高压氧治疗糖尿病足的临床观察

糖尿病足是糖尿病神经病变常见的临床表现,患者多因足部保护不当导致病发。其发病机制一般认为有两方面的原因。首先认为高血糖和低血糖都可能导致糖尿病神经病变;其次是微血管病变导致。另外,必需脂肪酸代谢异常、神经生长营养因子调节失常、C肽、神经轴突运转异常、自身免疫因素等均可导致该病。但是至今临床尚无确实可靠的治疗方法,探求一种切实可行的治疗方法是当前治疗该病的主要研究方向。高压氧是在高压力下吸氧直接提高血液中氧容量,对改善微血管病变有明显作用。     

糖尿病足高压氧与非高压氧治疗的疗效对比观察

目的探讨高压氧综合治疗糖尿病足的疗效。方法选择糖尿病病人68例,随机分为高压氧治疗组和对照组各34例,均采用控制血糖、营养末梢神经血管、改善循环、全身应用有效抗生素、局部清创处理等治疗措施。高压氧治疗组在上述治疗的基础上加用高压氧治疗。疗效依据Wagner分级下降情况及自觉症状改善程度评价疗效。结果高压氧治疗组总有效率91.1%,对照组总有效率67.6%,差异有统计学意义(P<0.05)。结论高压氧治疗对糖尿病足有较好的康复价值。     

糖尿病足部坏疽截肢术的护理探讨

目的探讨糖尿病足部坏疽截肢术的护理体会。方法回顾分析该院2011年7月—2013年7月收治的80例糖尿病足部坏疽的患者,随机分为两组,实验组采用舒适护理,对照组采用常规护理。结果实验组所有患者疗效均优于对照组,没有发生一例截肢并发症。结论糖尿病足坏疽截趾术患者应用舒适护理可提高治疗效果,能够大大减少糖尿病足部坏疽截肢手术的并发症,值得临床推广。     

糖尿病足溃疡的高压氧治疗

近年来,糖尿病和糖尿病足的发病率在逐年上升,缺血、神经病变和感染是糖尿病足溃疡形成的主要病因.除常规治疗手段以外,高压氧是一种有效的辅助治疗手段.该方法针对病因,副作用少,可通过不同的机制发挥作用,改善患者的预后.

Abstract：

Recently, the incidence of both diabetes mellitus and diabetic foot has been increasing.Ischemia, neuropathy, and infection are major causes of diabetic foot ulcer. In addition to other conventional treatments, hyperbaric oxygen is an effective adjunctive therapy with less side-effects. Hyperbaric oxygen may play a role through different mechanisms in improving the prognosis of diabetic foot.     

高压氧治疗糖尿病足的临床疗效及护理

目的探讨高压氧对糖尿病足的临床疗效及护理。方法选取2010年—2011年108例糖尿病足患者按自愿的原则分为两组,每组54例。对照组进行糖尿病的常规治疗。治疗组在常规治疗的基础上,又行高压氧治疗。10 d为一疗程,连续治疗3-6个疗程。结果治疗组总有效率明显优于对照组（P〈0.05）。结论高压氧对糖尿病足有明显的疗效,减轻了患者的痛苦,提高了患者的生存质量。     

高压氧治疗糖尿病足的疗效研究

目的 探讨高压氧治疗糖尿病足的临床疗效.方法 选取100例糖尿病足患者按照区组随机化分为高压氧组,对照组,各50例.对照组给予糖尿病饮食、降血糖、局部创面处理、抗感染等常规治疗,高压氧组在常规治疗基础之上同时予以高压氧治疗,高压氧治疗压力为0.20 ～0.25MPa,患者吸纯氧60 min,每天1次,共6个疗程.观察治疗前、后空腹血糖、血液流变学、患侧下肢动脉血流峰值的变化情况.结果 治疗后,与对照组相比,高压氧组空腹血糖较低[(5.1±0.8)mmol/L vs.(7.2±0.7)mmol/L,P=0.011];血液流变学得到改善(t=2.381 ～3.854,P均＜0.05);患侧下肢动脉血流峰值较低(t=3.169 ～9.899,P均＜0.05);糖尿病足皮损明显改善[(2.11±1.34) cm2vs.(3.65±1.65)Cm2,P=0.021].高压氧组总有效率和治愈率分别为98％和78％;对照组总有效率和治愈率为76％和48％,差异有统计学意义(P＜0.05).结论 高压氧治疗糖尿病足疗效优于常规治疗,是糖尿病足治疗的有效途径.     

降纤酶及高压氧联合治疗糖尿病足初探

随着我国糖尿病患者数的增加 ,糖尿病足患病率也在逐年上升。糖尿病足是非创伤性截肢的主要原因 ,糖尿病患者截肢的危险性较非糖尿病患者增加 15～ 4 6倍 [1 ] 。作者自1998年～ 2 0 0 0年 ,应用降纤酶、高压氧联合治疗糖尿病足患者 35例 ,获得良好疗效 ,报道如下。一、对象和方法1.对象 :住院糖尿病足患者 6 5例 ,糖尿病足的诊断标准及病变程度依据《糖尿病足检查方法及诊断标准》分级[2 ] ,随机分为两组 :(1)联合治疗组 35例 ,男 15例 ,女 2 0例 ,年龄 (5 4 .6±8.9)岁 ,糖尿病病程 (10 .5± 6 .7)年 ,诊断糖尿病足时间 2 0天～ 4年。入院…     

心理护理对糖尿病足截肢术后康复的影响

目的 观察心理护理干预对该院收治的糖尿病足患者截肢术后康复的临床应用效果.方法 选取2017年1月—2019年11月该院收治的100例糖尿病足截肢患者作为观察对象,并根据随机数表法分为对照组和观察组,对照组50例给予临床上的常规护理,观察组50例在常规护理的基础上给予心理护理.采用统计学分析两组干预前后血糖水平、术后并...     

高压氧综合治疗糖尿病足的疗效分析及护理

目的 分析高压氧综合治疗糖尿病足的临床疗效及护理.方法 选取2016年10月—2019年3月该院接收的94例糖尿病足患者,根据治疗方法不同分为对照组和观察组,各47例,对照组应用常规的换药方法和治疗以及护理进行干预,观察组在常规的换药方法及治疗和护理干预的基础上,综合高压氧治疗,对比两组患者治疗和护理后血糖水平、糖尿病...     

老年糖尿病足截肢相关危险因素

糖尿病足(DF)是糖尿病常见且严重的慢性并发症,我国目前糖尿病患者高达(4000～6000)万人,DF溃疡发病率约占糖尿病患者的4％-10％,其导致的下肢截肢是糖尿病最严重并发症之一,有研究指出我国DF占住院糖尿病人2.45％,截肢率14％[1].本文探讨老年DF患者截肢相关危险因素.     

The effect of hyperbaric oxygen therapy on the adverse effects of octreotide on wound healing

OBJECTIVE: Octreotide, a long-acting somatostatin analogue, has been used in the treatment of various disorders. Octreotide has significant detrimental impacts upon wound healing. We tested the hypothesis that hyperbaric oxygen therapy may overcome octreotide-mediated suppression of wound healing. DESIGN: Prospective, randomised, parallel-group animal study. METHODS: Operated rats were divided into four groups: (1) controls, (2) octreotide therapy, (3) hyperbaric oxygen therapy and (4) combination of octreotide and hyperbaric oxygen therapy. Wound healing was assessed by breaking-strength measurements, hydroxyproline levels and fibrosis scores. RESULTS: Octreotide decreased the breaking-strength measurements, hydroxyproline levels and fibrosis scores to 72%, 88% and 55%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy increased breaking-strength measurements and hydroxyproline levels to 137% and 126%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy tended to increase the fibrosis scores to 111% of the control group, but without statistical significance. CONCLUSION: Hyperbaric oxygen therapy tends to reverse the octreotide-induced impairment of wound healing.     

糖尿病足溃疡转归相关因素的分析

目的 研究糖尿病足溃疡的愈合,并对影响因素进行相关分析.方法 回顾性研究2008年1月至11月我科住院治疗的106例糖尿病足溃疡患者愈合情况及其影响因素.结果 患者年龄、贫血、溃疡深度、感染、骨髓炎、糖尿病外周神经病变、坏疽和血流灌注是影响愈合的危险因素(P均＜0.05).回归分析示骨髓炎、血流灌注、坏疽是影响愈合的独立危险因素.对不存在坏疽、骨髓炎和缺血的27例患者溃疡愈合情况研究发现,合并感染的溃疡愈合时间显著延长(P＜0.05).结论 无论溃疡是否缺血,感染均是影响溃疡愈合的重要因素,及时就诊可以减少坏疽或骨髓炎的发生.     

经皮氧分压检测在糖尿病足截肢手术中的应用

目的评价经皮氧分压（TcPO2）检测在糖尿病足截肢手术中的临床应用价值。方法对68例2型糖尿足截肢手术患者进行回顾性分析。其中32例（A组）运用经皮氧分压检测方法确定氧分压40 mmHg以上的部位为截肢平面,36例（B组）根据术者临床经验判断截肢平面进行截肢手术。将两组患者的切口愈合情况及术后并发症发生情况进行统计分析和比较。结果 A组术后切口愈合情况明显优于B组（P〈0.01）,截肢术后并发症发生率低于B组（P〈0.01）。结论经皮氧分压检测是一种经济、可靠、重复性好、操作简单、无创性、对选择截肢平面有指导作用的可靠指标。     

糖尿病足溃疡局部炎性反应状态与伤口愈合的关系

糖尿病伤口局部的炎性反应状态表现为炎性反应起始晚、持续时间长、消退障碍,与巨噬细胞对凋亡中性粒细胞的吞噬减少和促炎消退脂类介质分泌减少有关.而炎性反应过程中中性粒细胞数量和功能的异常、不同表型巨噬细胞比例异常、促炎/抗炎因子失平衡、晚期糖基化终末产物(AGEs)/细胞外新发现的AGEs受体结合蛋白(EN-RAGEs)和AGEs受体相互作用干扰了参与伤口愈合的多种细胞和细胞外基质的功能,导致糖尿病伤口愈合障碍.     

The role of hyperbaric oxygen in the treatment of diabetic foot ulcers

Diabetic foot ulcers are still extremely difficult to heal. Therefore, therapeutic options to improve healing rates are continuously being explored. Hyperbaric oxygen (HBO) has been used in addition to standard treatment of the diabetic foot for more than 20 years. Evidence suggests that HBO reduces amputation rates and increases the likelihood of healing in infected diabetic foot ulcers, in association with improved tissue oxygenation, resulting in better quality of life. Nonetheless, HBO represents an expensive modality, which is only available in few centers. Moreover, adverse events necessitate a closer investigation of its safety. Finally, it is not entirely clear which patients stand to benefit from HBO and how these should be selected. In conclusion, HBO appears promising, but more experience is needed before its broad implementation in the routine care of the diabetic foot.     

Monitoring wound progression to healing in diabetic foot ulcers using three-dimensional wound imaging

Aim3D wound imaging has provided clinicians with even greater wound measurement options. No data is available to guide clinicians as to which 3D measurements may yield the most reflective marker of wound progression to healing.MethodA prospective pilot study was undertaken to assess the accuracy of five 3D wound measurements that best reflect metrics of interest to clinicians. Twenty-one diabetic foot ulcers were enrolled from initial ulcer presentation, through to healing. The relationship between mean wound healing measurement variables was examined using linear regression and Pearsons correlation coefficient, in addition to assessing clinician inter-rater reliability of measurements using Intra-class correlation coefficients (ICC).ResultsStatistical analysis demonstrated a linear healing slope for each wound measurement as having a value greater than R 0.70 and a statistical significance of p = 0.0001. This suggests that all five wound measurements are useful prognostic markers of wound progression to healing. Low variability of measurements between users indicates good inter-observer reliability.Conclusion3D wound measurements demonstrate a linear correlation between the measurement and time to healing. This suggests they could be effective prognostic markers of a wounds progression to healing and closure. It may also provide important early identification of wounds not responding to standard care. Larger studies are required to validate our results.     

典必殊对翼状胬肉老年患者手术后疗效的观察

目的观察典必殊对翼状胬肉老年患者术后治疗的效果。方法对90例翼状胬肉老年患者采用改良单纯翼状胬肉切除术＋带蒂结膜瓣转位术，手术后患者随机采用典必殊眼膏点眼或金霉素眼膏点眼。裂隙灯下观察角膜上皮完全愈合后，均改为局部点用典必殊眼液，前3d为6次／d，拆线后改为4次／d，渐减。观察2组患者的临床症状和体征。结果术后应用典必殊眼膏的舒适度及局部反应均明显好于金霉素眼膏组。结论及时足量应用皮质类固醇激素可以有效降低翼状胬肉复发率。因此典必殊可作为翼状胬肉术后的常规用药。     

Effect of hyperbaric oxygen on cardiac neural regulation in diabetic individuals with foot complications

Aims There are relatively few effective methods to treat autonomic neuropathy in patients with diabetes mellitus. Our aim was to test the hypothesis that hyperbaric oxygen therapy may restore cardiac neural regulation dysfunction in diabetic individuals with foot complications. Methods We conducted a prospective randomized controlled study in patients with diabetic foot problems. Daily heart‐rate variability analysis from 5‐min electrocardiography was used to evaluate the temporal change of cardiac neural regulation. The experimental group consisted of 23 subjects exposed to hyperbaric oxygen therapy of 202.65 kPa for 90 min every Monday to Friday for 4 weeks (20 treatments). The control group consisted of 15 age‐, sex‐ and disease‐matched subjects who were not exposed to hyperbaric therapy. Patients with medical complications and failure of wound healing were excluded to eliminate possible confounding effects. Results There was no significant difference in baseline R–R interval (RR), variance, high‐frequency power (HF), low‐frequency power (LF), and LF/HF ratio between the two groups. In the hyperbaric oxygen group there were significant increases in changes of RR (82.7 ± 16.02 ms); variance 0.88 ± 0.12 ln(ms²); HF 1.06 ± 0.18 ln(ms²); and LF 0.87 ± 0.15 ln(ms²) after the treatment. Measurements of tissue oxygen demonstrated significant increases in local tissue oxygenation in the hyperbaric oxygen group (53.0 ± 2.6 mmHg) compared with the control group (27.5 ± 3.1 mmHg), P < 0.05. Conclusion Hyperbaric oxygen therapy has a significant vagotonic effect, which is beneficial in improving cardiac neural regulation in patients with diabetic autonomic dysfunction. Diabet. Med. (2006)