论文部分内容阅读
目的回顾性分析249例糖尿病足(DF)深部感染病人的临床特点,并对影响伤口愈合的因素进行相关分析。方法根据病人是否截肢和伤口愈合情况,将249例 DF 深部感染病人分为未截肢愈合组(A 组),截肢后愈合组(B 组),截肢后未愈合组(C 组),对其临床资料、实验室参数及足部伤口的特征进行比较和分析。结果 A 组病人为107例,B 组病人为114例,C 组病人为28例。A 组病人年龄低于 B 组,B 组年龄低于 C 组(59±12)岁、(67±11)岁,(72±9)岁。(P<0.01),超敏C反应蛋白(hs-CRP)分别为 A 组:(18±5)mg/L,B 组(13±5)mg/L,C 组(7±6)mg/L(P<0.01),A 组血浆白蛋白高于 B、C 组分别为(32±7)g/L、(29±5)g/L,(28±3)g,(P<0.01)。B 组比 A 组病人糖尿病病程更长分别为(17±11)年、(10±6)年(P<0.05),B 组比 A 组病人更常见可探及骨质和存在脓性分泌物、坏死、骨暴露及恶臭味、水肿(P<0.01或 P<0.05)。B 组体温[(38.1±1.1)℃,(P<0.05)],血白细胞计数[(10±3)×10~9/L,P<0.05)],hs-CRP[(13±5)mg/L,P<0.05)]均高于 C 组[(37.4±0.8)℃、(8±2)×10~9/L、(7±6)mg/L]。严重下肢缺血在 A、B、C 组分别为7%、37%、77%,差异有统计学意义(P<0.05)。多因素 Logistic 回归分析,hs-CRP、血白蛋白为创面愈合的保护因素,高龄、脓性分泌物、可探及骨质、骨暴露、水肿、恶臭味、坏死、下肢严重缺血为创面愈合的危险因素。结论所有糖尿病足深部感染病人都需要外科的治疗,即使接受一个糖尿病足多学科团队的综合治疗,仍有部分的病人需要截肢。
Objective To retrospectively analyze the clinical features of 249 patients with deep DF infection and to analyze the factors influencing wound healing. Methods According to whether the patients were amputated and wound healing, 249 patients with DF deep infection were divided into three groups: group without amputation (group A), group with amputation after amputation (group B) and group without amputation (group C) Data, laboratory parameters and characteristics of foot wounds were compared and analyzed. Results There were 107 patients in group A, 114 patients in group B and 28 patients in group C. The age of group A was lower than that of group B, the age of group B was lower than that of group C (59 ± 12), (67 ± 11) and (72 ± 9) years old. The levels of hs-CRP in group A were (18 ± 5) mg / L in group A, 13 ± 5 mg / L in group B and 7 ± 6 mg / (32 ± 7) g / L, (29 ± 5) g / L and (28 ± 3) g, respectively (P <0.01) .The plasma albumin in group A was higher than that in group B . The duration of diabetes in group B was longer than that in group A (17 ± 11) years and (10 ± 6) years respectively (P <0.05). In group B, the duration of diabetes was more common than that in group A, and bone and purulent secretions , Necrosis, bone exposure and malodour, edema (P <0.01 or P <0.05). The body temperature of group B was significantly higher than that of group B (38.1 ± 1.1 ℃, P <0.05), the number of white blood cells was (10 ± 3) × 10-9 / L, P <0.05) / L, P <0.05)] were higher than those in C group [(37.4 ± 0.8) ℃, (8 ± 2) × 10 ~ 9 / L, (7 ± 6) mg / L] Severe lower limb ischemia in group A, B, C were 7%, 37%, 77%, the difference was statistically significant (P <0.05). Multivariate Logistic regression analysis, hs-CRP and serum albumin were the protective factors for wound healing. The elderly and purulent secretions could be probed into the bone, bone exposure, edema, stink odor, necrosis and severe lower extremity ischemia as the wound surface Healing risk factors. Conclusion All patients with deep-seated diabetic foot require surgical treatment, and some patients require amputation despite being treated with a multidisciplinary team of diabetic foot.