糖尿病足坏疽截肢平面的判定

随着生活水平的提高,人们饮食结构发生改变,糖尿病患者数量逐年递增,其常见并发症糖尿病足坏疽的发生率也迅速上升,文献报道高达12％～25％[1-3]。截肢往往是挽救此类患者生命的最后方法。日本糖尿病足坏疽的截肢率为21.4％[4];中国香港达30.3％[5]。然而目前截肢平面的确定尚存争议。不恰当的截肢平面将对患者造成巨大伤害,加重他们的经济负担。确定保证伤口愈合且最低的截肢平面不仅可挽救患者生命,提高患者生活质量,而且能预防再次手术,节省人力、财力。目前截肢平面的判定主要有以下几种。     

糖尿病足截肢技术进展

目的总结各种糖尿病足截肢技术的研究进展。方法查阅近年关于糖尿病足截肢技术的文献,进行综合分析。结果根据截肢平面的不同,糖尿病足的截肢技术可分为小范围截肢术和大范围截肢术两种,并衍生出多种截肢方法,截肢方式与方法的选择需要综合各种因素考虑。结论 对于糖尿病足截肢,应在保证截肢效果的前提下,尽可能降低截肢平面。患者的身体状况、糖尿病足累及的部位、组织的血流灌注情况、局部组织对感染的易感性、创口的愈合能力等是影响选择糖尿病足截肢方式和方法的重要因素。截肢后仍要重视糖尿病的综合治疗,防止截肢平面的进一步上升。     

糖尿病足的手术截肢治疗

目的探讨糖尿病足的手术截肢治疗方式。方法通过对34例晚期糖尿病足病人截肢治疗,包括小腿截肢24例,经足截肢10例,手术后控制血糖,改善局部循环,积极处理残端疼痛等。结果术后平均随访8个月(3~16个月),残端完全愈合者28例,占82%。结论对于糖尿病足的治疗,采用截肢手术虽然迫不得已,但可以提高病人生存率,改善生存质量。     

经皮氧分压在瘢痕评估中的应用北大核心CSCD

目的总结经皮氧分压(transcutaneous oxygen pressure,TcPO_2)测量在瘢痕评估中的应用以及研究进展。方法查阅国内外与瘢痕以及TcPO_2相关的文献,并进行总结分析。结果组织中缺氧环境在瘢痕发生发展过程起重要作用,TcPO_2能准确反映瘢痕组织内的氧分压情况,已用于瘢痕成熟度评估、指导瘢痕治疗以及研究缺氧对瘢痕发生发展的影响方面。结论 TcPO_2测量在瘢痕评估、治疗以及缺氧与瘢痕发生机制研究中有重要意义。     

糖尿病足截肢术研究进展

糖尿病足是导致糖尿病患者截肢的主要原因.患肢局部血流灌注情况、组织营养状况、创缘愈合潜力和功能康复潜力是影响糖尿病足截肢平面选择的重要因素.该文就糖尿病足截肢平面选择、各种截肢术研究进展作一简要综述.     

经皮氧分压和二氧化碳分压监测组织缺氧的可行性

休克的监测和治疗需要准确及时反映组织缺氧的指标,但是近年来肺动脉的应用受到质疑、监测局部组织代谢的胃粘膜张力计也逐渐淡出临床、能够应用到临床的反映组织缺氧的监测工具和指标非常有限,迫切需要探索其他技术方法,本文论述了经皮氧和二氧化碳分压监测能否用于组织缺氧的监测。     

经皮氧分压监测在急性呼吸窘迫综合征治疗中的应用

目的观察经皮氧分压（PtcOz）在急性呼吸窘迫综合征（ARDS）患者中的变化特点，了解其在ARDS治疗中的作用。方法采用经皮氧分压监测仪对49例ARDS患者实施连续动态监测PtcO2，记录通气前和通气后4、8、16、24hPtcO2值，同期抽取动脉血检测PaO2、SaO2，记录心率（HR）和平均动脉压（MAP）。并比较存活组与死亡组不同时间PtcO2的差异。结果SaO2、HR、MAP随时间变化的程度不明显（均P〉0．05），PtcO2和PaO2随时间变化显著（均P〈0．05）；存活组（35例）与死亡组（14例）PtcO2比较，差异有显著性意义（P〈0．05）。结论PtcO2监测对ARDS治疗能提供连续、可靠的指导作用，PtcO2早期的变化对判断预后有一定帮助。     

经皮氧分压监测在急性呼吸窘迫综合征治疗中的应用

目的 观察经皮氧分压(PtcO2)在急性呼吸窘迫综合征(ARDS)患者中的变化特点,了解其在ARDS治疗中的作用.方法 采用经皮氧分压监测仪对49例ARDS患者实施连续动态监测PtcO2,记录通气前和通气后4、8、16、24 hPtcO2值,同期抽取动脉血检测PaO2、SaO2,记录心率(HR)和平均动脉压(MAP).并比较存活组与死亡组不同时间PtcO2的差异.结果 SaO2、HR、MAP随时间变化的程度不明显(均P＞0.05),PtcO2和PaO2随时间变化显著(均P＜0.05);存活组(35例)与死亡组(14例)PtcO2比较,差异有显著性意义(P＜0.05).结论 PtcO2监测对ARDS治疗能提供连续、可靠的指导作用,PtcO2早期的变化对判断预后有一定帮助.     

1例糖尿病足双下肢截肢伴自杀倾向病人的心理护理

对1例糖尿病足双下肢截肢伴有自杀倾向的病人进行心理支持,调动病人正性心理,发挥身体其他部位及残肢的功能,协调家庭关系.结果病人情况稳定.     

Hyperbaric oxygen therapy of diabetic foot ulcers, transcutaneous oxymetry in clinical decision making

The foot ulcer is one of most common and devastating complications of diabetes and is associated with considerable morbidity and mortality. The major causes of these ulcers are ischemia/hypoxia, neuropathy, and infection, and they often coexist. Despite conventional therapy including revascularization procedures when appropriate, three situations lead frequently to amputation: persistent critical limb ischemia, soft tissue infection, and impaired wound healing from osteomyelitis. In these conditions, hyperbaric oxygen therapy may be used as an adjunctive treatment and is associated with a better outcome. Randomized, prospective, controlled trails have shown the benefit of hyperbaric oxygen therapy in diabetic ulcers of the lower extremity. Transcutaneous oxygen measurement performed under hyperbaric oxygen therapy has a prognostic significance when used to select patients who are the most likely to benefit from therapy. Hyperbaric oxygen should be added to conventional treatment if the transcutaneous oxygen tension close to the trophic lesion in 2.5 ATA hyperbaric oxygen is over 200 mmHg. Peri-wound transcutaneous oxygen tensions over 400 mmHg in 2.5 ATA hyperbaric oxygen or over 50 mmHg in normobaric pure oxygen predict healing success with adjuncted hyperbaric oxygen therapy with high accuracy.     

The use of adjuvant hyperbaric oxygen in treatment of the diabetic foot

Hypoxia in the relatively ischemic diabetic foot impairs leukocyte bacterial killing and fibroblast-collagen support for capillary angiogenesis. Infection in even the relatively young, "warm-foot" diabetic with microangiopathy, neuropathy, and infection leads to hypoxia due to local high oxygen consumption. The 1100 to 1300 mm Hg arterial PO2 achievable with hyperbaric oxygen results in elevation of wound PO2. Periodic correction of wound hypoxia improves leukocyte bacterial killing and support for capillary angiogenesis. Hyperbaric oxygen is usually futile in the elderly diabetic with significant and generalized large-vessel occlusion.     

负压创面治疗联合高压氧治疗糖尿病足的临床疗效

目的 探讨负压创面治疗联合高压氧治疗糖尿病足的临床疗效.方法 采用回顾性病例对照研究分析江苏大学附属人民医院整形烧伤科自2013年2月至2017年12月收治的46例糖尿病足患者的临床资料,根据治疗方法分为对照组(24例)和联合治疗组(22例).糖尿病足创面按Wagner分级为3～5级;共46足.对照组采用控制血糖、抗感...     

Rapid tissue expansion: value of the measurement of the transcutaneous oxygen pressure and intraprosthetic pressure]

Tissue expansion is often unpleasant for the patient because of its long duration. The authors present a series of 16 rapid expansion prostheses implanted in 10 patients. The expansion was monitored by measuring the percutaneous oxygen partial pressure and intraprosthetic pressure. The expansions were performed without any complications. Monitoring of the expansion by measuring the pcPO2 appears to ensure good results.     

Clinical evaluation of transcutaneous oxygen tension measurement for lower limb ischemia

Transcutaneous oxygen tension (tcPO2) of superficial layer of the foot at 44 degrees C was studied preoperatively in 33 patients (38 legs) with arteriosclerosis (ASO) or thromboangiitis obliterans (TAO). The cases were divided into two groups. The first group consisted of 3 legs, amputated. The second group consisted of 35 legs, not amputated but receiving such treatments as arterial bypass, lumbar sympathectomy or conservative therapy. The tcPO2 index was calculated by dividing the tcPO2 of the chest wall by the tcPO2 of the foot. The value of the tcPO2 of the chest decreased in proportion to the advance of age. There was no significant differences in the tcPO2 indices between ASO and TAO, nor among different sites of peripheral vascular occlusion. On the other hand, as the grade of Fontaine classification increased, the tcPO2 index reduced, with significant difference between grade II and IV. The tcPO2 index of the amputated group was 0.08 +/- 0.04. In contrast, the tcPO2 indices of the lumbar sympathectomy, arterial bypass and conservative therapy groups were 0.74 +/- 0.18, 0.84 +/- 0.12 and 0.74 +/- 0.13, respectively. There was significant difference between the amputated and non-amputated groups. From our results, it is suggested that oxygen tension measured transcutaneously is a useful indicator for the decision of operative indication and surgical procedure.     

Assessment of perfusion in the diabetic foot by regional transcutaneous oximetry

Regional transcutaneous oximetry is a new, noninvasive diagnostic technique for the investigation of peripheral vascular disease (PVD) that uses differences in limb and trunk transcutaneous PO2 to assess the adequacy of local perfusion. The application of such measurements would be of great importance in diabetes, in which limb ischemia is commonly difficult to assess. A group of diabetic subjects with symptomatic PVD was studied with regional oximetry, Doppler-assisted blood pressure measurements, and arteriography. Doppler studies correlated poorly to symptom grade and angiographic data, while oximetry clearly demonstrated limb hypoxia under the functional conditions appropriate to the patients' clinical symptomatology. The superiority of oximetry to Doppler studies was highly significant (X2 = 12.64, P less than 0.001). Regional transcutaneous oximetry should therefore be the noninvasive diagnostic test of choice in the initial evaluation of the diabetic limb for PVD. Because of its dependence on the adequacy of local oxygenation, transcutaneous oximetry is a powerful tool for investigation of the pathophysiology of PVD and will, in the future, have wide-ranging applications to the diagnosis and therapy of PVD.     

Application of transcutaneous oxygen measurement in podiatric surgery

A practical, noninvasive method of determining the actual physiological state of tissue being examined is presented. The measuring of actual oxygen tension in the skin capillary bed enables the podiatric physician to assess peripheral vascular status. Healing predictability to a tissue area may also be evaluated.