CAJ | 학술논문

目的探讨住院糖尿病足患者截肢率与截肢的危险因素.方法回顾性分析2005年1月1日至2011年6月30日在四川大学华西医院糖尿病足诊治中心住院的685例Wagner分级1～5级的糖尿病足患者临床资料,分为非截肢组和截肢组,并根据截肢部位分为小截肢组和大截肢组,进行回顾性分析.结果 685例患者中有78例(11.4％)患者截肢,大截肢41例(6.0％),小截肢为37例(5.4％).14例(17.9％)患者接受二次截肢术.截肢组比非截肢组患者住院时间更长[(66±57)d比(34±34)d,P＜0.05],血白细胞、中性粒细胞和糖化血红蛋白更高(P＜0.05)；血红蛋白和血清白蛋白水平更低(P＜0.05).截肢组患者合并糖尿病周围神经病变明显高于非截肢组(大截肢76.7％、小截肢91.9％比63.6％；P ＜0.05).截肢组患者躁肱指数(ABI)(0.41±0.25),显著性低于非截肢组(0.91±0.36,P＜0.01)；但大截肢组(0.39±0.26)和小截肢组(0.43±0.24)间ABI差异无统计学意义(P=0.087).多因素回归分析显示,糖化血红蛋白、ABI、既往截肢(趾)史和糖尿病足Wagner分级是截肢的独立危险因素.结论糖尿病周围神经病变、下肢动脉缺血、感染程度、全身营养状况与糖尿病足截肢密切相关.早期控制血糖,有效控制感染、改善全身状况以及多学科协作治疗有助于预防糖尿病足截肢.
목적 탐토주원당뇨병족환자절지솔여절지적위험인소.방법 회고성분석2005년1월1일지2011년6월30일재사천대학화서의원당뇨병족진치중심주원적685례Wagner분급1～5급적당뇨병족환자림상자료,분위비절지조화절지조,병근거절지부위분위소절지조화대절지조,진행회고성분석.결과 685례환자중유78례(11.4％)환자절지,대절지41례(6.0％),소절지위37례(5.4％).14례(17.9％)환자접수이차절지술.절지조비비절지조환자주원시간경장[(66±57)d비(34±34)d,P＜0.05],혈백세포、중성립세포화당화혈홍단백경고(P＜0.05)；혈홍단백화혈청백단백수평경저(P＜0.05).절지조환자합병당뇨병주위신경병변명현고우비절지조(대절지76.7％、소절지91.9％비63.6％；P ＜0.05).절지조환자조굉지수(ABI)(0.41±0.25),현저성저우비절지조(0.91±0.36,P＜0.01)；단대절지조(0.39±0.26)화소절지조(0.43±0.24)간ABI차이무통계학의의(P=0.087).다인소회귀분석현시,당화혈홍단백、ABI、기왕절지(지)사화당뇨병족Wagner분급시절지적독립위험인소.결론 당뇨병주위신경병변、하지동맥결혈、감염정도、전신영양상황여당뇨병족절지밀절상관.조기공제혈당,유효공제감염、개선전신상황이급다학과협작치료유조우예방당뇨병족절지.
Objective To evaluate the incidence and risk factors of lower extremity amputation among inpatients with diabetic foot.Methods For this retrospective study,a total of 685 inpatients with diabetic foot (Wagner grade 1 -5 )admitted at a multi-disciplinary Diabetic Foot Care Center,West China Hospital,Sichuan University during January 1,2005 and June 30,2011.The data of each patient including clinical information,laboratory results and final outcome were collected and analyzed.They were divided into non-amputated and amputated groups.And the latter included minor and major amputation groups according to amputation site.Results The overall amputation rate was 11.4％ in diabetic foot inpatients. The incidences of minor amputation and major amputation were 5.4％ and 6.0％ respectively. 17.9％ of amputated patients experienced a second amputation.The amputated patients had a longer hospitalized stay,higher counts of white blood cells and neutrophils,greater HbA1c and lower serum levels of hemoglobin and albumin than the non-amputation patients (P ＜ 0.05 ).The prevalence of diabetic peripheral neuropathy was significantly higher in the amputation group than that in the non-amputation group (P ＜ 0.05 ).However,no difference existed between the minor and major amputation groups ( P ＞ 0.05 ).Ankle brachial index (ABI) in the amputation group was significantly lower than that in the non-amputation group ( 0.41 ± 0.25 vs 0.91 ±0.36,P ＜0.01 ).Minor and major amputation inpatients had similar ABI (0.43 ±0.24 vs 0.39 ± 0.26,P =0.087 ).Ordinal regression showed that HbAlc ( P =0.015 ),ABI ( P =0.016 ),history of amputation ( P ＜ 0.01 ) and Wagner grade of diabetic foot ( P ＜ 0.01 ) were the independent risk factors of amputation.Conclusions Diabetic foot inpatients have a higher rate of lower extremity amputation.The risk factors of amputation include HbA1 c,ABI,history of amputation and Wagner grade of diabetic foot And diabetic peripheral neuropathy,ischemia of lower limbs (especially peripheral arterial diseases below knees),infection and nutritional state are closely associated with amputation of diabetic foot inpatients.