早期应用脂肪基质血管成分技术对糖尿病足患者溃疡的治疗效果观察

目的探讨早期应用脂肪基质血管成分(stromal vascular fraction,SVF)技术对糖尿病足患者溃疡的治疗效果。方法2015年5月至2016年12月,便利抽样法选取在南京大学医学院附属鼓楼医院伤口护理室治疗的糖尿病足患者66例为研究对象。按数字随机表法将其分为观察组(n=35)和对照组(n=31)。观察组患者采用SVF技术治疗后常规换药,而对照组患者采用常规换药方法。观察两组患者的创面愈合时间、治疗总显效率及不良反应情况。结果观察组和对照组患者伤口平均愈合时间分别为(33.4±8.6)d和(41.8±5.9)d,差异有统计学意义(P0.001)。观察组患者治疗的总显效率为85.72%,高于对照组的64.52%,差异有统计学意义(P0.05)。两组患者均无不良反应。结论 SVF技术用于治疗糖尿病足溃疡患者疗效显著,无不良反应,促进了创面的愈合。     

皮下移植骨髓间充质干细胞修复大鼠糖尿病足溃疡

背景：糖尿病足溃疡严重威胁患者的健康甚至生命,目前缺乏良好的治疗手段,而干细胞疗法在组织再生和创面修复方面展现出独特的优势及潜力。目的：评价骨髓间充质干细胞经创缘皮下移植对大鼠糖尿病足溃疡的治疗效果。方法：全骨髓贴壁法体外培养Wistar大鼠骨髓间充质干细胞至第3代,经DAPI标记。36只雄性Wistar大鼠随机分成骨髓间充质干细胞移植组、正常足溃疡对照组、糖尿病足溃疡对照组,大鼠糖尿病经腹腔注射链脲佐菌素诱导,所有大鼠在双后足背上切取一3mm×7mm矩形全层皮肤制成足溃疡模型。于骨髓间充质干细胞移植后第2,5,8,11天评估各组大鼠创面愈合情况及相关蛋白和基因水平的表达情况。结果与结论：正常足溃疡对照组的创面愈合率大于骨髓间充质干细胞移植组和糖尿病足溃疡对照组,但后2组之间无差异。冰冻切片发现骨髓间充质干细胞移植组荧光强度和区域在第5天达到高峰。苏木精-伊红染色显示第5天正常足溃疡对照组肉芽组织最厚,骨髓间充质干细胞移植组比糖尿病足溃疡对照组厚。免疫组化发现骨髓间充质干细胞移植组CD31平均小血管数目在第8天和第11天比糖尿病足溃疡对照组多（P〈0.05）;骨髓间充质干细胞移植组平均Ki-67阳性细胞数在各时间点均比糖尿病足溃疡对照组多（P〈0.01）。ELISA和RT-PCR结果均显示,正常足溃疡对照组血管内皮细胞生长因子表达水平较骨髓间充质干细胞移植组、糖尿病足溃疡对照组高。第5天和第8天骨髓间充质干细胞移植组表达水平显著高于糖尿病足溃疡对照组（P〈0.01）。说明骨髓间充质干细胞经创缘皮下移植明显促进大鼠糖尿病足溃疡的愈合,此疗效可能是通过促进创伤中血管内皮细胞生长因子的表达实现的。     

28例糖尿病足患者的护理

目的:总结对糖尿病足患者的护理经验,早期预防、早期综合治疗及护理,降低致残率。方法:根据糖尿病足不同分级,采用全身及局部溃疡处综合治疗及护理措施,即良好血糖控制、局部创面护理、合理饮食、适量运动、心理护理、健康教育等。结果:28例2~5级糖尿病足患者取得良好的临床治疗效果,有26例患者经治疗创面愈合,1例患者由于创面较大,转入外科行植皮术,有1例患者感染严重,全足坏疽,行截肢手术,治愈率92.9%。结论:糖尿病足早期发现、早期进行综合治疗及护理多能治愈。     

Plastic surgery reconstruction of the diabetic foot

SOFT TISSUE RECONSTRUCTION of the diabetic foot is a challenge for the perioperative team.PRIMARY CLOSURE may not be an option and secondary healing may not be reliable. Therefore, surgery is vital and should be coordinated among a well-functioning multidisciplinary team that specializes in caring for patients with diabetes mellitus.TEAM MEMBERS must have expertise in reconstructive surgery to ensure adequate wound healing.THIS ARTICLE EMPHASIZES the appropriate timing and staging of surgery, discusses the most common plastic surgery techniques, and underscores the importance of a team approach in the management of diabetic foot wounds. AORN J 87 (May 2008) 951-966. © AORN, Inc, 2008.     

Case study in treatment of diabetic foot ulcer with alimentary gelatin

The patient with diabetic foot ulceration is undoubtedly one of the major challenges faced by nurses and physicians working in the field of wound treatment. About 15% of diabetic patients experience foot ulceration in the course of their disease. This article reports the adoption of an unconventional treatment, based on gelatin, in a case of a stagnant diabetic foot ulcer, resulting in the successful healing of the wound and the limb being saved. Gelatin is fundamentally denatured collagen; its presence is paramount in the natural healing process, and this may be one of the reasons that the treatment obtained a good result. The fact that the gelatin used is of animal origin does not appear to compromise the outcome of treatment.     

多学科协同的个案管理模式在糖尿病足管理中的应用

目的 探讨多学科协同的个案管理模式在糖尿病足患者中的应用效果。方法 采用便利抽样法,选取2019年1月至2020年12月在上海市第八人民医院就诊的60例糖尿病足患者,采用简单随机法分组,分为观察组(n=30),对照组(n=30),对照组给予常规换药治疗、口头健康教育及门诊随访,观察组实施多学科个案管理模式,建立糖尿病患者个案管理手册,当糖尿病足患者伤口愈合或终止接受伤口护理后随访6个月,比较两组患者在糖尿病管理自我效能、伤口愈合、血糖控制等方面情况。结果 多学科联合个案管理模式实施后,观察组患者自我效能在随访6个月后均高于对照组(P<0.05)；观察组糖尿病足伤口愈合率高于对照组组(P<0.05)；观察组患者血糖控制方面优于对照组组(P<0.05)。结论 对糖尿足患者实施多学科协同个案管理模式,可提高糖尿病足患者自我效能、糖尿病足伤口愈合及血糖控制,值得临床推广。     

苯扎氯铵溶液联合藻酸钙敷料治疗老年糖尿病患者足部病变的效果

目的探讨苯扎氯铵溶液联合藻酸钙敷料应用于老年糖尿病患者足部病变的治疗与护理效果。方法便利抽样法选择2009年1月至2011年9月在解放军总医院住院的老年糖尿病足部病变患者62例,采用随机数字表法将其分为对照组和观察组各31例,对照组采用常规聚维酮碘消毒后使用硫酸庆大霉素加入小剂量普通胰岛素冲洗伤口、纱球隔离、纱布包扎的方法;观察组则在对照组的基础上增加使用苯扎氯铵溶液足部浸泡5～10min,再用藻酸钙敷料隔离覆盖伤口。观察两组患者足部伤口的愈合时间、愈合效果、护理换药耗时等,并比较患者对糖尿病足护理的满意度。结果两组患者足部伤口的愈合时间、愈合效果、换药耗时以及患者对糖尿病足护理满意度比较,差异均有统计学意义(均P<0.01)。结论苯扎氯铵溶液联合藻酸钙敷料应用于老年糖尿病患者的早期足部病变,能有效缩短足部伤口愈合时间、提高伤口愈合效果、减少护理人员换药总耗时,并明显提高患者的满意度,是适宜老年糖尿病患者足部病变的良好换药方法。     

探讨健康教育对糖尿病足护理的效果

【目的】探讨健康教育对糖尿病足护理的效果。【方法】选择2012年6月-2013年6月就诊于上海交通大学医学院附属新华医院内分泌科的糖尿病足患者70例,将其随机分为观察组(35例)和对照组(35例)。观察组患者在传统护理的基础上实施有针对性的健康教育,对照组患者采取传统护理。比较两组患者情绪变化和创面愈合情况。【结果】观察组患者焦虑症状明显改善,而且足部创面愈合情况明显优于对照组(P<0.05)。【结论】针对性的健康教育运用到糖尿病足的护理工作中比传统护理能更有效地促进患者的创面愈合,减轻患者的焦虑情绪,提高患者的生活质量。     

糖尿病足局部抗感染治疗的研究进展

糖尿病足病抗感染是目前糖尿病足病治疗的难题之一,合并感染的足病创面不仅会延长创面愈合时间,而且可能导致截肢,甚至危及生命。单纯的全身抗生素治疗并不能解决所有足病患者感染的问题,目前局部清创、抗菌敷料、局部抗生素应用等局部的抗感染辅助治疗具有一定的抗菌作用,本文就上述局部抗感染治疗的研究进展进行综述。     

转染血管内皮生长因子基因的骨髓间充质干细胞修复糖尿病大鼠足背创面

背景：糖尿病足溃疡严重威胁患者的健康甚至生命,其治疗仍是国际性难题,目前缺乏良好有效的治疗手段,而基因疗法和干细胞疗法在创伤修复领域展现出独特的优势和潜力。目的：探索转染人血管内皮生长因子165（human vascular endothelial growth factor 165, hVEGF165）基因的骨髓间充质干细胞对大鼠糖尿病足背创面的治疗效果。方法：体外构建hVEGF165基因的腺病毒表达载体,转染第3代大鼠骨髓间充质干细胞;将120只雄性Wistar大鼠分成正常溃疡对照组、模型组、基因治疗组、干细胞治疗组和基因转染干细胞治疗组。后4组大鼠经腹腔注射链脲佐菌素诱导糖尿病,在所有大鼠的后足背切取一3 mm×7 mm矩形全层皮肤制成足背创面模型。各组大鼠均在足背创缘皮下分点注射移植,距创缘5 mm处、等距6点,正常溃疡对照组和模型组各点均注射50μL的PBS,基因治疗组各点注射50μL的腺病毒悬液（1×1013 pfu/L）,干细胞治疗组各点注射50μL的干细胞悬液（1×1010 L-1）,基因转染干细胞治疗组各点注射50μL的病毒转染后的干细胞悬液（1×1010 L-1）。结果与结论：与模型组、基因治疗组、干细胞治疗组相比,基因转染干细胞治疗组大鼠创面愈合率、血管内皮生长因子mRNA及蛋白表达水平、局部毛细血管数量均有显著提高（P〈0.05）,但较正常溃疡对照组差（P〈0.05）。说明 hVEGF165基因联合骨髓间充质干细胞疗法能够促进大鼠糖尿病足背创面的愈合,其主要机制为促进局部血管的生成及血管内皮生长因子的表达。     

糖尿病足创面处理研究进展

本文系统阐述了糖尿病足创面修复的机制和意义、时机把握、治疗原则、方法选择原则和技巧。特别强调要以糖尿病足清创和感染处理为基础,阐述了创面修复的方式和方法。针对不同阶段的创面,对遵循相应处理原则做出诠释。列举了近年来一些在创面的不同治疗阶段促愈合所应用的新技术、新方法。同时将糖尿病足创面修复的根本目标是功能康复的观念贯穿文章始终。为临床糖尿病足创面的预防及修复提供有效的治疗方案,进行了经验总结。     

《国际糖尿病足疾病预防和管理指南2019》在糖尿病足患者中的应用效果

目的探讨《国际糖尿病足疾病预防和管理指南2019》(简称"指南")在糖尿病足患者中的运用效果。方法选取2018年4月—2020年4月医院100例糖尿病足患者,其中2018年4月—2019年4月50例患者接受常规护理,设为对照组;2019年5月—2020年4月50例患者接受"指南"中的相关护理措施,设为观察组。比较两组患者抗生素使用以及创面愈合时间、平均换药次数,并基于糖尿病足溃疡瓦格纳(Wagner)分级评价治疗总有效率。结果观察组抗生素使用以及创面愈合时间、平均换药次数均低于对照组,差异具有统计学意义(P<0.05);观察组治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。结论基于"指南"相关护理措施能够规范糖尿病足的临床护理措施,缩短抗生素使用以及创面愈合时间,降低换药次数,并提升溃疡愈合效果。     

Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis.

OBJECTIVE: The aim of the study was to determine the percentage of individuals with neuropathic diabetic foot ulcers receiving good wound care who heal within a defined period of time. RESEARCH DESIGN AND METHODS: We conducted a systematic review of the control groups of clinical trials that evaluated a treatment for diabetic neuropathic foot ulcers. The meta-analytic techniques used include an estimation of the weighted mean percentage healed by end point, an evaluation of the homogeneity of trials, and an estimate of the 95% CI of the grouped data. Grouped-data univariate and multivariate logistic regression was conducted to assess the impact of mean age, ulcer size, and duration on the percentage of ulcers healed at end point. RESULTS: We found a total of 10 control groups meeting our criteria. Six control groups used 20 weeks as the end point for healing or nonhealing. For the six control arms with a 20-week end point, we found a weighted mean healing rate of 30.9% (95% CI 26.6-35.1). A similar analysis for the four 12-week arms found a mean healing rate of 24.2% (19.5-28.8). We failed to detect any statistically significant heterogeneity for either the 20-week or the 12-week trials. CONCLUSIONS: After 20 weeks of good wound care, approximately 31% of diabetic neuropathic ulcers heal. Similarly, after 12 weeks of good care, approximately 24% of neuropathic ulcers attain complete healing. Further patient-level analyses are necessary to definitively determine the associations of age, wound size, and wound duration with likelihood of healing.     

含银敷料辅助治疗糖尿病足溃疡感染的效果观察

目的观察评价含银敷料辅助治疗糖尿病足溃疡感染的有效性。方法2012年5月一2014年4月对人选的105例糖尿病足溃疡患者随机分为A、B两组：患者在整体干预的基础上,A组使用进口的银离子藻酸盐敷料,B组使用国产纳米银敷料,在设定治疗时间内,通过观察创面细菌转阴率和伤口愈合计分评价含银敷料处理糖尿病足溃疡的效果。结果两组创面细菌转阴率基本一致（P〉0．05）,伤口愈合计分随着治疗时间的延长均呈下降趋势,但A组伤口愈合计分下降较B组明显（P〈0．01）。结论两种含银敷料辅助治疗糖尿病足溃疡创面感染均有效,但银离子藻酸盐抗菌敷料的促愈效果更佳;细菌转阴率和伤口愈合计分评价含银敷料的治疗效果是客观可行的观察指标。     

Caring for the diabetic patient with a foot ulcer

Neuropathy is the most common complication of diabetes. Those patients with diabetic foot ulceration on the plantar, medial and lateral surfaces of the foot will almost all have clinically significant peripheral neuropathy. The diabetic ulcer is a significant healthcare problem and inadequate or improper therapy may lead to amputation. Therefore, an understanding of foot pathology associated with diabetes is essential for anyone who will be caring for diabetic patients. Equally important is an understanding of how to prevent these life-threatening wounds and at least a basic knowledge of wound healing in hard-to-heal foot ulceration. This article provides a basic understanding of the pathology and describes preventative techniques.     

自体富血小板血浆在糖尿病足溃疡的临床应用

目的 探究自体富血小板血浆在糖尿病足溃疡治疗中的应用效果.方法 选择2020年8月至2021年8月我院收治的Wagner 2～4级糖尿病足溃疡患者40例进行研究,根据其治疗方案不同分为对照组和观察组,两组均予以常规基础治疗,在此基础上,对照组(n=18)予以创面清创和负压封闭引流,观察组(n=22)于创面上覆盖自体富血...     

Versajet hydroscalpel: treatment of diabetic foot ulceration

Treatment of diabetic foot ulceration continues to be a challenge to healthcare professionals. Wound healing can be affected in a number of ways, and it is of paramount importance that wound healing is achieved as quickly as possible to minimize the risk of amputation. One key aspect of management is wound debridement. A number of techniques can be employed, including, in severe cases, surgical debridement. These case histories illustrate where the novel Versajet hydroscalpel (Smith & Nephew) would be a useful tool for debriding a foot ulcer effectively without the patient undergoing orthopaedic surgery. The Versajet debrides quickly and efficiently, and a pink and granulating wound base was achieved in all cases. It should be considered for use in specialist centres where complex diabetic foot ulcers are treated and the expertise is available to use it.     

脂质水胶敷料结合对口引流治疗糖尿病足的疗效

目的:观察脂质水胶敷料结合对口引流技术在糖尿病足溃疡患者换药治疗中的应用效果。方法:选取2017年1月至2018年1月该院住院及门诊糖尿病足溃疡需要换药的患者150例作为研究对象,采用随机数字表法分为对照组和观察组各75例。对照组采用常规换药方法,观察组采用脂质水胶敷料对口引流换药方法。对比分析两组的治疗时间、治疗效果...     

综合护理对小面积糖尿病足部溃疡的效果研究

目的探讨小面积糖尿病足部溃疡的综合护理措施。方法将58例小面积糖尿病足部溃疡患者随机分为2组。综合护理组（综护组）30例采用外科清创＋红外线照射创面＋生长因子（碱性成纤维细胞生长因子和重组人表皮细胞生长因子）＋水胶敷料“安普贴”敷贴的综合护理治疗措施；对照组28例采用0．5％多聚维酮碘液或0．5％呋哺西林液湿敷。临床观察2组患者创面愈合进展情况、平均愈合时间以及创面细菌培养阳性率。结果综护组创面平均愈合时间（29．6±9．4）d，较对照组（39．2±13．5）d显著缩短（P〈0．05），差异有统计学意义。第7天和第14天创面细菌培养阳性例数2组间比较差异有统订学意义（P〈0．05）。结论在常规内科治疗和一般护理措施基础上，外科清创＋红外线照射＋生长因子＋水胶敷料敷贴的综合护理措施对小面积糖尿病足部溃疡具有较好的促进愈合效果。     

Effects of vacuum-compression therapy on healing of diabetic foot ulcers: randomized controlled trial

A single-blind, randomized controlled trial was conducted to evaluate vacuum-compression therapy (VCT) for the healing of diabetic foot ulcers. Eighteen diabetic patients with foot ulcers were recruited through simple nonprobability sampling. Subjects were randomly assigned to either an experimental or a control group. Before and after intervention, the foot ulcer surface area was estimated stereologically, based on Cavalieri's principle. The experimental group was treated with VCT in addition to conventional therapy for 10 sessions. The control group received only conventional therapy, including debridement, blood glucose control agents, systemic antibiotics, wound cleaning with normal saline, offloading (pressure relief), and daily wound dressings. The mean foot ulcer surface area decreased from 46.88 +/- 9.28 mm(2) to 35.09 +/- 4.09 mm(2) in the experimental group (p = 0.006) and from 46.62 +/- 10.03 mm(2) to 42.89 +/- 8.1 mm(2) in the control group (p = 0.01). After treatment, the experimental group significantly improved in measures of foot ulcer surface area compared with the control group (p = 0.024). VCT enhances diabetic foot ulcer healing when combined with appropriate wound care.