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糖尿病足(diabctic foot)是指与下肢神经病变和下肢外周血管病变相关的足部感染、溃疡和(或)深层组织破坏.随着目前糖尿病发病率逐渐上升,糖尿病足患者也逐年增多,其足部溃疡创面的处理是糖尿病足综合治疗的关键之一,直接关系到患者的预后和生存质量.     

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.     

糖尿病足溃疡创面的局部处理

糖尿病足溃疡的创面处理在临床上一直是个难题。近年来基于现代创面愈合理论,在国际上关于慢性溃疡创面的局部处理新进展的基础上,提出对糖尿病足溃疡创面采用“创面床准备”的方法进行治疗的方案,其核心内容是对溃疡创面所处时期进行评价,不同的时期采用不同的处理方法,应用不同的敷料或生长因子创造一个适于创面愈合的微环境,促进创面愈合。     

创面局部注射胰岛素对糖尿病足溃疡患者全身血糖水平及创面的影响

目的研究创面局部注射胰岛素对糖尿病足溃疡患者全身血糖以及创面的影响。方法选取2012年1月至2013年12月该院收治的糖尿病足患者40例,按照随机数字表法分为研究组和对照组各20例。均清创治疗,研究组给予创面局部注射胰岛素,对照组给予腹部皮下注射胰岛素,两组均治疗7 d,比较两组创面的肉芽组织生长程度、创面微血管密度(MVD)以及空腹血糖值。结果研究组空腹血糖维持在(9.5±0.3)mmol/L,对照组维持在(9.4±0.2)mmol/L(t=4.192,P=0.104);治疗后研究组创面肉芽组织生长(59.2±0.1)%显著优于对照组的(24.8±0.7)%(t=10.038,P=0.023);研究组创面组织每200倍视野中MVD为(11.3±0.4)个,显著多于对照组的(5.9±1.2)个(t=11.923,P=0.019)。结论糖尿病足患者创面局部注射胰岛素能控制全身血糖,有助于肉芽组织生长,有利于创面愈合。     

探讨湿性愈合理论指导糖尿病足溃疡创面换药的效果

目的探究湿性愈合理论指导对糖尿病足溃疡创面换药的临床治疗价值。方法选取该院2018年8月—2019年11月收治的82例糖尿病足溃疡患者为研究对象,依据随机数字表法,将入选患者分为湿性组与干性组,其中干性组(n=41例)采取传统干性换药法,湿性组(n=41例)采取湿性愈合理论指导换药法。观察两组患者的治疗效果、一般指标及溃疡愈合速度。结果湿性组的总有效率、换药间隔时间、溃疡愈合速度显著高于干性组,差异有统计学意义(P<0.05);湿性组的住院时间、换药时间显著低于干性组,差异有统计学意义(P<0.05)。结论湿性愈合理论指导应用于糖尿病足溃疡中具有较好的治疗价值,可显著缩短换药时间及住院时间、加快溃疡愈合速度。     

细胞衰老在糖尿病足溃疡中的研究进展

糖尿病足溃疡在老年糖尿病人群中常见。对糖尿病足溃疡复杂的分子水平机制研究仍在不断探索中, 细胞衰老对糖尿病足溃疡愈合延迟的作用受到关注, 分析细胞衰老与糖尿病足溃疡的关系, 探索细胞衰老延缓糖尿病足伤口愈合的作用机制, 明确清除衰老细胞、延缓细胞衰老的治疗方法, 可为研发糖尿病足溃疡药物提供新的治疗靶点和策略。     

2型糖尿病并发糖尿病足患者溃疡创面微生物分布及药敏结果分析

目的 探究2型糖尿病并发糖尿病足患者溃疡创面微生物分布及药敏结果.方法 甄选2020年1—12月该院收治的2型糖尿病合并糖尿病足患者108例,应用全自动细菌鉴定与药敏分析仪以及相关配套设备对患者进行糖尿病足溃疡创面微生物进行检验.结果 108例2型糖尿病合并糖尿病足患者实施足部溃疡分泌物培养,分离出111株细菌,其中革...     

清创机、红光照射联合生物敷料治疗糖尿病足部溃疡的疗效观察

我科从2011年6月至2013年7月收治的糖尿病足部溃疡病人中筛选42例纳入研究并随机分成两组,两组均进行系统的内科治疗和一般护理,研究组用清创机彻底清创后、红光照射联合活性因子生物敷料治疗创面,而对照组应用传统的清创方法治疗创面。结果：研究组创面周围红肿消退时间明显短于对照组,研究组创面愈合时间明显短于对照组。结论：清创机彻底清创后、红光照射联合活性因子生物敷料的治疗方案可为临床治疗糖尿病足部中小创面溃疡提供指导。     

糖尿病足溃疡大鼠模型的建立

目的建立一种稳定简单的糖尿病足溃疡大鼠模型。方法50只雄性Wistar大鼠随机分为对照组（10只）和造模组（40只）。造模组高脂喂养后腹腔注射链脲佐菌素（STZ）,对照组注射等量缓冲液。监测两组空腹血糖、体质量、饮水量、尿量及股动脉血流变化。将两组大鼠足背部-矩形全层皮肤组织切除,建立糖尿病足溃疡模型,记录二组溃疡愈合时间。结果造模组比对照组大鼠血糖升高,体质量减轻,饮水量、尿量增加;造模3周后造模组双股动脉呈粥样化性改变,即血流频谱呈锯齿形,对照组血流正常;造模组溃疡愈合时间较对照组延迟（P〈0．01）。结论该方法建立的糖尿病足溃疡大鼠模型操作简单,成功率高,溃疡面积可控,是稳定的糖尿病足溃疡模型。     

透明质酸联合中药治疗糖尿病足的临床观察

对20例糖尿病足患者随机分为B组为对照组，A组局部加用透明质酸及内服中药，记录每位病人给药后溃疡而积缩小率的评价及溃疡创口愈合的时间。结果：观察组的完全治愈率明显高于，无效率明显低于对照组。结论：透明质酸联合中药治疗糖尿病足可以提高治愈效果。     

The diabetic foot: The importance of biofilms and wound bed preparation

Biofilms are ubiquitous and medically important complex structures consisting of microbial-associated cells embedded in self-produced extracellular matrix of hydrated extrapolymeric substances, which are irreversibly attached to a biological or nonbiological surface. Bacteria that reside as biofilms are resistant to traditional therapy. This alternative community in which microbes exist has recently attracted interest as a potential reason why chronic wounds do not heal. This may be especially important for diabetic foot ulcers, which are often characterized by their refractory nature, their predisposition to have associated underlying infection, and their improvement with de’bridement. Animal and in vitro models have been developed to better study biofilms, which will allow a venue for therapeutic intervention. Potential opportunities exist that include prevention of bacterial attachment, prevention of biofilm formation, disruption of the biofilm to allow penetration of topical antimicrobial agents, interference with quorum sensing, and enhancement of bacteria dispersion from biofilms to a more easily destroyed planktonic state.     

MiR-503 promotes wound healing of diabetic foot ulcer by targeting FBN1

Objective: To highlight the relationship between miR-503 and wound healing of diabetic foot ulcer(DFU). Methods: Microarray analysis was used to detect the dysregulated miRNAs between the DFU tissues and normal tissues. The expression of miR-503 in tissues and serum of patients with DFU was detected by qRT-PCR technique. Then, CCK-8 assay was applied to determine the cell proliferation. TUNEL assay was used for assessing the apoptosis of cells after treatment with miR-503. Possible correlation between miR-503 and fibillinl(FBN1)was predicted according to data accessed on RNA22 website online, and was detected for confirmation by luciferase reporter assay. Results: Microarray analysis showed that miR-503 was significantly decreased in the DFU tissues compared with normal tissues. While marked increase in the expression of miR-503 in tissues and scrum of patients with DFU was confirmed by qRT-PCR technique. Then, CCK-8 assay indicated that transfection of miR-503 mimic obviously accelerated the cell proliferation. However, TUNEL assays suggested that miR-503 mimic inhibited the apoptosis of cells to improve the survival of fibroblasts.Besides. miR-503 AMO played a role in fibroblasts of DFU tissues exactly countering to miR-503 mimic treatment. It was predicted that MiR-503 is a complementary to the FBN1 by RNA22. Besides, SiRNA-FBN1 promoted the proliferation, but brought down the apoptosis of fibroblasts. Conclusions: MiR-503 regulates the function of fibroblasts and wound healing of patients with DFU by targeting FBN I directly which provids a novel and critical target for diagnosis and treatment of DFU.     

Management of a diabetic foot ulcer

A chronic diabetic foot ulcer requires a search for the etiology. The three main causes to search for are poor off-loading compliance, osteomyelitis, and peripheral vascular disease. The level of severity is measured with the U.T. classification and the level of infection with the classification of the International Consensus on the Diabetic Foot. Peripheral vascular disease must be precisely evaluated by Doppler ultrasound, which describes all the arteries of the lower limb. Angiography is required only in case of revascularization. Treatment of the ulcer includes strict off-loading, topical treatment, optimal treatment of hyperglycemia, and antibiotic therapy on a case-by-case basis for osteomyelitis and/or, angioplasty or by-pass procedures. Osteomyelitis can be treated by associating conservative surgery, antibiotic therapy, and off-loading. No amputation, even of one toe, must be done without a previous vascular check-up. Off-loading of the ulcer must be regularly checked. Poor off-loading compliance must be systematically investigated if the ulcer worsens or healing is delayed.     

两种伤口负压治疗模式对糖尿病足溃疡治疗作用的比较

目的比较两种伤口负压治疗模式对糖尿病足溃疡的治疗作用。方法选取2018年4至8月广西壮族自治区人民医院内分泌科收治的糖尿病足溃疡患者,经全身综合治疗和创面评估、清创后,对创面床适合伤口负压治疗的16例患者(男10例,女6例)按入组时间顺序进行随机分组,采用开放、平行、交叉方法,分为先负压辅助闭合(VAC)组(8例)和先负压封闭引流(VSD)组(8例),先VAC组第一周采用VAC治疗,第二周接受VSD治疗;先VSD组第一周采用VSD治疗,第二周接受VAC治疗。分别于治疗前、治疗1周末及治疗2周末对所有患者足部溃疡创面拍照,采用Image J软件分析溃疡面积及肉芽组织面积变化,同时采用丹麦雷度经皮氧分压测定仪测定2个部位的组织氧分压。运用两阶段交叉设计的方差分析方法,对治疗期间第1周和第2周两种治疗模式的溃疡面积及肉芽组织面积变化、经皮氧分压变化进行比较。结果(1)16例糖尿病足溃疡患者与治疗前比较,治疗后溃疡面积缩小[4.61(3.11)比9.51(6.55)cm^2,Z=3.517]、肉芽面积增加[4.08(2.49)比0.90(1.12)cm^2,Z=-3.516],2个部位的经皮氧分压值均升高[(54.19±6.91)比(32.16±10.16)mmHg(1 mmHg=0.133 kPa)、(56.75±12.95)比(30.56±11.93)mmHg,t=-11.814、-14.028],差异均有统计学意义(均P<0.05)。(2)VSD和VAC两种不同负压治疗模式对患者的溃疡面积、肉芽组织面积及2个部位的经皮氧分压变化有统计学意义(F=5.763~22.090,均P<0.05),且VAC治疗后的经皮氧分压增大值、溃疡面积缩小值及肉芽组织面积增加值要大于VSD治疗后(P<0.05)。(3)无论采用哪种负压治疗模式,治疗第1周后的2个部位的经皮氧分压增大值均大于治疗第2周后,差异有统计学意义(F=13.254、11.205,均P<0.05)。结论VAC在缩小糖尿病足溃疡面积,增加创面肉芽组织面积及提高溃疡周围组织氧分压方面要优于VSD,VAC治疗模式在治疗糖尿病足溃疡上更具有优势。     

The process of implementing a rural VA wound care program for diabetic foot ulcer patients

Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.     

糖尿病足创面的局部治疗

糖尿病足是糖尿病的严重并发症之一.良好的创面治疗可以促进创面愈合,减少截肢风险.糖尿病足溃疡创面的局部治疗主要包括局部减压、清创和敷料及高级伤口愈合产品的应用.近年,新观念、新技术及新材料小断涌现,并且取得了显著的临床疗效.如速成全接触石膏支具在减压中的应用.蛆虫疗法应用于糖尿病足清创日趋成熟,新型敷料及高级愈合产品通过多种生理机制促进糖尿病溃疡的愈合.本文主要对糖尿病足创面的局部治疗及相关研究作一综述.     

羧甲基壳聚糖生物胶液负压滴灌治疗糖尿病足溃疡的疗效

目的:探讨羧甲基壳聚糖生物胶液负压滴灌治疗糖尿病足溃疡的临床疗效。方法:为前瞻性研究。收集2019年2月至2020年3月北京中医药大学东直门医院的60例糖尿病足患者,采用随机数字表法将患者分为试验组和对照组,各30例。对照组在基础治疗的同时采用生理盐水滴灌负压治疗,试验组采用羧甲基壳聚糖生物胶液进行滴灌负压治疗。治疗1...