马来酸桂哌齐特治疗糖尿病足的临床效果观察

糖尿病足（diabetic foot,DF）是指糖尿病（diabetes mellitus,DM）患者踝关节以下部位的溃疡、坏疽或感染,是DM的一种严重并发症,是DM患者致残致死的重要原因。糖尿病的中小血管病变、神经病变和感染是引起糖尿病足的主要原因[1],其临床治疗较困难。笔者使用马来酸桂哌齐特（cinepazide maleate）治疗DF30例,并与常规治疗30例进行对照观察,现报道如下。     

专家小组在糖尿病足护理管理中的应用

糖尿病足（diabetic foot，DF）是糖尿病严重的并发症之一，以肢体末端疼痛、感染、溃疡、坏疽为主要表现，病程长，不易愈合，是糖尿病患者致残、致死的重要原因。2006—01成立糖尿病足专家小组，对全院的糖尿病足患者进行干预，并进行系统管理，为临床护士提供新的理论、新的方法来护理糖尿病足患者，效果明显。     

糖尿病足的护理体会

糖尿病足（diabetic foot，DF）又称糖尿病肢端坏疽，以肢体末端疼痛、感染、溃疡、坏疽为主要临床表现，是糖尿病病人致残、致死的重要原因.近几年来我们采用中西医结合方法综合治疗护理糖尿病足36例疗效满意，现报告如下。[第一段]     

糖尿病足发生的危险因素及护理进展

糖尿病足（diabetic foot,DF）是由于糖尿病患者并发神经病变及不同程度的末梢血管病变而导致的下肢感染、溃疡形成和（或）深部组织的破坏。数据表明［1］,中国成年人糖尿病的患病率为9？7%,糖尿病患病总人数约9240万,已经成为糖尿病患者数最多的国家,糖尿病患者足部并发症是其住院治疗的主要原因,也是截肢术的主要原因。据报道［2］,约有25%的糖尿病患者在其一生中会因为各种原因出现足部溃疡,而这些患者20%可能需要接受截肢,给家庭、社会带来巨大的压力及经济负担。了解患者糖尿病足发生的原因,采取积极的预防和护理措施,可以有效控制或预防糖尿病足的发生,现将糖尿病足发生危险因素及护理进展综述如下。     

糖尿病足的中西医结合防治研究

糖尿病足（diabetic foot，DF）又称糖尿病性肢端坏疽、糖尿病性动脉闭塞症，是2型糖尿病（diabetic mellitus，DM）患者的严重并发症之一，也是DM患者致残、死亡和能力丧失的重要原因.本病最早由Oakley于1956年提出.1972年，Callerall再次明确定义：DF是“因神经病变而失去感觉和因缺血而失去活力并感染的足患”.1999年WHO对DF的定义是：DM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.据统计，大约15%的DM患者将在生活的某一时间发生足溃疡或坏疽.近年来的临床实践表明，中西医结合防治DF有较大的优势，大大减少了截肢率.笔者参阅了近年来有关DF的文献报道，对中西医结合防治DF的临床研究状况作一综述。     

医用臭氧气浴治疗糖尿病足的作用机制探讨

糖尿病足（diabetic foot,DF）是与周围神经、血管病变相关的糖尿病慢性并发症之一。随着糖尿病患者逐年增多,糖尿病足发病率也逐年增高,严重威胁着糖尿病患者的生活质量。糖尿病足一旦合并溃疡感染治疗难度大,     

41例糖尿病足临床治疗体会

糖尿病足(diabetic foot，DF)是糖尿病患者足或下肢组织破坏的一种病理状态，如溃疡、骨及关节病乃至所引起的坏疽等。糖尿病足是引致糖尿病患者截肢的首要原因，使患者的生活质量明显下降。现将我科1996年1月-2002年1月收治的41例DF患者资料进行总结。报道如下：     

53例糖尿病足临床特点分析

糖尿病足（（diabetic foot，DF）是由于糖尿病血管神经病变引起的下肢病变的总称，严重者可因合并感染引起肢端坏疽称为糖尿病肢端坏疽，是糖尿病发展的一个严重阶段。大量资料表明糖尿病足不但导致糖尿病患者生活质量下降。而目造成巨大的经济负担和社会负担，有5％-10％的患者需要行截肢手术，在非创伤截肢中，糖尿病患者占50％以上。     

浅谈糖尿病足的防治

糖尿病足（diabetic foot，DF）是糖尿病患者严重的并发症之一，以肢体末端疼痛、感染、溃疡、坏疽为主要表现，病程长，不易愈合，是糖尿病病人致残、致死的重要原因。最常见的后果是慢性溃疡，最严重的结局是截肢，甚至直接导致死亡。现代医学认为，本病为糖尿病慢性致残并发症。多发生于年龄较大、病程长而病情控制不佳的患者。加强教育，积极预防，早期诊断，合理治疗可有效减少致残率。     

前列地尔注射液联合大剂量甲钴胺治疗糖尿病足60例

糖尿病足（diabetic foot，DF），又称糖尿病性肢端坏疽。其主要病因为下肢中、小血管及微循环障碍，周围神经病变并发感染所致。临床表现以足部感觉减退、麻木、发凉、疼痛、溃疡和坏疽为特征。是糖尿病患者致死、致残的重要原因。因此，如何更有效的治疗糖尿病足日益引起人们的重视。我们对应用前列地尔注射液和大剂量甲钴胺治疗糖尿病足进行了临床随机对照研究，取得了满意的疗效，报告如下。     

Best practice in the assessment and management of diabetic foot ulcers.

Diabetes is an increasingly serious health issue in the rehabilitation population. Foot ulcers develop in approximately 15% of people with diabetes and are a preceding factor in approximately 85% of lower limb amputations. Nurses have significant opportunity to positively influence client outcomes and quality of life by promoting maintenance of healthy feet, identifying emerging problems, and supporting evidence-based self-care and interdisciplinary intervention. Best practice guidelines (BPG), such as those developed by the Registered Nurses Association of Ontario, provide a framework to enhance nursing practice and promote excellence in client care. This article highlights key evidence from the BPG, "Assessment and Management of Foot Ulcers for People with Diabetes," and other relevant diabetes literature. This information better equips rehabilitation nurses to promote ulcer prevention strategies; identifies key factors in ulcer risk; and utilizes current, best evidence for ulcer assessment, management, and evaluation.     

Incorporating foot care education into diabetic foot screening.

Rehabilitation nurses care for patients with diabetes who have strokes, orthopedic surgery, and spinal cord injuries; therefore, they should be knowledgeable about foot screening technique and foot care education so that they can identify patients who are at risk for foot skin breakdown. The objectives of diabetic foot screening are to identify foot problems, determine a foot risk category and management category for patients, and to instruct patients with diabetes and their families in proper foot care. The screening technique is simple and can be used in clinic settings or at the bedside. Incorporating foot care education into the foot screening process increases or reinforces patients' knowledge of self-care. Such knowledge empowers patients to join with their healthcare teams to decrease the incidence of ulceration and amputation.     

糖尿病足多学科分级闭环管理体系的构建

随着我国人群糖尿病患病率的提高，糖尿病足患病率逐年上升，2021年我国糖尿病足患者数以百万计。目前糖尿病足防治存在以下难题：诊断延迟；涉及多个科室，难以协同治疗；随访和监控困难；缺乏高危人群的筛查和宣教。为解决上述难题，在MDT模式的基础上应逐步建立“糖尿病足多学科分级闭环管理体系”，有望为糖尿病足确诊或高危患者提供专业、精准、系统、个体、全方位的“一体化”疾病管理模式。该体系包括横向“多学科诊疗”和纵向“闭环分级管理”，体系运作注重防治结合，预防上兼顾重点人群随访、高危人群筛查以及全人群科普宣教，治疗上做好一线工作者基础知识培训、对治疗模式与时机把控达成共识、打通多向转诊通道。通过这一体系的建立，逐步做到糖尿病足的“应知尽知”、“应防尽防”、“应治尽治”，形成糖尿病足多学科分级闭环管理体系的建设标准，逐步在上海市、长三角、乃至全国推广，推动我国糖尿病足诊疗工作不断进步。     

糖尿病足患者足部自护能力及健康需求的调查

目的探讨糖尿病足患者足部自护能力及健康需求情况。方法采用自行设计的问卷调查表,对80例糖尿病足患者进行足部自护能力及健康需求调查。结果患者对糖尿病基本知识、对糖尿病足的认识、足部保健知识、正确的穿鞋袜知识、正确的修剪指甲知识等了解甚少,93.8%的患者希望接受糖尿病足知识教育。结论医护人员应加强对糖尿病患者糖尿病足知识的健康教育,提高患者的自护能力。     

Implementing Diabetic Foot Care in the Primary Care Setting

Patients with diabetes mellitus are at risk for foot ulcers and subsequent amputations. The outpatient diabetic population could benefit from services to prevent factors that lead to the development of foot ulcers and further complications. The purpose of this project was to evaluate the effectiveness and feasibility of implementing a foot care program in the primary care setting. An evaluation of the outcomes supported these foot care services. Future studies showing the effectiveness of foot care services in the primary care setting would further substantiate the benefits of providing diabetic foot care in primary care practice.     

Modern management of diabetic foot osteomyelitis. The when,how and why of conservative approaches

Introduction: Diabetic foot osteomyelitis (DFO) has long been considered a complex infection that is both difficult to diagnose and treat, and is associated with a high rate of relapse and limb loss.

Areas covered: DFO can usually be diagnosed by a combination of clinical evaluation, serum inflammatory markers and plain X-ray. When the results of these procedures are negative or contradictory, advanced imaging tests or bone biopsy may be necessary. Staphylococcus aureus remains the most frequent microorganism isolated from bone specimens, but infection is often polymicrobial. Antibiotic therapy, preferably with oral agents guided by results of bone culture, for a duration of no more than six weeks, appears to be as safe and effective as surgery in cases of uncomplicated forefoot DFO. Surgery (which should be limb-sparing when possible) is always required for DFO accompanied by necrotizing fasciitis, deep abscess, gangrene or in cases not responding (either clinically or radiographically) to apparently appropriate antibiotic treatment.

Expert commentary: Research in the past decade has improved diagnosis and treatment of DFO, and most cases can now be managed with a ‘conservative’ approach, defined as treatment either exclusively with antibiotics or with surgery removing as little bone and soft tissue as necessary.     

强化管理在糖尿病足高危患者保肢治疗中的意义

目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。     

红外温度检测足部皮肤温度预防糖尿病足并发症效果的Meta分析

目的评价红外温度检测足部皮肤温度对预防糖尿病足并发症的效果。方法计算机检索Cochrane Library、PubMed(1990-2010)、EMBase(1990-2010)、EBSCO、中国期刊全文数据库(1999-2010)、维普中文科技期刊全文数据库(1989-2010)中关于红外温度检测仪的使用对预防糖尿病足溃疡的效果的随机对照试验(randomized controlled trial,RCT),同时筛检纳入文献的参考文献。按照Cochrane协作网等推荐的方法评价纳入研究的方法学质量和提取有效数据后,采用RevMan 5.0统计软件进行Meta分析。结果共纳入3篇RCT文献。分析结果显示,以红外温度测量为干预措施的观察组糖尿病足溃疡的发病率低于对照组。结论对于糖尿病足高危患者,足部皮肤温度监测作为一种预防措施能及时发现足部并发症的发生。     

Overview of Diabetic Foot Care for the Nurse Practitioner

Foot and ankle complications of diabetes result in significant morbidity, mortality, and health care expenditure. Diabetes may result in foot deformity, neuropathy, and peripheral artery disease with risk of callus, foot ulcer, infection, and subsequent amputation. Appropriate patient education, medical management, and use of therapeutic footwear can prevent many diabetic foot complications. Nurse practitioners are key members of foot care teams in both primary and specialty care. The nurse practitioner managing a patient’s diabetes is an appropriate provider to certify the need for diabetic shoes and should be authorized to do so to provide quality care without unnecessary delay.     

新型伤口敷料联合贝复剂在糖尿病足中的应用

目的探讨新型伤口敷料联合贝复剂在糖尿病足伤口换药中的应用效果。方法将40例糖尿病足患者随机分为观察组和对照组,各20例。观察组采用新型伤口敷料联合贝复剂进行换药。对照组采用常规敷料进行换药。并对两组治疗8周后伤口愈合率及治疗4周后使用有效率、换药次数及愈合时间进行比较。结果观察组药物使用有效率及伤口愈合率明显优于对照组,有显著性差异（P〈0．05）。两组换药次数及愈合时间比较有显著性差异（P〈O．05）。结论新型伤口敷料联合贝复剂在糖尿病足伤口中的应用,能为创面愈合提供更好的环境,减少换药次数,缩短治愈时间,提高患者的生活质量,可应用于临床。