扶正降浊方改善慢性肾衰竭患者营养不良的临床观察

目的观察扶正降浊方（又称肾病2号方）改善慢性肾衰竭患者营养不良和肾功能的临床疗效。方法将96例慢性肾衰竭患者随机分为扶正降浊方组（治疗组）49例和尿毒清颗粒组（对照组）47例。分别采用在基础治疗的基础上加汤剂或颗粒。观察两组治疗前后的改良SGA评分、血清前白蛋白（PA）、血清白蛋白（Alb）、血红蛋白（Hb）、24h尿蛋白定量、血肌酐（Scr）及尿素氮（BUN）等指标。结果治疗组治疗后改良SGA评分、PA、Alb、Hb较治疗前明显升高,Scr明显下降,（P〈0．05）;治疗组治疗后与对照组治疗后比较,改良SGA评分、PA、Alb差异有统计学意义（P〈0．05）;治疗组与对照组中医证候疗效及中医症侯积分比较,均有统计学意义（P〈0．01）。结论扶正降浊方能有效改善慢性肾衰竭患者的营养不良,缓解临床症状,保护肾功能,延缓疾病进展。     

股动脉注射山莨菪碱治疗糖尿病足溃疡的临床观察

为探讨股动脉注射山莨菪碱（６５４－２）治疗糖尿病足溃疡的疗效,对２５例糖尿病足溃疡病人采用股动脉注射山莨碱１０ｍｇ治疗,并与静脉注射组进行对照,观察病人症状改善情况及足部血流速度变化。结果示股动脉注射组自觉症状显著改善,血流速度增快,与静脉注射组比较,Ｐ〈０．０１,差异有非常显著性。提示股动脉注射山莨若碱治疗糖尿病足溃疡疗效优于静脉注射用药。     

益肾和胃降浊方治疗慢性肾衰竭营养不良54例临床观察

目的：观察益肾和胃降浊方对慢性肾衰竭（CRF）营养不良的疗效。方法：96例CRF患者随机分为治疗组54例,对照组42例。治疗组采用益肾和胃降浊方,对照组用开同片。结果：益肾和胃降浊方能明显改善CRF营养不良患者的营养状况,能升高血清白蛋白、血红蛋白水平（P〈0.05）,降低主症评分及SGA评分（P〈0.05）。结论：益肾和胃降浊方能有效改善CRF营养不良患者的营养状况。     

臭氧治疗糖尿病足溃疡的机制与临床应用

糖尿病是一组以高血糖为特征的代谢性疾病,糖尿病足溃疡(DFU)是糖尿病最常见和最严重的并发症之一,是糖尿病致残与死亡的主要原因 [1-2].DFU是糖尿病患者因长期糖尿病病史、持续高血糖状态、合并外周血管病变、外周神经病变等危险因素,因足趾小创口、截肢、既往溃疡等局部因素导致的难愈性创面.目前临床针对DFU的常规治疗有...     

中西医结合治疗糖尿病足溃疡1例报道

糖尿病足溃疡具有较高的截肢率和致残率,是临床疑难病。本文报告1例糖尿病足溃疡患者采用中西医结合综合疗法治疗,取得较满意疗效,以供分享。     

穴位注射结合四妙勇安汤辅助治疗糖尿病足溃疡临床效果观察

目的：探讨穴位注射维生素B1结合四妙勇安汤辅助治疗糖尿病足溃疡（DFU）的临床疗效。方法：选取2021年10月—2023年2月我院收治的湿热毒盛型DFU患者96例,随机分为观察组与对照组各48例,对照组给予西医常规治疗,观察组在对照组基础上给予穴位注射结合四妙勇安汤治疗。观察两组患者治疗前后的临床疗效、中医证候评分、踝肱指数及创面情况（创面面积、创面深度）,血清炎症指标（超敏C反应蛋白、白细胞介素-1、肿瘤坏死因子-α）、超声检查指标（足背动脉的血流速度、血管内径、阻力指数）,血管内皮功能（血管内皮生长因子及血清碱性成纤维细胞生长因子）及复发率。结果：治疗后观察组总有效率为91.67%,显著高于对照组的77.08%(P <0.05);治疗后两组中医证候评分、血清炎症指标、创面面积、创面深度均较治疗前降低,且观察组低于对照组(P <0.05);两组治疗后血清血管内皮生长因子、血清碱性成纤维细胞生长因子水平、踝肱指数及各超声检查指标均较治疗前升高,且观察组高于对照组（P<0.05）;观察组复发率10.42%低于对照组的27.08%(P<0.05)。结论：穴位注射维生...     

臭氧治疗糖尿病足溃疡的有效性和安全性 Meta分析

目的:评价臭氧治疗糖尿病足溃疡(DFU)的有效性和安全性。方法:检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、万方、维普数据库中有关臭氧治疗DFU的随机对照试验(RCT),检索时限为建库至2020年6月,采用RevMan5.3进行数据Meta分析,用漏斗图及Egger's、Begg's检验进行发表偏倚检测。结果:共纳入13个RCT研究,合计995例DFU患者。Meta分析显示,共纳入7项RCT研究溃疡完全愈合情况,采用固定效应分析,结果显示臭氧组溃疡完全愈合患者比例显著多于非臭氧组[OR=5.22,95%CI(3.21~8.51),Z=6.64,P<0.05],差异有统计学意义;纳入2项RCT研究足部溃疡面积变化,使用固定效应分析,结果显示使用臭氧比非臭氧治疗可显著促进DFU溃疡的愈合[MD=-2.73,95%CI(-3.18~2.28),P<0.05];共纳入2项RCT研究截肢/趾情况,采用固定效应分析,结果显示臭氧组比非臭氧组可显著降低截肢/趾情况的发生[RR=0.31,95%CI(0.20~0.47),Z=5.37,P<0.05];共纳入2项RCT研究不良反应情况,采用随机效应分析,结果显示臭氧组与非臭氧组不良反应的发生率差异无统计学意义[RR=0.67,95%CI(0.05~8.89),Z=0.30,P>0.05]。结论:臭氧治疗DFU是一种相对安全有效的可选方案,可以促进溃疡创面的痊愈,降低截肢/趾的发生率,缩小溃疡面积,而并发症较常规处置未见明显差别,但是目前相关临床研究随访时间偏短,未能完全做到双盲对照,未能评估长期使用该方法的疗效,且临床使用方法多种多样疗效无法做到完全同质化对比,所以今后可进一步开展大样本,标准化的臭氧治疗DFU随机双盲对照研究评估其长期疗效。     

蜂蜜治疗糖尿病足溃疡的研究进展

糖尿病足溃疡(DFU)是糖尿病常见并发症,周围神经病变、周围动脉疾病和创伤是导致糖尿病足溃疡的主要因素,往往因创面愈合不良成为慢性创面,进而导致截肢 [1].     

抗生素骨水泥地塞米松棕榈酸酯治疗糖尿病足溃疡

[目的]探究抗生素骨水泥（antibiotic-loaded bone cement, ABC）联合小剂量地塞米松棕榈酸酯（dexamethasone palmitate, DXP）治疗糖尿病足溃疡（diabetic foot ulcer, DFU）的有效性。[方法] 2020年11月—2022年5月,将36例DFU患者随机分为DXP组和盐水组。DXP组在应用ABC术后3、6、9 d在创面局部注射小剂量DXP,而盐水组局部注射等量的0.9%NaCL生理盐水,两组进行对照。[结果]DXP组住院时间、创面愈合时间、创面愈合率均显著优于盐水组（P<0.05）。随时间推移两组VAS显著降低（P<0.05）,治疗第9,15 d时此评分DXP组显著优于盐水组（P<0.05）。随时间推移,两组创面细菌培养阳性率均显著下降（P<0.05）,相应时间点两组间细菌培养阳性率的差异均无统计学意义（P>0.05）。与治疗前相比,治疗15 d两组TNF-α和IL-6均显著下降（P>0.05）。治疗后15 d, DXP组的TNF-α和IL-6显著低于盐水组（P<0.05）...     

负压封闭引流技术联合重组人表皮生长因子治疗糖尿病足溃疡效果分析

目的 探讨负压封闭引流技术(VSD)联合重组人表皮生长因子(rhEGF)治疗糖尿病足溃疡的临床效果。方法 回顾性分析2019-01—2021-02中国人民解放军联勤保障部队第九八八医院整形烧伤科收治的50例糖尿病足溃疡患者的临床资料,分为对照组和联合组,各25例。2组均给予常规清创处理及VSD。联合组联合rhEGF注射。比较2组患者的溃疡创面愈合时间、住院时间、住院费用及不良反应。评价2组的临床治疗效果。结果 联合组溃疡创面愈合时间和住院时间均短于对照组,住院费用少于对照组,治疗总有效率高于对照组,差异均有统计学意义(P<0.05)。治疗期间2组患者均未出现严重不良反应。结论 VSD联合rhEGF治疗糖尿病足溃疡,溃疡创面愈合快、患者住院时间短、住院费用低、治疗总有效率高,而且无不良反应。是安全、可行性的治疗方案。     

Safety,efficacy and pitfalls of fibrocyte application in the treatment of diabetic foot ulcer

Fibrocytes are unique bone marrow‐derived cells with great potential in wound healing. Hence, the aim of this study was to determine the safety and efficacy of the applied circulating fibrocytes in the treatment of non healing diabetic foot ulcers. Peripheral blood mononuclear cells were isolated by centrifugation through Ficoll–Paque method. After 3 days, the non adherent cells were removed by a single, gentle aspiration. Adherent cells were cultured in the same medium for 10 days. The cells were characterised using mouse anti‐human‐CD45‐fluorescein isothiocyanate (FITC) and mouse anti‐human–collagen I, and also characterised by immunofluorescence microscopy using the above mentioned antibodies. Sterility measures were applied for clinical evaluation. Based on the literature review, cell transplantation generally requires at least 3 × 10⁶ cells regarding efficacy measures. As fibrocytes are non proliferating cells, 350 ml patient's blood is required to prepare patient‐specific serum before cell isolation and culture, and 85 ml patient's blood is needed for cell isolation and differentiation on cell transplantation applications. In our survey, no diabetic patient was inclined to be donor of such blood volume, mainly because of their pre‐assumption that they are anaemic. It is concluded that fibrocytes do not seem to be candidate cells for cell therapy in the treatment of diabetic foot ulcers because of the rarity of this cell population in circulation.     

Insensate foot of diabetic foot ulcer can have underlying silent neuropathic pain

Subjects with diabetic foot ulcer (DFU) are believed to be less likely to complain of symptoms of painful diabetic peripheral neuropathy (PDPN). When we assessed this using Leeds Assessment of Neuropathic Symptoms and Signs questionnaire (s-LANSS) we found that out of total 44 subjects with DFU, 19 (43·2%) had possible neuropathic discomfort. s-LANSS score was significantly higher in DFU group (8·1 ± 7·7 versus 4·7 ± 4·6; P = 0·04). However, there was no difference in the perception of pain in 10-point Likert scale (3·9 ± 3·6 versus 3·3 ± 3·0; P = NS) between these two groups. This study suggests that subjects with DFU may suffer from PDPN, but do not perceive it. Further studies are needed to assess if treatment of PDPN in these subjects is beneficial.     

糖尿病足溃疡创面的综合治疗

目的：探讨如何促进糖尿病足溃疡创面愈合,降低致残率。方法：对糖尿病足溃疡患者,在积极的内科治疗稳定病情的基础上,采用以创面清创换药,改善局部血运和促进局部组织生长,或采用整形外科手术的方法治疗。结果：52例糖尿病足溃疡创面,除1例因溃疡坏疽创面较深大合并骨髓炎行截肢外,其余均顺利修复。平均随访90．4%,疗效满意率91．5%,出现溃疡复发或有新的皮肤溃疡者8．5%。结论：在全身治疗稳定病情的基础上,积极进行创面处理和整形外科手术的综合治疗是促进糖尿病足溃疡创面早期愈合,缩短病程和降低致残率切实可行的方法。重视糖尿病足患者溃疡愈合出院后的康复指导工作至关重要。     

胫骨横向骨搬移结合负压引流治疗糖尿病足溃疡的临床疗效分析

目的 :探讨胫骨横向骨搬移微血管网再生技术结合封闭负压引流治疗伴溃疡形成的糖尿病足的临床疗效。方法:对2015年11月至2016年12月采用胫骨横向骨搬移结合负压引流治疗的19例伴溃疡形成的糖尿病足的临床资料进行回顾性分析,男15例,女4例;年龄42~82岁,平均(64.57±7.14)岁;糖尿病平均病程(14.62±6.19)年;左足12例,右足7例;溃疡面积2 cm×3 cm~8 cm×6 cm;按照Texas分类法进行分类,所有病例为D期,其中2级3例,3级10例,4级6例。手术前后测量踝肱指数及密歇根神经体征评分(MNSI)评价患足周围血管和周围神经功能恢复情况,术后复查血管造影或血管彩超。结果:19例患者中17例术后获得随访,时间3~13个月,平均6.9个月。17例患足创面均得到愈合;术后3个月踝肱指数由术前的0.51±0.20升至0.93±0.18,差异有统计学意义(t=13.63,P=0.000);术后3个月的MNSI为5.76±1.44,优于术前的4.06±1.36,差异有统计学意义(t=7.31,P=0.000)。术后复查血管造影或血管彩超显示患足微血管网再生满意,患足功能达到正常运动和日常生活需要。结论:胫骨横向骨搬移微血管网再生技术可以重建患肢小腿以下微血管网,促进周围血管及周围神经恢复,结合封闭负压引流可促进创面愈合,具有手术简便、疗效确切,保肢成功率高的优点,是治疗糖尿病足溃疡的理想方法之一。     

Single nucleotide variations in the development of diabetic foot ulcer: A narrative review

Diabetes mellitus has become a global health problem, and the number of patients with diabetic foot ulcers (DFU) is rapidly increasing. Currently, DFU still poses great challenges to physicians, as the treatment is complex, with high risks of infection, recurrence, limb amputation, and even death. Therefore, a comprehensive understanding of DFU pathogenesis is of great importance. In this review, we summarized recent findings regarding the DFU development from the perspective of single-nucleotide variations (SNVs). Studies have shown that SNVs located in the genes encoding C-reactive protein, interleukin-6, tumor necrosis factor-alpha, stromal cell-derived factor-1, vascular endothelial growth factor, nuclear factor erythroid-2-related factor 2, sirtuin 1, intercellular adhesion molecule 1, monocyte chemoattractant protein-1, endothelial nitric oxide synthase, heat shock protein 70, hypoxia inducible factor 1 alpha, lysyl oxidase, intelectin 1, mitogen-activated protein kinase 14, toll-like receptors, osteoprotegerin, vitamin D receptor, and fibrinogen may be associated with the development of DFU. However, considering the limitations of the present investigations, future multi-center studies with larger sample sizes, as well as in-depth mechanistic research are warranted.     

Health economics of diabetic foot ulcer and recent trends to accelerate treatment

Diabetic foot ulcer is a preventable complication of diabetes that imposes a significant burden on the community. It leads to amputation and increased disability if left untreated and thus bears profound implications on the individual, the community and the health system at large. Diabetic foot (DF) is an area of research interest where interdisciplinary researchers are trying to elucidate the best strategy to halt the progression of chronic diabetic wounds. It is an area where tissue engineering research is making a strong impact through the use of scaffolds and skin substitutes for diabetic wound healing. This review aims at discussing the geographical health economics, its impact on healing and factors influencing financial costs of DFU. The upcoming economic and clinical impacts due to disease outbreak such as the 2020 COVID-19 has also been discussed. Finally, it will discuss novel therapy available with emphasis on skin tissue engineering scaffolds with a cost-benefit analysis. The review aims at promoting better management of people with diabetes with emphasis on emerging treatments and technologies.     

Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.     

Literature review on the management of diabetic foot ulcer

Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.     

封闭式负压引流联合点状植皮在糖尿病足溃疡治疗中的临床应用

目的探讨封闭式负压引流联合点状植皮治疗人糖尿病足溃疡的疗效。方法将20例Wagner分级2~4级的糖尿病足溃疡患者分成对照组和观察组,每组10例,对照组溃疡创面持续应用封闭式负压引流,观察组溃疡创面应用封闭式负压引流联合点状植皮治疗。比较两组患者创面愈合率及创面愈合时间。结果观察组与对照组相比,创面愈合率明显增加(98.39%±1.61%vs 78.80%±1.85%)、创面愈合时间明显缩短(56.40±5.33天vs 74.70±8.55天),两组比较差异具有统计学意义。结论封闭式负压引流联合点状植皮可以促进糖尿病足溃疡创面愈合,缩短愈合时间,降低了截肢率。     

胫骨横向搬移治疗糖尿病足溃疡

目的:探讨采用Ilizarov技术行胫骨横向搬移术治疗糖尿病足溃疡的临床疗效。方法 :自2013年7月至2017年3月,采用Ilizarov胫骨横向搬移术治疗20例糖尿病足溃疡患者,男14例,女6例;年龄46～61(51.6±6.8)岁。Wagner分级:3级5例,4级15例。手术前后观察并记录截肢平面、溃疡愈合情况、创面愈合时间、VAS疼痛评分、患足皮温,CTA观察血管再通及血管网重建情况。结果:20例患者均进行了随访,时间12～58个月,平均22.4个月,所有患者足部溃疡顺利愈合,时间6～18(13.2±3.7)周,坏死及截肢平面没有上移,患足疼痛明显缓解,VAS评分由术前的5.6±0.8降低至术后1年的0.9±0.4,差异有统计学意义(t=-26.55,P0.05);患足皮温由治疗前的(27.9±1.1)℃提高至术后1年的(30.9±1.1)℃(t=-5.98,P0.05)。CTA可见术前闭塞的血管再通,微血管数量明显增加,足部血管网重建。结论:Ilizarov胫骨横向搬移术能促进足部血管的再生、微血管网的再通或重建,从而改善糖尿病足患者的血液循环,促进溃疡的愈合,适合以微血管病变为主的糖尿病足患者。对于主干大动脉严重狭窄或闭塞的患者应当慎重或配合介入等血管再通技术联合应用。