强化管理在糖尿病足高危患者保肢治疗中的意义

目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。

Significance of reinforcing management on limb salvage therapy in patients at high risk for diabetic foot

Aim To evaluate the efficacy of the comprehensive reinforcing management and medical therapy to reduce amputation incidence and promote quality of life in diabetic patients at high risk for diabetic foot(DF).Methods 123 diabetic patients at high risk for diabetic foot were employed to participate in a 2-year prospective study.All of them received a routine education and foot care program for type 2 diabetes in Diabetic Care Center, and were randomly divided into two sex and age-matched groups: reinforcing management group(n=65,group A) and standard management group(n=58, group B).Diabetic education questionnaire were conducted in all the patients before and after education. At the end of the investigation, the differences between group A and group B were evaluated in the diabetic knowledge, foot care knowledge, blood sugar control and incidence of diabetic foot ulcer and amputation. Results There was an insignificant difference between the general and foot care knowledge of the group A and B before and after 1 month intervention (P >0.05), but a significant difference between the two groups after 1- 2 year intervention(P< 0.001).The concentration of HBA1c in the group A was (7.1± 2.3)% , significantly lower than that of the group B (8.5± 4.2)% ,t=2.310,P< 0.05]. The average systolic pressure and diastolic pressure of the group A were ( 142± 10) mmHg and (80± 10)mmHg respectively, significantly lower than those of the group B (158± 9) mmHg and (92± 10)mmHg respectively,t=9.019, 6.647,P< 0.05].The concentrations of total cholesterol and triacylglycerol in the group A were(4.4± 1.1)mmol/L and (1.8± 0.9)mmol/L respectively, significantly lower than those in the group B (5.6± 2.6)mmol/L and (2.5± 1.8)mmol/L respectively,t=2.804, 2.745,P< 0.05]. The DF incidence and amputated rate of the group A were 7.7% and 3.1% respectively, significantly lower than those of the group B(20.7% and 13.8% respectively, t=4.347,4.712,P< 0.05). Conclusion The reinforcing management was beneficial to reduce the incidence of diabetic foot and amputation, and meanwhile to promote the quality of life and save medical cost.