【作者】 夏冰； 李仕明；

【Author】 Xia bing;Li Shiming;Beijing ruijing Diabetes Hospital;China PLA General Hospital;

【机构】 北京瑞京糖尿病医院； 中国人民解放军空军总医院空军糖尿病研究中心；

【摘要】 目的:探讨糖尿病足患者中西医结合治疗对减少外科高位截肢手术、降低致残率、提高患者生活质量的影响。方法:糖尿病足患者599例,其中男性331例,女性268例;1型糖尿病患者41例,2型糖尿病患者558例。平均年龄60.1±8.4岁。糖尿病病程平均9.1±0.8年。入院时平均血糖12.2±4.9mmol/L。下肢及足坏疽581例,上肢及手坏疽18例。合并湿性坏疽457例,干性坏疽48例,混合坏疽94例。在中西医结合治疗过程中,分为基础、祛腐、生肌三个治疗阶段。首先常规治疗糖尿病、抗感染、控制相关并发症,同时运用川芎嗪、脉络宁等静脉点滴,山莨菪碱股动脉注射;对大血管阻塞者采用经皮穿刺血管成形术介入治疗,使下肢大血管再疏通,提高肢体血流量;坏疽局部处理:主要根据坏疽的不同类型和轻重程度进行分级、分期,选择适当时机,以蚕食的方法清创、引流,外敷复方祛腐生肌、消炎止痛,同时采用药水、药垫、药膏、药膜及药粉等综合治疗。结果:糖尿病足患者599例,其中治愈525例(87.7%),因好转后中途出院38例(6.3%),无效12例(2.0%),截肢10例(1.7%),因急性心、肾衰竭及脑卒中死亡14例(2.3%)。结论:本研究运用中西医结合治疗活血化瘀、改善了全身和坏疽局部的循环与微循环障碍,提高局部血氧含量;局部清创,引流,外敷复方祛腐生肌药物,促进了坏疽早日愈合;介入治疗使下肢大血管再疏通,对大血管阻塞导致的坏疽愈合效果明显。本研究证明通过中西医结合治疗大大减少了坏疽患者的高位截肢手术、降低了致残率、提高了患者的生活质量。中西医结合治疗糖尿病足目的明确、方法简单、临床效果显著,为糖尿病足开创了新的治疗途径。更多还原

【Abstract】 Objective:To investigate the effects of treatment combined traditional medicine with western medicine on decreasing surgical amputation incidence,reducing disability and improving life quality in patients with diabetic foot disease.Methods:599 inpatients with diabetic gangrene were included in the study,containing 331 male and 268 female patients.The average age was 60.1 ± 8.4 years old and the average diabetic history was 9.1 ± 0.8years.The patients were admitted into the hospital with an average blood glucose level at 12.2 ± 4.95mmol/L.Of these 599 patients,581 with foot gangrene and 18 with hand and upper extremity gangrene were found.Pathological diagnosis showed that there were 457 cases with wet gangrene,48 cases with dry gangrene and 94 cases with mixture.Treatment Combined traditional Chinese medicine and western medicine included three aspects:basic treatment,debridement and healing.First,intensive blood glucose control,anti infection and diabetic complication treatment procedures were taken.In the same time,intravenous injection,artery injection and acupoint injection of traditional Chinese drugs Chuan Xiong Qin and mailuonin(MLN) combined with raceanisodamine were underwent to promote general and local blood circulation and remove blood stasis.Percutaneous Transluminal Angioplasty(PTA) was also carried to the patients with large blood vessel blocked.According to clinical and pathological manifestation,the patient’ s gangrene was classified to different grades.Combination therapy including liquid medicine,medicated pad,ointment and membrane was used differently for wound debridement,drainage and over coating in different grades.Results:In 599 inpatients with diabetic gangrene,525 cases(87.7%) achieved clinical cure,38 cases(6.3%) effective and 12 cases(2.0%) ineffective.Surgical amputation underwent in 10 cases(1.7%).14 cases(2.3%) died for acute myocardial infarction,kidney function failure or stroke.Conclusion:Our study indicated traditional Chinese medicine and western medicine combination therapy has an important role in the treatment of diabetic gangrene.Promotion of general and local blood circulation and removal of blood stasis were in connection with wound debridement,drainage and over coating can help local tissue healing.Percutaneous Transluminal Angioplasty significantly improved the clinical outcome in large vessel blocked patients.This study showed combination therapy could decrease surgical amputation incidence,reduce disability and enhance the patient’s life quality.Treatment combined traditional Chinese medicine with western medicine in diabetic gangrene was shown to be clinically practical and very effective.更多还原