latent content analysis. Living with PAD meant carrying a hard-to-bear physical, social and emotional burden, and struggling for relief. The experience of burden was interpreted in the following themes representing consequences and strategies for gaining control in daily life: (I) “being limited by the burden” (II) “striving to relieve the burden” (III) “accepting and adapting to the feeling of burden”. The use of different coping strategies was crucial to achieve some relief. Pain and sleep disturbance emerged as a major feature of living with PAD, and by combining both analgesics and non-pharmacological methods some pain relief was received. To provide optimal alleviation of pain for these patients, education about pain and pain management is of great importance followed by regular evaluations of the pain and pain management. Furthermore, the study underlines the importance of preventing the progression of the vascular disease and from the individual power and knowledge support and preserve as independent life as possible.     

糖尿病足感染的细菌学特点与预后分析

目的了解糖尿病足感染的细菌学特点及其耐药性，并分析糖尿病足分级、其缺血与否与感染细菌的菌种及预后的相关性。方法取52例糖尿病足感染患者足部分泌物进行常规细菌培养和药敏试验。结果52例糖尿病足分泌物标本细菌培养获阳性结果46例，阴性结果6例。共检出需氧菌20种，菌株61株，革兰阳性球菌30株，以表皮葡萄球菌、金黄色葡萄球菌、粪肠球菌多见，分别为12、6、5株；革兰阴性杆菌24株，以奇异变形杆菌、大肠埃希菌、阴沟肠杆菌多见，分别为8、6、4株；革兰阳性杆菌5株，念珠菌2株。其中有15份标本为混合性细菌感染，主要是表皮葡萄球菌与其他革兰阴性杆菌混合存在。本组糖尿病足分级与感染细菌的菌种无明显相关，与预后明显相关，其缺血与否与预后明显相关，但与菌群无明显相关。结论糖尿病足感染以葡萄球菌、奇异变形杆菌和大肠埃希菌多见，分别对万古霉素、亚胺培南最敏感。重视糖尿病足感染的细菌学特点及药敏试验结果，指导合理使用抗生素，提高糖尿病足感染治愈率，改善预后。     

28例糖尿病足患者的护理

目的:总结对糖尿病足患者的护理经验,早期预防、早期综合治疗及护理,降低致残率。方法:根据糖尿病足不同分级,采用全身及局部溃疡处综合治疗及护理措施,即良好血糖控制、局部创面护理、合理饮食、适量运动、心理护理、健康教育等。结果:28例2~5级糖尿病足患者取得良好的临床治疗效果,有26例患者经治疗创面愈合,1例患者由于创面较大,转入外科行植皮术,有1例患者感染严重,全足坏疽,行截肢手术,治愈率92.9%。结论:糖尿病足早期发现、早期进行综合治疗及护理多能治愈。     

老年住院患者周围血管病变筛查及其与代谢指标的相关性研究

目的探讨老年住院患者周围血管病变(PAD)的患病率,并分析其与代谢异常的关系。方法纳入60岁以上住院患者213例,通过电子血压计检测踝肱指数(ABI)进行分组:PAD组和非PAD对照组。所有患者检测空腹血糖(FBG)、血脂、C-反应蛋白(CRP)、尿酸(SUA)、同型半胱氨酸(HCY)、尿白蛋白排泄率(UAER)、空腹胰岛素(FIns)等,通过多元逐步回归分析探讨影响PAD的危险因素。结果 213例住院患者中PAD组35例(16.43%);非PAD对照组178例(83.54%)。PAD组年龄、舒张压与非PAD对照组比较差异无统计学意义(t值为0.47、1.53,P0.05);腰围、收缩压(SBP)、FBG、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(α)[Lp(α)]、载脂蛋白B100(APOB)、HCY、CRP、肌酐(Cr)、SUA、UAER、FIns、胰岛素抵抗指数(HOMA-IR)明显增高(t值分别为4.25、10.08、4.684、.334、.684、.144、.51、2.47、2.206、.29、4.01、3.48、12.09、8.85、15.63,P0.01或P0.05);高密度脂蛋白胆固醇(HDL-C)或脂蛋白A1(APOA1)明显低于非PAD对照组(t值为6.12、5.93,P0.01)。多元逐步回归分析显示,HOMA-IR、UAER、SBP、Lp(a)是影响PAD的独立危险因素。结论 16.43%的老年住院患者存在PAD,电子血压计测量ABI简单、准确,可用于临床进行PAD患者的筛查。HOMA-IR、UAER、SBP、Lp(a)是加剧PAD的主要因素。     

2型糖尿病患者外周血管病变的临床研究

目的探讨2型糖尿病患者外周动脉病变（PAD）的发生率及其危险因素。方法利用Huntleig Healthcare糖尿病足诊断箱检测我院184例2型糖尿病的ABI和PBI,同时检测血压、血小板、血脂、尿酸、HBA1C等相关指标,通过统计学方法探讨影响ABI的相关因素。结果ABI降低组（ABI〈0．90）40例（21．74％）,ABI升高组（ABI≥1．30）23例（12．5％）,ABI正常者（0．90≤ABI〈1.30）121例（65．76％）。与ABI正常组比较,ABI降低组患者病程及住院天数更长,吸烟率、HBA1C、SBP、2HPG、TC、LDL—C、血小板计数更高;病程、SBP、HBA1C、2HPG是ABI升高的危险因素。ABI异常组糖尿病的合并症及心脑血管事件的几率增高。结论ABI诊断T2DM伴PAD简便实用可靠,病程、高血脂、吸烟史、高血糖、高血压和高凝状态是PAD的主要危险因素。