本文選題：糖尿病足 + 糖尿病足潰瘍��； 參考：《蚌埠醫(yī)學(xué)院》2015年碩士論文

【摘要】：WHO將糖尿病足定義為:糖尿病患者由于合并神經(jīng)病變和各種不同程度的末梢血管病變而導(dǎo)致下肢感染、潰瘍和(或)深部組織的破壞。糖尿病足(diabetes foot,DF)又稱糖尿病肢端壞疽,是糖尿病常見(jiàn)且嚴(yán)重的并發(fā)癥,具有很高的致殘性和致死性,物理治療作為一種簡(jiǎn)便、經(jīng)濟(jì)、安全可靠的輔助治療手段,其療效已逐漸得到大多數(shù)學(xué)者的認(rèn)可。目的觀察物理治療方法(包括遠(yuǎn)紅外線、半導(dǎo)體激光、氣壓循環(huán))使用后DF患者生化指標(biāo)、下肢血管超聲及檢測(cè)結(jié)果,分析該綜合物理治療對(duì)糖尿病足潰瘍(diabetic foot ulcer,DFU)的臨床療效。方法收集2010年6月-2013年6月住院病人中80例DFU患者,均為2型糖尿病(type2 diabetic mellitus,T2DM)患者,符合1999年WHO糖尿病專家委員會(huì)提出診斷標(biāo)準(zhǔn)。將2010年6月至2012年1月收治的60例作為常規(guī)治療組,2012年2月以后病房開(kāi)展物理治療后收治的20例患者作為物理治療組,常規(guī)治療組采用常規(guī)綜合內(nèi)科抗感染、控糖等治療方法,物理治療組在使用常規(guī)治療上聯(lián)合物理療法,每天一次,采用序貫方法分別使用遠(yuǎn)紅外線照射、半導(dǎo)體激光照射及氣壓循環(huán),連續(xù)觀察3周,記錄兩組各項(xiàng)生化指標(biāo)、下肢血管超聲、潰瘍面積變化進(jìn)行比較。計(jì)量資料用平均值±標(biāo)準(zhǔn)差(x±s)表示,組間比較采用t檢驗(yàn),計(jì)數(shù)資料以陽(yáng)性例數(shù)、率表示,有效率比較采用χ2檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1、與治療前比較,常規(guī)治療組與物理治療組治療后血糖、血脂、CRP水平指標(biāo)均不同程度下降,其中物理治療組治療后CRP水平顯著低于常規(guī)治療組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、80例DFU患者下肢動(dòng)脈明顯病變者達(dá)56例,包括動(dòng)脈內(nèi)膜增厚、粥樣斑塊形成,管腔狹窄、血流速度減慢等。治療后,兩組患者股動(dòng)脈、乆動(dòng)脈、及足背動(dòng)脈的峰值流速均較治療前顯著好轉(zhuǎn)(P0.05),平均流速也有不同程度改善;物理治療組治療后股動(dòng)脈、足背動(dòng)脈的峰值流速、平均流速均顯著優(yōu)于常規(guī)治療組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、兩組患者經(jīng)過(guò)測(cè)量治療前后潰瘍面積比較,其中物理治療組顯效10例,有效7例,無(wú)效3例,總有效率為85.0%,常規(guī)治療組顯效23例,有效9例,無(wú)效28例,總有效率為53.3%。兩組總有效率比較,差異具有統(tǒng)計(jì)學(xué)意義(χ2=6.34,P0.05)。結(jié)論1、常規(guī)治療、常規(guī)治療聯(lián)合物理療法治療DFU均可取得一定的臨床效果。2、常規(guī)控糖、抗感染等治療同時(shí)聯(lián)合物理治療方案可改善局部血液循環(huán),促進(jìn)潰瘍愈合,減輕潰瘍面的炎癥反應(yīng),且操作簡(jiǎn)單,成本更低,值得推廣應(yīng)用。
[Abstract]:WHO defines diabetic foot as lower extremity infection, ulcers and / or destruction of deep tissues due to neuropathy and various peripheral vascular lesions.Diabetic foot gangrene (DFD) is a common and serious complication of diabetes mellitus. It has high disability and mortality. Physical therapy is a simple, economical, safe and reliable adjuvant treatment.Its curative effect has gradually been recognized by most scholars.Objective to observe the biochemical indexes, ultrasound of lower extremity blood vessels and the results of physical therapy (including far infrared ray, semiconductor laser, pneumatic circulation) in DF patients, and to analyze the clinical effect of this comprehensive physical therapy on diabetic foot ulcer foot ulcerus.Methods from June 2010 to June 2013, 80 DFU patients, all of whom were type 2 diabetes mellitus type 2 diabetic mellitusus T2DM, were collected. The results were in accordance with the diagnostic criteria put forward by the 1999 WHO Diabetes expert Committee.From June 2010 to January 2012, 60 patients were treated as routine therapy group, and 20 patients treated after physical therapy in ward after February 2012 were treated as physical therapy group. The routine treatment group was treated with routine comprehensive internal medicine anti-infection, sugar control and other treatment methods.The physiotherapy group was treated with routine physical therapy once a day, followed by sequential methods of far infrared radiation, semiconductor laser irradiation and air pressure circulation. The biochemical indexes of the two groups were recorded for 3 weeks.Lower extremity vascular ultrasound, ulcer area changes were compared.The measurement data were expressed by mean 鹵standard deviation (x 鹵s). T test was used for the comparison between groups, the counting data was expressed as positive cases and the rate was expressed. The effective rate was compared with 蠂 2 test (P0.05).Results 1. Compared with before treatment, the levels of blood glucose, blood lipids and serum lipids in the routine treatment group and the physiotherapy group were decreased in varying degrees, and the CRP level in the physiotherapy group was significantly lower than that in the routine treatment group.The difference was statistically significant in 56 patients with obvious lesions of lower extremity arteries in 80 patients with DFU, including intimal thickening, atherosclerotic plaque formation, stenosis of lumen, and slow down of blood flow.After treatment, the peak velocities of femoral artery, body artery and dorsum pedis artery in both groups were significantly improved compared with those before treatment, and the average velocity of flow was improved to some extent, and the peak velocity of femoral artery and dorsalis pedis artery in physiotherapy group was also improved.The mean flow velocity was significantly better than that in the routine treatment group (P 0.05). The area of ulcer in the two groups was measured before and after treatment. There were 10 cases in the physical therapy group, 7 cases in the effective group, and 3 cases in the failure group.The total effective rate was 85.0. In the routine treatment group, 23 cases were effective, 9 cases were effective, and 28 cases were ineffective. The total effective rate was 53.3%.There was significant difference in the total effective rate between the two groups (蠂 ~ 2 = 6.34, P 0.05).Conclusion (1) routine therapy, conventional therapy and physical therapy can all achieve certain clinical effects in DFU. The combination of conventional glucose control and anti-infection therapy and physical therapy can improve local blood circulation and promote ulcer healing.Reduce the inflammation of ulcer surface, and simple operation, lower cost, it is worth popularizing.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2

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本文編號(hào)：1737371