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

【摘要】：目的:觀察股動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)組治療組對比,評估比較遠期療效,以期為臨床醫(yī)生在選擇DF治療方案時提供循證醫(yī)學依據(jù)。通過對新發(fā)潰瘍影響因素進行分析,得出危險因素,指導患者避開危險因素,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,血糖等指標經(jīng)方差分析無統(tǒng)計學差異(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)股動脈穿刺,灌注溶栓劑和血管擴張劑。應用Seldinger法從患者同側(cè)或?qū)?cè)股動脈穿刺進入,對雙下肢動脈進行跟蹤X線數(shù)字減影血管照影,依次有股動脈、乆動脈、脛前動脈、脛后動脈、腓動脈及足背動脈,然后分批予藥物勻速灌注入左、右下肢動脈:尿激酶250000u1、罌粟堿30mg、山莨菪堿10ml、低分子肝素4ml、復方丹參30ml。給藥后再次照影,小血管分支增多,狹窄或閉塞部位改善,退出導管。對兩組進行隨訪,隨訪記錄新發(fā)潰瘍、踝肱指數(shù)(ABI)、糖化血紅蛋白(HbA1c)、振動覺閾值(VPT)、血清肌酐(Scr)、頸動脈斑塊、吸煙、飲酒及Barthel指數(shù)。應用多因素非條件Logistic回歸分析法對新發(fā)潰瘍影響因素進行分析。結(jié)果:70例患者隨訪率為100%。兩組潰瘍復發(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)計學差異(P0.05)。且藥物灌注組患者日常生活能力測定Barthel指數(shù)明顯優(yōu)于常規(guī)治療組(P0.05)。新發(fā)潰瘍獨立危險因素為ABI(1.0)、HbA1c(≥7.0%)、病程(≥10年)、頸動脈斑塊形成、吸煙(P0.05)。結(jié)論:(1)股動脈藥物灌注DF遠期效果較常規(guī)治療效果好,降低了DF潰瘍復發(fā)率,提高DF患者的生活質(zhì)量,減輕患者家庭經(jīng)濟負擔。(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發(fā)率。(3)臨床醫(yī)生在擇優(yōu)DF治療方案時,可根據(jù)適應癥選擇股動脈藥物灌注治療,達到近期療效顯著,又可減少遠期復發(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：1535653