知信行模式对预防0级糖尿病足患者发展为糖尿病足部溃疡的影响研究

目的探讨知信行模式(knowledge attitude belief practice, KABP)对预防0级糖尿病足患者发展为糖尿病足部溃疡的影响。方法以我院2015年12月~2017年10月86例糖尿病足患者为研究对象,随机分为实验组与对照组,各43例。对照组给予常规护理及健康教育,实验组在对照组基础上给予KABP健康教育。对比两组糖尿病足相关知识知晓率、自我管理能力评分、多伦多临床神经病变评分及糖尿病足危险程度。结果干预后,实验组糖尿病相关知识知晓率明显高于对照组(P0.05);实验组自我管理能力各方面评分均明显高于对照组(P0.05);实验组多伦多临床神经病变评分为(4.77±1.69)分,明显低于对照组的(6.89±1.60)分(P0.05);实验组糖尿病足危险程度较对照组明显降低(P0.05)。结论对0级糖尿病足患者实施KABP健康教育,可提高患者对疾病的认识程度,加强患者自我行为管理能力,改善足部神经病变程度,预防足部溃疡的发生。     

Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease.

We report a 71 year old lady who presented with weight loss, rectal bleeding and bilateral foot drop having been previously fit and well. Clinical examination, laboratory investigation and postmortem examination confirmed the diagnosis of active Crohn''s disease and acute peripheral neuropathy. The clinical course of this patient suggests that the peripheral neuropathy might have resulted from the common pathogenesis for Crohn''s disease.     

The association of hereditary neuropathies and heritable skeletal disorders.

We describe two patients with associations of hereditary neuropathies and heritable skeletal disorders not previously reported. The first patient had Marfan''s syndrome and hereditary motor and sensory neuropathy Type 1. The second patient had Ehlers-Danlos syndrome, Klippel-Feil syndrome and tomaculous neuropathy.     

A case of hereditary sensory and autonomic neuropathy (HSAN) type II

We describe a case of hereditary sensory and autonomic neuropathy (HSAN) type II in a child with a penetrating foot ulcer, acral sensory impairment, and anhidrosis. This is the first documentation of HSAN in Sri Lanka.     

Some clinical factors contributing to the development of the diabetic foot

Clinical neurological studies, blood pressure measurements and some haematological investigations were performed on a random sample of forty-four patients, at the Diabetes Out-Patient Clinic of the University Hospital of the West Indies (UHWI), to examine some of the factors that predispose to the development of the diabetic foot. Our results revealed that 86% of the patients had elevated glycosylated haemoglobin (HbA1 > 9.0%), 82% had clinical signs of peripheral sensory neuropathy, 29% had signs of autonomic neuropathy in addition to peripheral sensory neuropathy. Sixty-one per cent (61%) of the patients had ankle/arm systolic blood pressure ratio less than 1.0 and were diagnosed as having peripheral vascular disease (PVD). The group with neuropathy was found to have a significantly lower diastolic blood pressure (p < 0.0005) than the group without neuropathy. We believe that hyperglycaemia-induced vasodilation (indicated by a lower diastolic blood pressure) in a significant number of diabetics resulted in compensatory shunting of blood from the deeper tissues, including nerves, to the periphery. The resulting endoneural hypoxia could be responsible for the unusually high incidence of peripheral sensory neuropathy detected in this sample of diabetic patients. Metabolic factors may also play a role.     

补骨脂水提药渣灌胃给药4周的大鼠亚慢性毒性实验研究

多发性肋骨骨折是骨伤科临床上常见的一种骨折,其多由外部暴力所致。多发性肋骨骨折可引起胸肋部肿胀疼痛、呼吸困难及转侧不利,严重者可出现血胸、气胸等并发症甚至死亡。西医治疗多发性肋骨骨折常以手术治疗为主,而多发性肋骨骨折的中医辨治方法相对较少提及,文章结合作者在院临床所见,从中医角度对多发性肋骨骨折辨证治疗作简要论述,附典型病案1则加以佐证。     

Blood flow in the skin of the foot related to posture in diabetes mellitus

Normal healthy subjects show a reflex rise in precapillary resistance in the skin of the foot when they rise from lying to standing. To investigate the integrity of this reflex in patients with diabetes mellitus blood flow in the plantar region of the big toe was measured, using a laser Doppler flowmeter. The responses of diabetic patients with and without peripheral sensory neuropathy and healthy control subjects matched for age and sex were studied, with the foot at heart level and the foot passively lowered to 50 cm below the heart. In normal subjects mean blood flow recorded during the third to fourth minute of dependency fell to 18.1 (SD 11.9)% of the preceding resting flow determined with the foot at heart level. In the diabetic patients without neuropathy blood flow fell to 28.9 (18.6)% of the preceding resting flow. In the diabetic patients with neuropathy blood flow fell to 53.5 (23.7)% of the preceding resting flow, which was significantly different from the value achieved by the diabetics without neuropathy (p less than 0.02) and the healthy controls (p less than 0.002). Six normal subjects were indirectly heated to release sympathetic tone and achieve the same mean skin temperature of the foot as the diabetic patients with neuropathy, and blood flow fell to 38.7 (24.3)% of the preceding resting flow, a value not significantly different from the response seen in the patients with neuropathy. These findings suggest that the postural control of blood flow in the foot is disturbed in patients with diabetic neuropathy, and this disturbance is compatible with a loss of sympathetic vascular tone. The resultant hyperperfusion on dependency may account for the oedema seen in some patients with neuropathy and may also act as a stimulus for the thickening of capillary basement membranes.     

高分辨薄层CT诊断外伤性视神经损伤

目的：回顾性分析手术证实的29例外伤性视神经损伤的CT表现,研究薄层CT扫描对外伤性视神经损伤的诊断价值。方法：CT扫描时采用层厚2mm,层间距2mm,对临床论断为外伤性视神经损伤的29例病人进行视神经和视神经管扫描。结果：CT扫描发现视神经管骨折15例,视神经周围血肿3例,同侧蝶窦积血11例,同侧筛窦积血18例,视神经肿胀8例。结论：外伤性视神经损伤的CT表现为神经经管骨折、骨折的间接征象和视神经损伤的本身征象。     

糖尿病足诊治护理概况

糖尿病足部病变是最令糖尿病患者痛苦的常见慢性并发症之一,也是致残、致死的重要原因。糖尿病足的基本病理变化是糖尿病患者由于合并神经病变使足部感觉障碍,合并周围血管病变,使下肢缺血失去活动能力。对于糖尿病患者来说,一个微小的足部创伤都可能会造成终身残废,轻者皮肤溃烂、化脓感染,重则发展成坏疽而截肢。因此,对糖尿病患者足部病损的预防尤为重要。     

糖尿病足神经性溃疡外科治疗研究进展

糖尿病足神经性溃疡是糖尿病合并周围神经病变时常见的并发症 ,神经病变在糖尿病足部病变的早期起着主要作用 ,也是糖尿病足部溃疡形成最重要的危险因素。其后果可导致截肢或危及生命。作者就糖尿病足神经性溃疡外科治疗研究进展进行综述。     

中药足浴结合硫辛酸注射液治疗气虚血瘀型2型糖尿病周围神经病变的临床观察

目的 观察中药足浴结合硫辛酸注射液治疗气虚血瘀型的2型糖尿病周围神经病变的临床疗效。方法 选取2015-08～2017-03在延安市中医医院就诊的气虚血瘀型2型糖尿病周围神经病变患者70例,随机分为两组,治疗组35例为中药足浴法结合硫辛酸静脉滴注;对照组35例为硫辛酸注射液静脉滴注,1个疗程后(14d)观察临床疗效。结果 治疗组临床症状(疼痛、麻木、乏力、感觉减退)及神经传导速度、远端感觉阈值的改善明显优于对照组(P<0.05)。结论 中药足浴结合硫辛酸注射液治疗气虚血瘀型的2型糖尿病周围神经病变有明显的疗效,无不良反应,值得临床推广。     

消渴足浴方与足部穴位按摩治疗糖尿病周围神经病变的护理效果分析

目的探讨消渴足浴方与足部穴位按摩治疗糖尿病周围神经病变的护理效果。方法选择2014年12月~2016年12月本院收治的糖尿病并发周围神经病变者80例,按照随机数字法分为观察组与对照组,各40例,对照组行常规干预,主要针对使用药物方法进行健康教育、加强对患者血糖监测的干预,运用饮食干预、情志调节等常规护理方法,观察组则针对使用消渴足浴方熏洗联合足部穴位按摩进行针对性护理干预,对所有患者入组前及出院时情况进行观察,比较干预后两组神经缺陷评分(NDS)变化情况,比较正中神经、腓神经传导速度,统计干预前后两组诺丁汉生存质量评分变化情况。结果干预后观察组踝反射、大拇指振动感觉、针刺感觉、温度感觉评分均显著低于干预后对照组(P0.05),干预后观察组正中神经传导速度快于对照组(P0.05),腓神经传导速度快于对照组(P0.05),干预后,观察组诺丁汉生存质量评分显著高于干预前观察组与干预后对照组(P0.05)。结论针对糖尿病周围神经病变患者行消渴足浴方联合足部穴位按摩治疗同时,进行有效的护理干预,能显著改善患者神经缺损状况,增强局部神经传导功能,提高患者生存质量。     

急性有机磷中毒致迟发性周围神经病变10例分析

目的研究有机磷农药中毒迟发性神经病变的发生发展,进一步提高早期诊断及治疗效果。方法对10例有机磷农药中毒迟发神经病变患者进行回顾性分析。结果发病潜伏期为20天左右,首发症状是肢体无力、麻木、小腿胀痛,出现肢体远端感觉减退、足下垂、腱反射减弱或消失,肌电图呈神经原发性损害,预后良好。结论迟发性神经病变的发生与有机磷农药中毒有关,及时治疗,预后良好,激素治疗可加速神经功能恢复。     

中国部分省市糖尿病足调查及神经病变分析

目的调查和分析糖尿病足神经病变特点及相关因素。方法对全国14家医院的2004年全年门诊和住院糖尿病足患者进行统一调查,包括病史回顾、体格检查、生化检查等,对足溃疡进行分类、分期、神经病变特点及相关因素分析。结果纳入统计糖尿病足患者530例,神经性溃疡患者337例（63．6％）其中单纯性足部神经性溃疡172例（32．5％）,合并下肢血管病变的混合性溃疡165例（31．1％）,缺血性足部溃疡193例（36．42％）。足溃疡诱因物理因素占62．4％～84．9％。神经性足溃疡患者病程3（1,60）个月明显短于缺血性足溃疡组5（1,96）个月（P〈0．001）。混合性足溃疡患者病程12（1,108）个月长于神经溃疡患者及缺血性溃疡患者（P〈0,001）。足部溃疡程度Wagner分级与糖尿病病程、经济收入、足畸形、膝反射、踝反射、足部音叉振动觉、尼龙丝感觉点、踝肱指数（ABI）、足部动脉搏动、空腹血糖及糖化血红蛋白呈相关关系;显著相关的因素是左胫后ABI、右足音叉振动觉及经济收入。结论糖尿病足溃疡患者中神经性溃疡较常见,神经性损害预后优于血管性因素糖尿病足;混合性糖尿病足预后较差。周围神经病变中尼龙丝感觉点、足部音叉振动觉和肌腱反射的检查最为简单实用。     

游离穿支孪生复合组织瓣修复第1跖骨头及软组织缺损

目的探讨应用带胫骨（膜）瓣及隐神经的胫后动脉穿支孪生复合组织瓣游离移植修复足弓及第1跖骨头部感觉神经及软组织缺损的临床应用效果。方法2008年02月一2012年02月临床应用5例,均为拇趾及第1跖骨头毁损、前足软组织缺损,前足纵横弓完整性破坏。选择以胫骨滋养动脉或胫后动脉发出的骨（膜）皮穿支血管为蒂,切取带胫骨（膜）瓣及隐神经的胫后动脉穿支血管供血的孪生复合组织瓣游离移植修复第1跖骨头及软组织缺损,骨瓣切取大小为1．5cm×0．8cm×0．6cm～4．0cm×1．5cm×1．0cm,皮瓣切取为5．0cm×3．5cm～7．0cm×6cm。结果术后皮瓣全部成活,术后3个月足部皮瓣有部分感觉恢复。随访6～24个月,皮瓣外形满意,骨折骨性愈合,可负重行走,行走步态接近正常,前足部皮瓣感觉恢复达S3。结论该术式保留了足弓外形及负重支撑点,行走和负重良好,外形及功能满意,有感觉。具有创伤小、供区部位隐蔽、不牺牲主干血管,手术操作简便等优势,一次手术即可使第一跖骨及周围组织达到满意的解剖塑形及良好功能。是一种较理想的治疗方法。     

Fractures of the pelvis.

Pelvic fractures in this series constituted 3.3% of all traumatic admissions and 5.7% of all fractures. A classification of pelvic fractures was adopted in which five types were identified. Type I (24.2%) comprised fractures without a break in the pelvic ring. Type II (17.7%) comprised those with a single break in the pelvic ring. Fractures with a double break of the pelvic ring constituted Type III (23.6%). Multiple fractures of the pelvis were identified as Type IV (10.8%). Fractures of the acetabulum were grouped separately as Type V (23.7%). On the basis of blood loss, mortality and potential disability, Types I and II constituted the ''minor'' fractures of the pelvis. Types III, IV and V were the ''major'' fractures of the pelvis, of which Type IV were the worst. The commonest fracture encountered was that of a single pubic ramus. The pubic area was involved in 43.0% of the cases. Associated injuries were common (2.19 per patient). Some of these lesions were the result of the causative trauma. Some others, however, were related to certain types of pelvic fractures.     

糖尿病足感染病原微生物分布及风险预测模型的建立

目的 分析糖尿病足（DF）感染病原微生物分布特征，并建立DF感染风险预测模型。方法 选取2019年1月—2022年1月文昌市人民医收治的82例DF患者为研究对象，对其足部创面分泌物进行细菌培养，总结DF感染病原菌分布特点，多因素Logistic回归分析确定DF感染独立危险因素并建立风险预测模型，绘制受试者工作特征（ROC）曲线判断各独立指标与风险预警模型诊断的准确性，交叉验证法验证风险预警模型效能。结果 82例DF患者中有50例足部分泌物中分离出病原菌，共检出病原菌79株，其中革兰阳性菌37株（46.84%），革兰阴性菌38株（48.10%），真菌4株（5.06%）。多因素Logistic回归分析结果提示，DF病程［O^R=2.201（95% CI：1.754，2.763）］、周围神经病变［O^R=3.177（95% CI：1.518，6.652）］、白细胞计数（WBC） ［O^R=2.425（95% CI：1.512，3.890）］、低密度脂蛋白胆固醇（LDL-C） ［O^R=1.976（95% CI：1.481，2.636）］是DF感染的独立危险因素（P <0.05）。ROC曲线结果表明，DF病程、周围神经病变、WBC、LDL-C预测DF感染的曲线下面积（AUC）分别为0.665、0.659、0.685和0.645，敏感性分别为68.0%（0.538，0.841）、60.0%（0.563，0.794）、76.0%（0.550，0.882）和62.0%（0.512，0.803，特异性分别为68.7%（0.548，0.853）、71.9%（0.615，0.899）、59.4%（0.440，0.603）和62.5%（0.536，0.815）。将上述进入多因素Logistic回归模型变量的b作为系数，建立风险预警模型，Logit（P）=e^y/（1+e^y），y =0.789×DF病程+1.156×周围神经病变+0.886×WBC+0.681×LDL-C-3.157。ROC曲线分析结果表明，风险预测模型AUC为0.908，截断值为0.513，敏感性及特异性分别为84.10%（0.651，0.917）和75.61%（0.579，0.855）。结论 DF感染率较高，但多为单一病原菌感染，DF病程、周围神经病变、WBC、LDL-C是DF感染的独立危险因素，以此为基础建立风险预测模型，便于临床快速准确筛查DF感染高危人群。     

糖尿病足的治疗与新进展

糖尿病足是糖尿病的严重并发症,血管狭窄闭塞、神经病变和感染是主要的临床表现,本文复习了近年来的20余篇文献,主要从以下6个方面对糖尿病足的治疗进展进行总结。①糖尿病足的基础治疗;②血管狭窄闭塞和血栓的治疗,其中骨髓干细胞移植治疗糖尿病足取得了进展;③神经病变的治疗;④糖尿病足溃疡的处理;⑤抗菌素的使用原则;⑥祖国传统医学在糖尿病足治疗中的应用。糖尿病足的治疗是个系统工程,单一的方法难以治愈,并且早发现早治疗,可以起到事半功倍的效果。     

贝前列素钠联合硫辛酸治疗老年DPN患者的临床疗效及周围神经病变的改善作用

目的 应用贝前列素钠联合硫辛酸治疗老年糖尿病周围神经病变(DPN)患者,评估其临床疗效及对患者周围神经病变的改善作用。方法 随机选择本院2018年2月至12月DNP患者100例,随机分为对照组和研究组,对照组应用硫辛酸治疗,研究组给予贝前列素钠联合硫辛酸治疗。评估两组临床疗效、应用多伦多临床评分系统(TCSS)评分、神经病变主观感觉症状问卷评分(TSS)、密歇根糖尿病神经病变评分量表(MDNS)评估患者临床状况、主观症状、神经病变,检测患者腓总神经和正中神经等运动神经传导速度(MNCV)和感觉神经传导速度(SNCV)。结果 研究组总有效率为66.00(33/50),高于对照组54.00(27/50),差异有统计学意义(P＜0.05)；研究组治疗后TCSS评分、TSS评分、MDNS评分分别为(6.25±0.96)分、(3.23±0.45)分、(17.64±1.82)分,均低于对照组(8.19±1.06)分、(4.15±0.51)分、(22.29±1.93)分,差异有统计学意义(P＜0.05)；研究组正中神经和腓总神经MNCV和SNCV分别为(48.46±3.15)m/s、(46.95±2.68) m/s、(47.24±2.31)m/s和(43.68±2.64)m/s,均高于对照组治疗后(43.90±2.73)m/s、(42.72±2.50) m/s、(42.58±2.29)m/s和(37.82±2.39)m/s,差异有统计学意义(P＜0.05)。结论 应用贝前列素钠联合硫辛酸治疗老年DPN患者能够显著改善患者周围神经病变,临床疗效显著。     

神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值

目的探讨神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值。方法对10例以足下垂为主要临床表现的患者进行双侧胫神经F波、双侧腓总神经和胫神经传导、双侧胫前肌、胫后肌、腰椎旁肌肌电图检查。结果4例以腓骨小头上一下段传导速度减慢〉10rrds或动作电位波幅下降超过50％及胫前肌神经源性损害为主,诊断为腓总神经病;5例以胫神经F波潜伏期延长和胫前肌、胫后肌、腰椎旁肌肌神经源性损害为主,诊断为腰骶神经根病;1例为腓总神经、胫神经动作电位波幅下降,感觉电位未引出,胫前肌、胫后肌神经源性损害,腰椎旁肌肌电图未见异常,诊断为坐骨神经病。10例均行腰骶段脊髓MRI。其中5例所见均与神经电生理检查结果相符。结论神经电生理检查在腰骶神经根病与腓总神经病的鉴别诊断中具有重要提示意义。