糖尿病足溃疡中左室射血分数正常心功能不全的患病情况与治疗后改变

目的 观察糖尿病足溃疡患者心衰特点,探讨心功能随治疗的变化.方法 连续收集162例糖尿病足溃疡(足溃疡组)和75例糖尿病足溃疡高危患者足溃疡高危组一般临床资料,包括糖尿病病情、生理生化指标等,在入院时、治疗中和出院前评估患者心功能状态,通过心脏超声观察心脏左室射血分数等心功能指标.结果 本组资料中发生心衰共23.6%(56/237),其中足溃疡组27.2%(44/162),均为左室射血分数正常心功能不全.入院时总体患病率为8.9%(21/237),其中足部溃疡组10.5%(17/162),与足溃疡高危组相比差异有统计学意义(P＜0.01);在住院治疗期间,心衰新增加14.8%(35/237),其中足溃疡组为16.7%(27/162),均发生在治疗后2~7 d,高峰在治疗后第4天;治疗后发生的心衰在足溃疡Wagner分级各组间差异有统计学意义(P＜0.05);心衰经治疗后心功能均改善并能耐受足溃疡的治疗.结论 糖尿病足溃疡在治疗前和治疗中有较高的左室射血分数正常心功能不全患病率.

Abstract：

Objective To estimate heart function among patients with diabetic foot ulcer,and to investigate the characteristics of heart failure(HF) before and after treatment of ulcer. Methods Items associated with diabetes and some physiological and biochemical indicators were observed in patients with diabetic foot ulcer(162 cases) and with high risk factors of ulcer(75 cases). Heart function was evaluated at patients′ admission, during ulcer related treatment, and prior to discharge. Left ventricular ejection fraction and other cardiac assessment were measured with ultrasonic scan.Results During hospitalization, 23.6%(56/237) patients underwent HF with normal left ventricular ejection fraction, and it was 27.2%(44/162) in patients with foot ulcers. The prevalence of HF was 8.9%(21/237) in all patients studied on admission, and that was 10.5%(17/162) in patients with foot ulcer, more than that without foot ulcer(P＜0.01). More patients with HF were found, being 14.8%(35/237) during 2-7 days after ulcer related treatment initiated, and peak was on the 4th day. There was statistical difference among different Wagner grades(P＜0.05) about the morbidity rate of HF. All patients with HF were improved and tolerant to ulcer related treatment. Conclusion The prevalence of HF with normal left ventricular ejection fraction was relatively high in patients with diabetic foot ulcer, especially after ulcer treatment.     

常州市建筑工地食堂卫生现状调查及其分析

目的：了解常州市建筑工地食堂食品卫生现状，探讨相应的防制对策。方法：选择常州市区16个大型建筑工地52家工地食堂为调查对象，用调查表进行卫生基本情况调查，对食堂使用的熟食容器进行大肠菌群污染情况检测，对无健康证明的食品从业人员进行健康体检。结果：90％的工地食堂未建立健全卫生管理制度。卫生许可证持证率为50％，89名从业人员健康证明持证率为58．4％，办理卫生许可证工地食堂健康证持证率明显高于未办卫生许可证工地食堂（P〈0．01）；36．5％的工地食堂卫生状况差，98％的工地食堂流程布局、卫生设施不到位；使用塑料盆盛装熟食和生熟容器混用的分别占61．5％和57．7％：餐用具大肠菌群阳性率为80％，无健康证明从业人员HBsAg阳性率10％。结论：工地食堂流程布局、专间设置和卫生设施较差，普遍存在着餐用具使用前不消毒，卫生管理亟待进一步加强，建议应及时制订工地食堂卫生管理要求及相应的防制对策，加强卫生监管。