本文關(guān)鍵詞： 糖尿病足 潰瘍 藥物灌注　出處：《桂林醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察股動(dòng)脈藥物灌注治療糖尿病足(diabetic foot,DF)患者五年的轉(zhuǎn)歸情況,并與常規(guī)組治療組對(duì)比,評(píng)估比較遠(yuǎn)期療效,以期為臨床醫(yī)生在選擇DF治療方案時(shí)提供循證醫(yī)學(xué)依據(jù)。通過(guò)對(duì)新發(fā)潰瘍影響因素進(jìn)行分析,得出危險(xiǎn)因素,指導(dǎo)患者避開(kāi)危險(xiǎn)因素,從而減少DF患者新發(fā)潰瘍。方法:選取70例于2005年1月至2009年12月愈合出院的糖尿病足患者,根據(jù)治療方式將其分為藥物灌注組(DF1)35例和常規(guī)治療組(DF2)35例,兩組年齡、性別、病程、BMI,血糖等指標(biāo)經(jīng)方差分析無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。常規(guī)治療組5年前采用的是綜合治療,按照傳統(tǒng)局部清創(chuàng)換藥,控制血糖,輔以靜脈點(diǎn)滴全身活血化瘀,抗感染治療。藥物灌注組在綜合治療基礎(chǔ)上,經(jīng)股動(dòng)脈穿刺,灌注溶栓劑和血管擴(kuò)張劑。應(yīng)用Seldinger法從患者同側(cè)或?qū)?cè)股動(dòng)脈穿刺進(jìn)入,對(duì)雙下肢動(dòng)脈進(jìn)行跟蹤X線數(shù)字減影血管照影,依次有股動(dòng)脈、乆動(dòng)脈、脛前動(dòng)脈、脛后動(dòng)脈、腓動(dòng)脈及足背動(dòng)脈,然后分批予藥物勻速灌注入左、右下肢動(dòng)脈:尿激酶250000u1、罌粟堿30mg、山莨菪堿10ml、低分子肝素4ml、復(fù)方丹參30ml。給藥后再次照影,小血管分支增多,狹窄或閉塞部位改善,退出導(dǎo)管。對(duì)兩組進(jìn)行隨訪,隨訪記錄新發(fā)潰瘍、踝肱指數(shù)(ABI)、糖化血紅蛋白(HbA1c)、振動(dòng)覺(jué)閾值(VPT)、血清肌酐(Scr)、頸動(dòng)脈斑塊、吸煙、飲酒及Barthel指數(shù)。應(yīng)用多因素非條件Logistic回歸分析法對(duì)新發(fā)潰瘍影響因素進(jìn)行分析。結(jié)果:70例患者隨訪率為100%。兩組潰瘍復(fù)發(fā)率藥物灌注為34.3%,常規(guī)治療組為65.7%,兩組比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。且藥物灌注組患者日常生活能力測(cè)定Barthel指數(shù)明顯優(yōu)于常規(guī)治療組(P0.05)。新發(fā)潰瘍獨(dú)立危險(xiǎn)因素為ABI(1.0)、HbA1c(≥7.0%)、病程(≥10年)、頸動(dòng)脈斑塊形成、吸煙(P0.05)。結(jié)論:(1)股動(dòng)脈藥物灌注DF遠(yuǎn)期效果較常規(guī)治療效果好,降低了DF潰瘍復(fù)發(fā)率,提高DF患者的生活質(zhì)量,減輕患者家庭經(jīng)濟(jì)負(fù)擔(dān)。(2)DF患者控制HbA1c(7.0%)、ABI(≥1.0)、戒煙、降低血脂能降低潰瘍的復(fù)發(fā)率。(3)臨床醫(yī)生在擇優(yōu)DF治療方案時(shí),可根據(jù)適應(yīng)癥選擇股動(dòng)脈藥物灌注治療,達(dá)到近期療效顯著,又可減少遠(yuǎn)期復(fù)發(fā)率提高DF患者的生活質(zhì)量。
[Abstract]:Objective: to observe the outcome of femoral artery infusion in diabetic patients with diabetic foot footfoot (DFD) for 5 years, and to evaluate the long term curative effect in comparison with the control group. In order to provide evidence based medicine basis for clinicians to choose DF treatment plan, through analyzing the influencing factors of new ulcer, we can get the risk factors and guide the patients to avoid the risk factors. Methods: 70 diabetic foot patients who healed and discharged from January 2005 to December 2009 were divided into two groups according to the treatment methods: 35 cases of infusing drug group and 35 cases of routine treatment group. There was no statistical difference in BMI, blood glucose and other indexes by ANOVA. The routine treatment group was treated with comprehensive therapy five years ago, according to the traditional local debridement and dressing change, controlling blood sugar, and adding intravenous drip to promote blood circulation and remove blood stasis. Antiinfective therapy. On the basis of comprehensive treatment, the drug perfusion group received femoral artery puncture, infusion of thrombolytic agents and vasodilators. Seldinger was used to enter from ipsilateral or contralateral femoral artery puncture. The femoral artery, anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery were followed by digital subtraction angiography, followed by femoral artery, anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery. Right lower extremity artery: urokinase 2500U 1, papaverine 30 mg, anisodamine 10 ml, low molecular weight heparin 4 ml, compound salvia miltiorrhiza 30 ml. New ulcers, ankle brachial index (AFI), HbA1cP, vibrational threshold value (VPTT), serum creatinine (creatinine), carotid plaque, smoking were recorded. Alcohol consumption and Barthel index. The influencing factors of new ulcers were analyzed by multivariate conditional Logistic regression analysis. Results the follow-up rate of 70 patients with new ulcers was 100. The recurrence rate of ulcer was 34. 3% in the two groups and 65. 7 in the routine treatment group. The comparison between the two groups was made. There was a significant difference between the two groups (P 0.05), and the Barthel index of the patients in the drug perfusion group was significantly better than that in the routine treatment group. The independent risk factor of the newly developed ulcer was: ABI 1. 0 HbA1c (鈮，

本文編號(hào)：1535653