糖尿病患者足底坚硬胼胝下深度溃疡的个案护理

糖尿病足（Diabetic foot）的发生除了与周围神经病变、血管病变、感染等因素有关外,还与足部胼胝的形成有很大的关系。足底胼胝的存在增加了足底压力,胼胝下的正常组织由于受到过度持续的挤压而极易发生病变产生溃疡,严重时溃疡可并发感染,甚至导致截肢。溃疡表面的胼胝质地坚硬、与周边组织紧密粘边,难以去除,这给溃疡的愈合造成困难。本文报道1例高龄糖尿病患者因足底胼胝致使深度溃疡合并感染的病例,经过6周时间,精心护理,溃疡愈合。     

糖尿病足胼胝下溃疡的伤口护理体会

糖尿病足是糖尿病的一种严重并发症，特别是合并足底胼胝病人由于局部组织缺血严重，缺乏弹性而致抗冲击力差，治疗过程中如不进行彻底清创则会影响愈合；当足部胼胝感染严重可穿透皮下组织、肌肉，到达骨、肌腱、韧带，甚至足趾或肢体坏死。我院伤口护理中心2004年5月～2008年10月，共诊治糖尿病足合并胼胝下溃疡的病人398例，经过系统的伤口处置，临床效果良好，现报告如下。     

个性化足减压护理在顽固性糖尿病压力性足溃疡中的应用研究

目的分析个性化足减压护理在顽固性糖尿病压力性足溃疡中的安全性和有效性。方法选取2013年1月~2016年1月我科住院符合顽固性糖尿病压力性足溃疡患者78例,随机分为减压组和非减压组,各39例。非减压组采用基础治疗。减压组采用基础治疗联合个性化足减压护理。比较两组治疗创面愈合时间及治疗总有效率。结果经规范治疗3月后,减压组胼胝下感染、胼胝下合并足趾间感染愈合时间短于非减压组,两组比较差异有统计学意义(P0.05)。治疗总有效率高达94.9%,显著高于非减压组,两组比较差异有统计学意义(P0.05)。结论根据足底压力,提供个性化的足底减压护理,如合适的减压垫、减压鞋和配套的鞋垫,可有效促进糖尿病压力性足溃疡的愈合,缩短足溃疡愈合时间。     

全接触石膏治疗糖尿病足底溃疡的疗效观察

目的：观察全接触石膏疗法对久未愈合糖尿病足底溃疡患者的疗效。方法：糖尿病足底溃疡且久未愈合的患者35例分为观察组17例和对照组18例,2组均给予糖尿病足常规治疗,观察组加用全接触石膏进行治疗。结果：经过6～8周治疗后,观察组总有效率明显高于对照组（P〈0．05）,且足底溃疡愈合时间明显短于对照组（P〈O．01）。结论：对久未愈合糖尿病足底溃疡患者采用全接触石膏疗法,有显著的临床疗效,值得临床推广。     

糖尿病患者足底胼胝去除前后局部压力的比较

目的探讨糖尿病患者足底胼胝去除前后足部压力变化.方法对13例有胼胝的糖尿病患者检查身高、体重,以及足底总压力、总冲量、局部压力、局部冲量.去除胼胝后再次进行同样的检查.结果胼胝去除后,足底总压力、总冲量、局部压力、局部冲量等指标分别下降了13%、11%、18%和18%,差异有统计学意义.结论去除胼胝能降低糖尿病患者足部压力,对糖尿病足病的预防有重要意义.     

糖尿病患者足底坚硬胼胝下深度溃疡1例处理

糖尿病足的发生除了与周围神经病变、血管病变、感染等因素有关外,还与足部胼胝的形成有很大的关系。足底胼胝的存在增加了足底压力,胼胝下的正常组织由于受到过度持续的挤压而极易发生病变产生溃疡,严重时溃疡可并发感染,甚至导致截肢。溃疡表面的胼胝质地坚硬、与周边组织紧密粘边,难以去     

下肢动脉成形术并局部灌注治疗糖尿病足19例分析

目的：评价下肢动脉成形术联合局部动脉化疗灌注在糖尿病足合并足部溃疡及感染治疗中的疗效。方法：选择糖尿病足足部溃疡并感染患者19例,下肢动脉成形术后,局部留置导管7～15 d,持续灌注抗感染、溶栓药物。结果：17例患者局部感染病灶控制,溃疡瘢痕愈合,治愈率达89.4%。结论：下肢动脉成形术联合局部动脉药物灌注治疗对糖尿病足合并溃疡及感染的患者具有较好的疗效。     

我国糖尿病足患者足底减压治疗现状和未来发展方向

本文简明地介绍了关于足部压力的分布情况,列举了目前我国糖尿病足患者足底减压治疗现状,指出目前我国糖尿病足患者足底减压治疗的不足之处,旨在提高医务人员、患者及患者家属对足底减压的重视,做到预防糖尿病足从减压开始,早期发现异常足底压力,及时干预,从而降低溃疡的发生率、复发率,提高愈合率,降低截肢率及病死率。     

糖尿病足的护理

目的探讨糖尿病足的护理方法,提高糖尿病足的治疗效果。方法在控制好血糖、感染的前提下,做好局部溃疡的护理、心理护理和健康宣教。结果本组15例患者,血糖控制均比较满意。14例糖尿病足患处痊愈,1例创面缩小,局部干燥。结论应用全身治疗和护理相结合,有效缩短了溃疡愈合时间,减少了截肢的发生,提高了患者的生活质量。     

足底溃疡的治疗

<正> 在美国,绝大多数的足底溃疡是继发于糖尿病的神经并发症。其主要原因是因为足底受压过度和失去保护性感觉。传统的观点认为糖尿病的足底溃疡是因循环障碍引起,最近的研究对此持有异议。这种无痛性溃疡常经久不愈。为利用制动方法减少病变足的压力和重新分配足底部压力可促进伤口的愈合。减少足底压力的方法,可使糖尿病足底溃疡象其它周围神经病变患者的足底溃疡一样痊愈。然而,局部供血不足在一定程度下延缓溃疡的愈合。     

Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location

This study investigated healing rates of chronic diabetic neuropathic foot ulcerations located on the plantar surface of the forefoot (n = 30) versus those located on other parts of the foot (n = 25). Each type of ulceration was treated with total contact casting. Ulcerations in the first group were located on the metatarsal heads and toes, while ulcerations in the second group were located on the dorsum of the foot, heel, plantar arch, ankle, medial aspect of foot, and toe or transmetatarsal amputation sites. Successfully healed diabetic neuropathic foot ulcerations treated with total contact casting were rated according to patient age, ethnic origin, sex, patient weight, ulcer size, ulcer location, duration of ulcer prior to casting, and ulcer grade. Analysis of variance and posthoc analyses demonstrated that (1) total contact casting was a highly effective method of treatment regardless of ulcer location (forefoot ulcer healing time mean = 30.6 days; nonforefoot ulcer healing time mean = 42.1 days) and (2) forefoot ulcerations healed significantly faster than ulcerations located on other parts of the foot. Complex correlational relationships were explored in this study, and multiple regression equations were developed for each location grouping.     

An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers

BackgroundMechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences in cumulative plantar tissue stress between people with healing and non-healing plantar diabetic foot ulcers.MethodsWe analyzed a subgroup of 31 patients from a randomized clinical trial, treated with a removable offloading device for their plantar diabetic forefoot ulcer. We measured in-device dynamic plantar pressure and daily stride count to calculate cumulative plantar tissue stress at the ulcer location and associated this with ulcer healing and ulcer surface area reduction at four weeks (Student's t and chi-square test for significance, Cohen's d for effect size).FindingsIn 12 weeks, 68% (n = 21) of the ulcers healed and 32% (n = 10) did not. No statistically significant differences were found for cumulative plantar tissue stress, plantar pressure or ambulatory activity between people with healed and not-healed ulcers. Cumulative plantar tissue stress was 25% lower for people with healed ulcers (155 vs. 207 MPa·s/day; P = 0.71; Effect size: d = 0.29). Post-hoc analyses in the 27 patients who self-reported to be adherent to wearing the device showed that cumulative plantar tissue stress was 49% lower for those who reached ≥75% ulcer surface area reduction at four weeks (140 vs. 275 MPa·s/day; P = 0.09; d = 0.76); smaller differences and effect sizes were found for peak pressure (24%), peak pressure-time integral (30%) and ambulatory activity (26%); (P-value range: 0.14–0.97; Cohen's d range: 0.14–0.70).InterpretationMeasuring cumulative plantar tissue stress may provide insight beyond that obtained from plantar pressure or ambulatory activity alone, with regard to diabetic foot ulcer healing using removable offloading devices. These explorative findings provide baseline data for further studies on this relevant topic.     

Healing times of pedal ulcers in diabetic immunosuppressed patients after transplantation.

OBJECTIVE: To compare the healing time of neuropathic plantar ulcers treated by total-contact casting (TCC) in diabetic, immunosuppressed patients after organ transplantation with the healing time of plantar ulcers in control nonimmunosuppressed patients. DESIGN: A case-control design with the control group matched for age, race, sex, body dimensions (height, weight, and body mass index), presence of sensory neuropathy, foot deformity presence and location, and pedal ulcer area and depth. SETTING: An outpatient physical therapy clinic in a regional tertiary-care hospital and academic medical center. PARTICIPANTS: Nine patients with chronic diabetes mellitus and a previous organ transplantation who were currently receiving lifelong immunosuppressive drug therapy were treated for a neuropathic plantar ulcer by means of TCC. Fourteen group-matched control subjects with diabetes mellitus and a plantar ulcer but who had never had an organ transplantation and were not taking immunosuppressive agents were also studied. INTERVENTIONS: TCC with partial weight-bearing using an assistive device until ulcers healed. MAIN OUTCOME MEASURE: Healing time was defined as the number of days in the total-contact cast until the skin completely closed. RESULTS: All diabetic foot ulcers healed with casting. Immunosuppressed/transplanted patients healed in a mean time of 111 +/- 25 days; ulcers of control subjects healed in 47 +/- 18 days (p < .05). All patients returned to ambulation using prescribed therapeutic footwear. None of the patients required a lower extremity amputation throughout the follow-up period. CONCLUSIONS: TCC is a highly effective and rapid method of healing neuropathic pedal ulcers in diabetic immunosuppressed/transplantation patients, although it may take several weeks longer than it would for patients who were not immunocompromised.     

Biomechanical treatment approach to diabetic plantar ulcers. A case report

The purpose of this case report is to describe a physical therapy approach designed to reduce the mechanical pressure at the site of a diabetic plantar ulcer. The patient was a 69-year-old man with diabetes mellitus for 24 years, insensitive feet, and a right plantar ulcer at the first metatarsal head for 21 months. He had a fixed equinus and rear-foot varus deformity, which seemed to place increased pressure on his forefoot. The patient was treated with total contact casting and showed progressive healing until he refused additional casting. One week later, the ulcer was considerably larger. He consented to resume casting, and the ulcer was completely healed in 85 days from the initial treatment. We provided the patient with extra-depth shoes with rigid rocker-bottom soles and a polyethylene-lined ankle-foot orthosis. The ulcer remained healed at one-week and six-month follow-up visits. The primary cause of diabetic plantar ulcers is often excessive pressure on an insensitive foot, and physical therapists should utilize biomechanical principles to reduce these excessive plantar pressures.     

HYAFF 11-based autologous dermal and epidermal grafts in the treatment of noninfected diabetic plantar and dorsal foot ulcers: a prospective, multicenter, controlled, randomized clinical trial

OBJECTIVE: To evaluate the clinical efficacy and safety of HYAFF 11-based autologous dermal and epidermal grafts in the management of diabetic foot ulcers. RESEARCH DESIGN AND METHODS: A total of 79 patients with diabetic dorsal (n = 37) or plantar (n = 42) ulcers were randomized to either the control group with nonadherent paraffin gauze (n = 36) or the treatment group with autologous tissue-engineered grafts (n = 43). Weekly assessment, aggressive debridement, wound infection control, and adequate pressure relief (fiberglass off-loading cast for plantar ulcers) were provided in both groups. Complete wound healing was assessed within 11 weeks. Safety was monitored by adverse events. RESULTS: Complete ulcer healing was achieved in 65.3% of the treatment group and 49.6% of the control group (P = 0.191). The Kaplan-Meier mean time to closure was 57 and 77 days, respectively, for the treatment versus control groups. Plantar foot ulcer healing was 55% and 50% in the treatment and control groups, respectively. Dorsal foot ulcer healing was significantly different, with 67% in the treatment group and 31% in the control group (P = 0.049). The mean healing time in the dorsal treatment group was 63 days, and the odds ratio for dorsal ulcer healing compared with the control group was 4.44 (P = 0.037). Adverse events were equally distributed between the two groups, and none were related to the treatments. CONCLUSIONS: The autologous tissue-engineered treatment exhibited improved healing in dorsal ulcers when compared with the current standard dressing. For plantar ulcers, the off-loading cast was presumably paramount and masked or nullified the effects of the autologous wound treatment. This treatment, however, may be useful in patients for whom the total off-loading cast is not recommended and only a less effective off-loading device can be applied.     

Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial

OBJECTIVE: To assess the ability of the 4-week healing rate to predict complete healing over a 12-week period in a large prospective multicenter trial of diabetic patients with foot ulceration. RESEARCH DESIGN AND METHODS: We examined the change in ulcer area over a 4-week period as a predictor of wound healing within 12 weeks in patients who were seen weekly in a prospective, randomized controlled trial. RESULTS: Wound area measurements at baseline and after 4 weeks were performed in 203 patients. The midpoint between the percentage area reduction from baseline at 4 weeks in patients healed versus those not healed at 12 weeks was found to be 53%. Subjects with a reduction in ulcer area greater than the 4-week median had a 12-week healing rate of 58%, whereas those with reduction in ulcer area less than the 4-week median had a healing rate of only 9% (P < 0.01). The absolute change in ulcer area at 4 weeks was significantly greater in healers versus nonhealers (1.5 vs. 0.8 cm(2), P < 0.02). The percent change in wound area at 4 weeks in those who healed was 82% (95% CI 70-94), whereas in those who failed to heal, the percent change in wound area was 25% (15-35; P < 0.001). CONCLUSIONS: The percent change in foot ulcer area after 4 weeks of observation is a robust predictor of healing at 12 weeks. This simple tool may serve as a pivotal clinical decision point in the care of diabetic foot ulcers for early identification of patients who may not respond to standard care and may need additional treatment.     

20例糖尿病足病人的护理

[目的]探讨糖尿病足的护理方法.[方法]在控制好血糖、感染的前提下,做好局部溃疡的护理、心理护理、健康宣教.[结果]21例糖尿病足除1例截肢外,其余经3周至2个月治疗,均愈合.[结论]应用全身治疗和护理相结合,有效缩短了溃疡愈合时间,减少了截肢的发生,提高了病人的生活质量.     

A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers

OBJECTIVE: The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers. RESEARCH DESIGN AND METHODS: In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 相似文献   

68例糖尿病足的预防与护理

目的:探讨糖尿病足的预防与护理。方法:在控制好血糖、感染及改善微循环的前提下,做好患者的饮食护理、心理护理、运动护理及健康宣教。结果:68例糖尿病足除3例截(趾)肢外,其余经综合治疗后45例溃疡患者均有明显好转,19例足部疼痛、麻木症状明显改善,1例因经济情况未坚持治疗,自动出院。结论:应用综合治疗和护理相结合,减轻了糖尿病足患者的临床症状,缩短了溃疡愈合的时间,有效减少了截肢的发生。