高海拔地区糖尿病足患者手术的麻醉

正糖尿病是常见的慢性病之一,现仅次于心脑血管疾病、癌症,被列为第三大疾病,并成为全球性疾病。糖尿病患者由于周围神经病变以及外周血管疾病合并过高的机械压力,可造成足部软组织及骨关节系统的破坏与畸形形成,进而引发一系列足部问题。1999年世界卫生组织(WHO)对糖尿病足的定义是:糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏~([1])。局部压力改善失败或是评级较高的创面,因局部组织     

足部护理对糖尿病周围神经病变预后的影响

目的 探讨足部护理对糖尿病周围神经病变患者下肢神经传导速度及症状的影响.方法 将42例2型糖尿病周围神经病变患者随机均分为对照组和观察组各21例,两组均给予糖尿病饮食和规范的降血糖治疗,控制血糖达标,同时配合活血化淤类药物及营养神经治疗.观察组在此基础上配合实施足部护理,教育指导,时间3个月.评价治疗前后患者双侧腓神经和胫后神经感觉神经传导速度及双下肢症状改善情况.结果 观察组治疗效果和感觉神经传导速度改善状况显著优于对照组(P＜0.05,P＜0.01).结论 足部护理有利于糖尿病周围神经病变患者下肢神经传导速度的恢复及症状改善,有利于预防糖尿病足的发生.     

负压封闭引流技术治疗糖尿病足的护理观察

糖尿病足是糖尿病的常见并发症,指糖尿病患者合并神经病变及各种不同程度末梢血管病变导致下肢感染、溃疡形成和（或）深部组织的破坏,其病理变化包括神经病变、血管病变以及足部溃疡、感染等三个方面。对糖尿病足进行外科干预是有效防止其病情发展,减少截肢等严重并发症的发生,降低致残率的重要措施。如何有效控制创面发展、促使溃疡愈合、恢复患者肢体外形和功能是治疗的重点。     

足部护理对糖尿病周围神经病变预后的影响

目的探讨足部护理对糖尿病周围神经病变患者下肢神经传导速度及症状的影响。方法将42例2型糖尿病周围神经病变患者随机均分为对照组和观察组各21例，两组均给予糖尿病饮食和规范的降血糖治疗，控制血糖达标，同时配合活血化淤类药物及营养神经治疗。观察组在此基础上配合实施足部护理．教育指导，时间3个月。评价治疗前后患者双侧腓神经和胫后神经感觉神经传导速度及双下肢症状改善情况。结果观察组治疗效果和感觉神经传导速度改善状况显著优于对照组（P〈0．05。P〈0．01）。结论足部护理有利于糖尿病周围神经病变患者下肢神经传导速度的恢复及症状改善，有利于预防糖尿病足的发生。     

首发糖尿病足患者5年再发溃疡情况及相关因素分析

目的了解首发糖尿病足溃疡患者5年内复发情况,探讨其影响因素,为针对性干预提供参考。方法回顾性分析204例首次诊断为糖尿病足溃疡出院后5年内患者糖尿病足溃疡复发情况及影响因素。结果204例糖尿病足患者5年足溃疡复发率39.0%,再次发生足部溃疡距首发时间中位数36个月;再发溃疡的原因自发和外伤各为50.0%。吸烟、糖尿病足溃疡病程、糖尿病周围神经病变是糖尿病足患者再发溃疡的独立预测因素(RR为1.775~1.930,均P0.05)。结论糖尿病足患者首次发生溃疡后,易再次发生足部溃疡,其中外伤是导致再发溃疡的重要诱因。吸烟、糖尿病足溃疡病程≥2个月、有糖尿病周围神经病变患者再发糖尿病足溃疡风险较大,应给予针对性干预,避免再发溃疡。     

神经减压术在糖尿病周围神经病治疗中的应用

糖尿病足是糖尿病的并发症之一,主要表现为足部疼痛、溃疡形成和坏疽。糖尿病足形成原因包括周围神经病变、动脉硬化闭塞导致足部缺血及继发严重感染。糖尿病周围神经病（diabetic peripheral neuropathy。DPN）是常见的糖尿病性神经病变,以肢体远侧对称性多发感觉、运动神经病变（distal symmetric sensorimotor polyneuropathy．DSSP）最多见,50％～60％的糖尿病病人可发生DPN。     

Ilizarov骨搬移技术在糖尿病足治疗中的应用进展研究

正糖尿病足是糖尿病的一种严重慢性并发症,发病率高,病程迁延且医疗花费巨大。糖尿病足患者约占糖尿病患者的40%,因原发的糖尿病控制不佳,导致下肢血管病变和神经病变继而引发足部溃疡及深层组织破坏,同时可伴或不伴感染。国内报道显示,我国50～60岁和60岁以上糖尿病患者发生下肢动脉病变比例分别为19.5%和35.4%~([1])。我国糖尿病患者新发溃疡1年内发生率为8.1%,糖尿病足患者新发溃疡1年内发生率为31.6%~([2])。     

糖尿病足的病因分析及外科手术治疗

糖尿病足（diabetic foot,DF）是糖尿病（diabetes mellitus,DM）患者神经病变、外周血管病变和感染等因素引起的常见足部疾病。常导致下肢感染、溃疡形成和（或）深部组织的破坏。     

社区老年糖尿病患者足部皮肤问题现状调查与分析

目的 了解老年糖尿病患者足部皮肤受损情况及其相关因素,为采取针对性预防措施提供参考。 方法 采用自行设计的足部皮肤评估表对上海地区5个社区的411例老年糖尿病患者足部皮肤情况进行现状调查。 结果 社区老年糖尿病患者足部皮肤受损的发生率为50.1%。良好的自我管理行为、及时就诊为保护因素;年龄、高血脂、糖尿病周围神经病变为危险因素（均P＜0.05）。 结论 老年糖尿病患者足部皮肤受损发生率高,且受多种因素影响。应提升患者的自我管理行为、及时就诊,定期进行高血脂、糖尿病周围神经病变筛查及干预,以预防糖尿病足的发生。     

生长因子在糖尿病足溃疡愈合中的应用进展

糖尿病足溃疡是糖尿病最严重的并发症之一,它是指糖尿病因合并神经及末梢血管病变导致的下肢感染、溃疡形成或（和）深层组织破坏[1]。据统计,糖尿病患者一生中并发足部溃疡的几率约为15%,其中14%～24%的患者需接受截肢手术治疗,严重影响了其生活质量。     

Diabetic neuropathy: review of a surgical approach to restore sensation, relieve pain, and prevent ulceration and amputation

Diabetic neuropathy occurs in a stocking and glove distribution consistent with a systemic metabolic disease. Historically, this concept led to the conclusion that the only role for surgery in a patient with diabetic neuropathy is for treatment of wounds, amputation, or reconstruction of a Charcot foot. This article reviews the basic scientific and clinical research that support the concepts that metabolic neuropathy renders the peripheral nerve susceptible to compression in patients with diabetes and that decompression of lower extremity peripheral nerves in these patients can relieve pain, restore sensation, and prevent ulceration and amputation.     

Variable relationship between peripheral somatic and autonomic neuropathy in patients with different syndromes of diabetic polyneuropathy

The relationship between abnormal peripheral nerve electrophysiology and abnormal cardiovascular autonomic function has been studied in four groups of diabetic subjects, comparable with regard to age, duration, and type of diabetes. Thirty-three had no symptoms of neuropathy, 28 had newly developed painful neuropathy, 24 had chronic painful neuropathy, and 21 had painless neuropathy with associated recurrent foot ulcers. In all three symptomatic groups, electrophysiology and autonomic function were more abnormal than in asymptomatic diabetic subjects. There was a significant overall relationship between peripheral nerve (electrophysiologic) and autonomic (cardiovascular reflex) dysfunction. However, when considered by groups, the degree of cardiovascular reflex abnormality was similar in the three symptomatic groups, whereas electrophysiology was appreciably worse in the foot ulcer group than in patients with painful neuropathy. Thus, patients with painful neuropathy had a higher ratio of autonomic (small fiber) abnormality to electrophysiologic (large fiber) abnormality. By contrast, foot ulceration was associated with the worst electrophysiologic (large fiber) abnormality. Heavier alcohol consumption and more severe retinopathy were also related to foot ulceration. In diabetic subjects with symmetrical sensory neuropathy, the relationship between large fiber and small fiber damage is not uniform. We conclude that there may be different etiologic influences on large and small fiber neuropathy in diabetic subjects and that the predominant type of fiber damage may determine the form of the presenting clinical syndrome.     

Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.     

Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame

Charcot neuroarthropathy is a peripheral and autonomic neuropathy that typically presents as a hyperaemic event (e.g., a red, swollen foot). The diabetic Charcot ankle and foot is a potentially limb-threatening disorder that is being recognized with increasing frequency in persons with longstanding diabetes and concomitant peripheral sensory neuropathy. While considered a rare complication of diabetes, it can be a devastating complication requiring months of treatment to arrest its progression. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. Arthrodesis using an Ilizarov external fixator is regarded as an optimal choice for the treatment of Charcot arthropathy.     

Prevalence of risk factors for foot ulceration in a general haemodialysis population

It is well documented that diabetic foot ulceration contributes to increased morbidity and mortality associated with renal replacement therapy. Much less is known about the risk of foot ulceration and lower limb amputation in the non‐diabetic dialysis population. The aim of this study was to determine if the prevalence of risks factors for lower limb amputation in a stable haemodialysis population was greater in the diabetic cohort compared with the non‐diabetic cohort. The study design is a prospective observational cohort study. Sixty patients attending a satellite haemodialysis unit in Cardiff were invited to have a comprehensive foot assessment as part of a Podiatry service review. The medical notes and hospital information system were used to identify the diabetic cohort. Patients were classified according to diabetic status (diabetic versus non‐diabetic). The Renal Foot Screening Tool was developed to prospectively identify risk factors associated with foot ulceration. The assessment included peripheral neuropathy (PN), peripheral arterial disease (PAD) and foot pathology (FP). Fifty‐seven patients gave informed verbal consent prior to inclusion. Risk factors for foot ulceration were recorded at baseline in the diabetic (n = 24) and non‐diabetic (n = 33) groups and mortality data was revisited after a 3‐year period. FP was identified in 79% of patients. Eighteen per cent of the non‐diabetic patients had PN. PAD was identified in 45% of diabetic and 30% of non‐diabetic patients. Forty‐nine per cent of the total cohort had ≥2 of the 3 independent risk factors for foot ulceration (16/24 diabetic versus 12/33 non‐diabetic). The presence of PAD and PN was predictive of mortality independent of age. The limitations of this study are its small sample size and patients were from a single satellite dialysis unit. There was a high prevalence of risk factors for foot ulceration in this population, which were not confined to the diabetic cohort. These findings suggest that non‐diabetic patients on haemodialysis therapy are also at risk of developing foot ulceration. Further work on strategies to monitor and prevent FP in this high‐risk cohort is needed to minimize morbidity and mortality associated with foot ulceration.     

The current burden of diabetic foot disease

Neuropathy and ischaemia are two great pathologies of the diabetic foot which lead to the characteristic features of foot ulceration (neuropathic and ischaemic) and Charcot neuroarthropathy. These can be complicated by infection and eventually may result in amputation (minor or major) and increased mortality. All of these features contribute to considerable clinical and economic burden.Peripheral nerves in the lower limbs are susceptible to different types of damage in patients with diabetes leading to distinctive syndromes. These include symmetrical sensory neuropathy associated with autonomic neuropathy, which advances gradually, and acutely painful neuropathies and mononeuropathies which have a rather acute presentation but usually recover. Ischaemia in the form of peripheral arterial disease is an important contributor to the burden of the diabetic foot. The incidence of atherosclerotic disease is raised in patients with diabetes and its natural history is accelerated. Diabetes causes severe and diffuse disease below-the knee. The lifetime risk of developing a diabetic foot ulcer is between 19% and 34%. Recurrence is common after initial healing; approximately 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and 65% within 5 years. Charcot neuroarthropathy is characterised by bone and joint destruction on the background of a neuropathy. Its prevalence in diabetes varies from 0.1% to 8%.Infection develops in 50%–60% of ulcers and is the principal pathology that damages diabetic feet. Approximately 20% of moderate or severe diabetic foot infections result in lower extremity amputations. The incidence of osteomyelitis is about 20% of diabetic foot ulcers.Every 20 s a lower limb is amputated due to complications of diabetes. Of all the lower extremity amputations in persons with diabetes, 85% are preceded by a foot ulcer. The mortality at 5 years for an individual with a diabetic foot ulcer is 2.5 times as high as the risk for an individual with diabetes who does not have a foot ulcer. The economic burden exacted on health care systems is considerable and includes direct and indirect costs, with loss of personal earnings and burden to carers. The diabetic foot is a significant contributor to the global burden of disability and reduces the quality of life. It remains a considerable public health problem.     

Diabetic Neuropathy: Is Pain God's Greatest Gift to Mankind?

Diabetic neuropathy is common and it has been estimated that around 40% of older type 2 diabetic patients have risk factors for foot ulceration. It is the loss of the "gift of pain" that results in the development of what should be preventable foot lesions in many patients. As neuropathy is silent in up to 50% of patients, all diabetic patients should receive an annual screening by careful examination of the lower limbs for evidence of any sensory loss or peripheral vascular disease. Similarly, it must be remembered when treating neuropathic foot lesions that patients will willingly weight-bear on plantar ulcers: suitable offloading is therefore the first-line treatment for such lesions.     

Warm immersion recovery test in assessment of diabetic neuropathy--a proof of concept study

The aim of this article was to present results of warm immersion recovery test in the diabetic foot with neuropathy using a liquid crystal-based contact thermography system. It is intended to provide a 'proof of concept' for promoting the role of supplementary thermal assessment techniques and evidence-based diagnosis of diabetic neuropathy. A total of 81 subjects from the outpatient department of MV Hospital for Diabetes, India, were assessed using a liquid crystal thermography system. Each subject was assigned to one of three study groups, that is diabetic neuropathy, diabetic non neuropathy and non diabetic healthy. The room temperature and humidity were consistently maintained at 24 degrees C and less than 50%, respectively, with air conditioning. The right foot for each subject was located on the measurement platform after warm immersion in water at 37 degrees C. Whole-field thermal images of the plantar foot were recorded for 10 minutes. Local measurements at the most prevalent sites of ulceration, that is metatarsal heads, great toe and heel, show highest temperature deficit after recovery for diabetic neuropathy group. The findings of the current study support the ones of a previous study by the authors, which used cold immersion recovery test for the neuropathic assessment of the diabetic foot. A temperature deficit between the recovery and the baseline temperature for the neuropathic group suggests degeneration of thermoreceptors. Thermal stimulus tests can be useful to validate the nutritional deficits' (during plantar loading and thermal stimulus) contribution in foot ulceration.     

Diabetic foot ulcerations: biomechanics, charcot foot, and total contact cast

Diabetes is the seventh leading cause of death in the United States; approximately 6% of the US population has been diagnosed with diabetes. Fifteen percent of all people with diabetes will develop a foot ulceration, and 14% to 20% of them will require an amputation. During the past 25 years, much has been learned and written about lower extremity complications associated with diabetes. The single most significant discovery relative to diabetic foot ulceration is the role of peripheral sensory neuropathy. Once the correlation between the absence of sensation and foot breakdown was made, treatment algorithms began to develop. For the first time, the concept of biomechanics and the role of weight-bearing stress were considered when applying different treatments to the patient with a diabetic foot ulcer. Wound classification systems developed to aid the physician in treating what had been a very frustrating group of patients; those with diabetic foot ulcerations. From that, a myriad of treatments developed. In fact, the technology of wound management became a billion dollar business and, to this day, continues to present the clinician with unending options to effectively manage and heal wounds on the diabetic lower extremity.