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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.     

糖尿病足治疗体会

根据糖尿病足不同分级，采用综合治疗措施，即饮食控制、适量运动、良好血糖控制、改善微循环、营养神经、控制感染、局部处理、支持疗法和手术等治疗。结果：0、1、2级其30例均治愈；3级10例治愈8例；4级10例治愈4例。截肢1例；5级8例治愈2例，截肢2例。4～5级菸18例，转流手术治愈6例。总治愈率75．86％。其中0～3级治愈率为95％，4～5级治愈牢33．33％。结论：糖尿病是早期发现。早期综合治疗多能治愈。     

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??Abstract??Accompanying with the rapid development of modern radiological technologies??the term “artery-dissection” becomes a clinical concept rather than a pathological one.Nowadays??diagnosis of artery-dissection mostly depends on imaging examinations.Considering that the presentations and prognosis are different between extracranial and intracranial artery-dissection??an individual therapy is critical to different patients.     

糖尿病足31例临床预防对策

糖尿病足常导致下肢感染、溃疡形成和 (或 )深部组织的破坏 ,早期诊断和治疗 ,可提高患者的生活质量。现将我们收治的 31例糖尿病足报道如下。对象与方法1.对象 :31例患者 ,男性 17例 ,女性 14例。年龄 48～ 88岁 ,平均年龄 61.47岁 ,糖尿病程 6个月～ 30年 (平均 9.5 5年 ) ,其中 10年以上 2 1例。空腹血糖 10 .7～ 2 4mmol L ,平均16.3mmol L ,糖化血红蛋白 8.2 %～ 11.5 % (平均 9.4% )。按 1995年中华糖尿病学会第一届全国糖尿病足学术会议拟定的诊断标准[1 ] ,对糖尿病足进行分级 ,排除其他原因引起的下肢动脉闭塞所致的肢端病变。 31…     

糖尿病足治疗体会

根据糖尿病足不同分级,采用综合治疗措施,即饮食控制、适量运动、良好血糖控制、改善微循环、营养神经、控制感染、局部处理、支持疗法和手术等治疗.结果0、1、2级共30例均治愈;3级10例治愈8例;4级10例治愈4例,截肢1例;5级8例治愈2例,截肢2例.4～5级共18例,转流手术治愈6例.总治愈率75.86%,其中0～3级治愈率为95%,4～5级治愈率33.33%.结论糖尿病足早期发现,早期综合治疗多能治愈.     

糖尿病足59例临床治疗体会

对2008年6月至2009年6月59例糖尿病足病人的临床治疗进行综合分析.结果:显效17例,有效30例,无效12例.结论:早期干预、多学科综合治疗,能大大提高糖尿病足的治愈率,降低致残率.     

糖尿病足65例治疗体会

根据糖尿病足不同分期,采取扩张血管抗凝、改善血粘度、营养神经、控制感染、局部换药和手术等治疗.结果0级4例、1级6例、2级8例全部治愈;3级10例治愈9例;4级19例治愈8例,截肢2例;5级18例治愈4例,截肢6例.4～5级共37例,转流术治愈12例,死亡4例.总治愈率为60％.其中0～3级治愈率为96.43％,4～5级治愈率为32.43％.结论糖尿病足早期发现、早期治疗多能治愈.     

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??Abstract??Autosomal dominant polycystic kidney disease (ADPKD) is a common single-gene inherited kidney disease??and it is also the fourth leading cause of end-stage renal disease (ESRD).Currently??no effective treatment exists to delay ADPKD progression.The present strategy is to inhibit ADPKD progression and control complications.In recent years??with the development of radiological and molecular genetical techniques??researchers were focusing on using imaging methods to evaluate ADPKD progression??and promising therapies included blockade of RAAS??inhibition of cell proliferation and abnormal cyst fluid secretion??and other new diagnostic and treatment strategies.Further investigations of these issues will help to elucidate the pathogenic mechanisms of ADPKD and lay the basis for clinical cure of this disease in the future.     

Treatment for diabetic foot ulcers

People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life-threatening. Infection is defined clinically, but wound cultures reveal the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and should aim to cure the infection, not to heal the wound. Alleviation of the mechanical load on ulcers (off-loading) should always be a part of treatment. Neuropathic ulcers typically heal in 6 weeks with total contact casting, because it effectively relieves pressure at the ulcer site and enforces patient compliance. The success of other approaches to off-loading similarly depends on the patients' adherence to the effectiveness of pressure relief. Surgery to heal ulcers and prevent recurrence can include tenotomy, tendon lengthening, reconstruction, or removal of bony prominences. However, these procedures may result in secondary ulceration and other complications. Ulcer recurrence rates are high, but appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re-ulceration.     

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糖尿病足病发生在糖尿病患者中,是多种危险因素共同作用的结果。其定义是与下肢远端神经异常和下肢远端外周血管病变相关的足部感染、溃疡和(或)深层组织破坏。最常见的后果是慢性溃疡,最严重的结局是致残甚至截肢,大大降低了患者的生存质量,给患者带来极大痛苦及沉重的经济负担。据国外报道,糖尿病患者中约15%有不同程度足溃疡,大约1%的糖尿病患者被截肢。糖尿病足病在许多国家已是截肢的首位原因[1]。因此,在糖尿病发病率迅速增长的今天,糖尿病足病的防治工作必然是我国广大临床医生面临的一个挑战。为做好糖尿病足病的防治,有必要对糖尿…     

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糖尿病足部病变是糖尿病常见并发症之一,临床主要表现为足部溃疡、感染和坏疽,给患者带来很大的痛苦和沉重的经济负担,其后果常会导致截肢甚至危及生命.1999年,世界卫生组织(WHO)对糖尿病足定义为:糖尿病患者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.     

Treatment of diabetic foot ulcer: an overview strategies for clinical approach

Diabetic foot disease is a major health problem, which concerns 15% of the 200 million patients with diabetes worldwide. Major amputation, above or below the knee, is a feared complication of diabetes. More than 60% of non-traumatic amputations in the western world are performed in the diabetic population. Many patients who undergo an amputation, have a history of ulceration. Major amputations increase morbility and mortality and reduce the patient's quality of life. Treatment of foot complications is one of the main items in the absorption of economic and health resources addressed to the diabetic population. It is clear that effective treatment can bring about a reduction in the number of major amputations. Over recent years, we have seen a significant increase in knowledge about the physiopathological pathways of this complication, together with improvements in diagnostic techniques, but above all a standardized conservative therapeutic approach, which allows limb salvage in a high percentage of cases. This target has been achieved in specialized centers. An important prelude to diabetic foot treatment is the differing diagnosis of neuropathic and neuroischemic foot. This differentiation is essential for effective treatment. Ulceration in neuropathic foot is due to biomechanical stress and high pressure, which involves the plantar surface of toes and metatarsal heads. Treatment of a neuropathic plantar ulcer must correct pathological plantar pressures through weight bearing relief. Surgical treatment of deformities, with or without ulcerations, is effective therapy. A neuropathic ulcer that is not adequately treated can become a chronic ulcer that does not heal. An ulcer that does not heal for many months has a high probability of leading to osteomyelitis, for which treatment with antibiotics is not useful and which usually requires a surgical procedure. Charcot neuroarthropathy is a particular complication of neuropathy which may lead to fragmentation or destruction of joints and bones. A well-timed diagnosis of Charcot neuroartropathy is essential to avoid deformities of chronic evolution. In the diabetic population peripheral vascular disease (PVD) is the main risk factor for amputation. If peripheral vascular disease is ignored, surgical treatment of the lesion cannot be successful. In diabetic patients, PVD is especially distal, but often fully involves the femoral, popliteal and tibial vessels. It can be successfully treated with either open surgical or endovascular procedures. Infection is a serious complication of diabetic foot, especially when neuroischemic: phlegmon or necrotizing fascitis are not only limb-threatening problems, but also life-threatening ones. In this case, emergency surgery is needed. Primary and secondary prevention of foot ulceration is the main target. Prevention programs must be carried out to highlight risk factors, lowering amputation incidence.     

The diabetic foot

Diabetic foot problems are responsible for nearly 50% of all diabetes-related hospital bed days. Approximately 10–15% of diabetic patients developed foot ulcers at some state in their life and 15% of all load in amputations are performed in patients with diabetes. There is a need to provide extensive education to both primary care physicians and the patients regarding the relationship between glucose control and complications encountered in the foot and ankle. The management of diabetic foot disease is focussed primarily on avoiding amputation of lower extremities and should be carried out through three main strategies; identification of the “at risk” foot, treatment of acutely diseased foot, and prevention of further problems. These are several obstacles in the management of DFI that include poor knowledge and awareness of diabetes and its complications, lack of appropriate podiatry services. These goals are possible only by the establishment of a dedicated team of podiatrist, endocrinologist, vascular surgeon and a pedorthist. The plastic surgeons, orthopaedic surgeons & diabetes teaching nurses/educator dedicated to foot care could be a part of the team. Identifying the patients with diabetes at risk for ulceration requires feet examination, including the vascular & neurological systems, skin conditions, and foot structure. Conservative management of foot problems has dramatically reduced the risk of amputation by simple procedures, such as appropriate foot wear, cleanliness, aggressive surgical debridement, regular wound dressing by simple wet-to-dry saline guage, and ulcer management.     

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随着我国人们生活水平的不断提高,糖尿病的发病率在快速增长,由此所致的糖尿病足的发生率也越来越高。与单纯动脉硬化所致的下肢缺血相比,糖尿病足所致的下肢缺血处理难度更大、更复杂。与非糖尿病患者的血管硬化相比,糖尿病患者的动脉硬化具有以下几个特点:(1)更为常见。(2)发     

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Oakley于1956年首先提出了“糖尿病足”(DF)的概念。1972年,Catterall将糖尿病足定义为因神经病变而失去感觉,或因缺血而失去活力,同时合并感染的足。1995年,中国第一届糖尿病足学术会议对其进行了新的注释,糖尿病足是由于糖尿病血管、神经病变引起下肢异常的总称,因合并感染引