北京市某三甲医院创面修复专科病区5年间糖尿病足住院病例回顾性分析

目的回顾性调查解放军总医院第四医学中心烧伤整形三科暨创面修复中心糖尿病足住院病例的相关诊疗信息，分析其临床特点，为临床治疗提供一定参考。 方法回顾性分析2014年1月1日至2018年12月31日解放军总医院第四医学中心烧伤整形三科暨创面修复中心收治的糖尿病足住院患者资料。统计患者基本资料、病程、创面信息、治疗方式和结局。描述糖尿病足住院患者流行病学特征，比较性别、病程、治疗方式等因素对创面细菌感染、治疗效果的影响。 结果最终纳入研究505例患者，男321例，女184例。(1)患者平均年龄(64.112.9)岁，61~70岁年龄段患者最多(157例，31.1%)，女性患者年龄高于男性患者(F＝22.532，P<0.001)。(2)入组患者均合并慢性基础性疾病。其中，下肢动脉粥样硬化381例(75.45%)，高血压病318例(62.97%)，冠状动脉粥样硬化性心脏病168例(33.27%)，陈旧性脑梗死150例(29.70%)。(3)急性创面119例，慢性创面386例。(4)患者溃疡最常见的发病部位依次为足趾(48.9%)、足底(16.2%)、足背(14.7%)、足踝(11.1%)、足跟(9.1%)。(5)160例糖尿病足溃疡患者行创面微生物学检查，其中135例(84.38%)为阳性，急性创面多以革兰氏阳性菌感染为主，慢性创面多以革兰氏阴性菌感染为主(χ²＝7.860，P<0.05)。(6)301例患者行外科手术治疗，67例患者行单纯负压吸引治疗，137例患者行单纯换药治疗，165例(32.67%)患者治愈，268例(53.07%)患者好转，71例(14.06%)患者未愈，1例(0.198%)患者死亡，手术治疗的治愈率显著高于单纯负压吸引、单纯换药治疗(χ²＝135.614，P<0.001)。 结论患病群体主要为中老年，年龄集中在51~70岁，男性患者居多，女性患者年龄高于男性患者。患者多合并慢性基础性疾病，需重视基础疾病的治疗。创面常见发病部位为足趾、足底、足背、足踝、足跟。创面合并微生物感染率非常高，抗感染治疗要及时、合理。相比单纯负压吸引、单纯换药治疗，手术治疗的治愈率更高。

Retrospective analysis of diabetic foot cases within 5 years in the wound repair specialist ward

ObjectiveTo retrospectively investigate the clinical diagnosis and treatment information of diabetic foot patients in the Wound Repair Center, Department of Burn and Plastic Surgery, Fourth Medical Center of PLA General Hospital, and analyze their clinical characteristics, to provide some reference for clinical treatment of diabetic foot patients. MethodThe data of patients with diabetic foot admitted from January 1, 2014 to December 31, 2018 were retrospectively analyzed. The basic data, course of disease, wound information, treatment methods and outcomes were collected. To describe the epidemiological characteristics and to compare the effects of gender, course of disease, treatment methods on bacterial infection and therapeutic effect. ResultA total of 505 patients, including 321 males and 184 females, were enroll in the study. (1) The average age of the patients was (64.1 ± 12.9) years, and the patients aged 61-70 years were the largest (157 cases, 31.1%). The age of female patients was higher than that of male patients (F=22.532, P<0.001). (2)Five hundred and five patients were complicated with chronic complications. There were 381 cases with lower extremity atherosclerosis(75.45%), 318 cases with hypertension(62.97%), 168 cases with coronary atherosclerotic heart disease(33.27%) and 150 cases with old cerebral infarction(29.70%). (3) There were 119 cases with acute wounds and 386 cases with chronic wounds. (4) The most common sites of ulcer were toe (48.9%), pelma (16.2%), dorsum of foot (14.7%), ankle (11.1%) and heel (9.1%). (5)One hundred and sixty cases of diabetic foot ulcers were examined by microbiological examination, in which 135 (84.38%) were positive. Most of the acute wounds were infected by Gram-positive bacteria, and most of the chronic wounds were infected by Gram-negative bacteria(χ²=7.860, P<0.05). (6) Three hundred and one patients were treated with surgery, and 67 patients were treated with simple negative pressure therapy, 137 patients were treated with simple dressing change. One hundred and sixty-five patients (32.67%) were cured, 268 patients (53.07%) were improved, 71 patients (14.06%) were not healed, and 1 patient (0.198%) died. The cure rate of surgical treatment was significantly higher than that of simple negative pressure and dressing change(χ²=135.614, P<0.001). ConclusionsThe patiens are mainly middle-aged and elderly people which aged 51-70 years, which mostly are male patients. The age of female patients is higher than that of male patients. Most patients are complicated with chronic basic diseases, and attention should be paid to the treatment of basic diseases. The common sites of wound were toe, pelma, dorsum, ankle and heel. The bacterial infection rate is high which promotes the anti-infection treatment should be timely and reasonable. Compared with simple negative pressure and simple dressing change, the cure rate of surgical treatment is higher.