發(fā)布時間：2018-01-02 05:17

  本文關(guān)鍵詞：糖尿病足中醫(yī)辨證分型相關(guān)影響因素及與Wagner分級的相關(guān)性研究　出處：《山東中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 糖尿病足 中醫(yī)辨證分型 危險因素 截趾/肢

【摘要】：目的:探討糖尿病足中醫(yī)辨證分型的影響因素及與Wagner分級的相關(guān)性研究,重型糖尿病足、截趾/肢的危險因素。方法:選取2012-2016年于山東省立醫(yī)院內(nèi)分泌科住院的糖尿病足患者,其中符合納入標準的270例,對其資料進行回顧性分析。用二分類Logistic回歸分析確定發(fā)生重型糖尿病足和截趾/肢的危險因素。結(jié)果:(1)270例糖尿病足患者中,男女比例為:1.4:1,91.5%的患者年齡≥51歲,87.4%的患者糖尿病病程5年,91.1%的患者糖化血紅蛋白(Hb A1c)6.5%。(2)糖尿病足患者多并發(fā)糖尿病周圍神經(jīng)病變,燒/燙傷(54.7%)是足部潰瘍最常見的誘因,好發(fā)于足趾部位(63.7%)。(3)糖尿病足潰瘍分泌物細菌培養(yǎng)陽性率為71.2%。截趾/肢均發(fā)生在Wagner分級3-5級(重型)患者中,氣陰兩虛證組發(fā)生率最高(20.0%)。(4)寒濕阻絡(luò)證組總蛋白(TP)高于其他組,血清白蛋白(ALB)高于濕熱毒盛證組、熱毒傷陰證組、氣陰兩虛證組,氣陰兩虛組血小板計數(shù)(Pt)高于寒濕阻絡(luò)證組、血脈瘀阻證組、濕熱毒盛證組,p0.05。(5)下肢動脈閉塞以血脈瘀阻證組多見。(6)寒濕阻絡(luò)證組、血脈瘀阻證組主要見于Wagner分級0-2級(輕型)的患者,p0.05;熱毒傷陰證組、氣陰兩虛證組主要見于重型的患者,p0.01。(7)WBC計數(shù)高(OR=1.128,95%CI:1.032~1.233)、下肢動脈閉塞率高(OR=2.233,95%CI:1.253~3.980)為發(fā)生重型糖尿病足的危險因素,血紅蛋白水平高(OR=0.979,95%CI:0.965~0.993)是其保護性因素。(8)足部骨壞死率高(OR=15.491,95%CI:5.016~47.847)、下肢動脈閉塞率高(OR=2.837,95%CI:1.106~7.275)是發(fā)生截趾/肢的危險因素。結(jié)論:(1)糖尿病病程較長、血糖控制偏差、年齡偏大的患者易發(fā)生糖尿病足。其發(fā)生常有誘因和病原菌感染。(2)寒濕阻絡(luò)證組多見于糖尿病足初期,病情較輕,其總蛋白(TP)高于其他組;氣陰兩虛證組多見于糖尿病足后期,病情較重,發(fā)生截趾/肢率較高。(3)感染、下肢動脈閉塞率高是重型糖尿病足的危險因素,足部壞死、下肢動脈閉塞增加了截趾/肢的風險。
[Abstract]:Objective: To study the correlation factors of TCM syndrome types of diabetic foot and Wagner grading, severe diabetic foot risk factors, limb amputation. Methods: the patients with diabetic foot 2012-2016 in the Department of endocrinology of Shangdong Province-owned Hospital hospital, 270 cases which meet the inclusion criteria, the data were retrospectively analyzed by analysis. To determine the occurrence of the risk factors of limb with severe diabetic foot and amputation / two classification Logistic regression. Results: (1) 270 cases of patients with diabetic foot, male and female ratio: 1.4:1,91.5% of the patients were older than 51 years old, 87.4% patients with diabetes duration of 5 years, 91.1% of the patients with glycosylated hemoglobin (Hb A1c) 6.5%. (2) diabetic foot patients complicated with diabetic peripheral neuropathy, burn / scald (54.7%) is the most common cause of foot ulcers, good hair at the toe position (63.7%). (3) of diabetic foot ulcer secretions bacterial culture positive rate was 71.2 % of amputation occurred in 3-5 grade Wagner (severe) in patients with Qi and yin deficiency group had the highest rate (20%). (4) cold dampness syndrome group total protein (TP) was higher than other groups, serum albumin (ALB) was higher than that of dampness heat group, poison Yin Qi and Yin deficiency syndrome group. Qi and yin deficiency syndrome group, platelet count (Pt) group was higher than that of cold dampness syndrome group, blood stasis group, dampness heat group, p0.05. (5) with lower extremity arterial occlusion of blood stasis syndrome group. (6) cold dampness syndrome group, blood stasis group mainly in Wagner grade 0-2 level (light) in patients with P0.05; poison Yin Syndrome group, Qi deficiency group mainly in severe patients, p0.01. (7) WBC high count (OR=1.128,95%CI:1.032~1.233), lower extremity arterial occlusion rate (OR=2.233,95%CI:1.253~3.980) for high risk factors of severe diabetic foot, high levels of hemoglobin (OR=0.979,95%CI:0.965~0.993) is its protection Protective factors. (8) the foot bone necrosis rate (OR=15.491,95%CI:5.016~47.847), lower extremity arterial occlusion rate (OR=2.837,95%CI:1.106~7.275) is the risk factors of limb amputation. Conclusion: (1) a longer duration of diabetes, blood sugar control deviation, older patients susceptible to diabetic foot. It often causes and pathogens bacterial infection. (2) cold dampness syndrome group in early diabetic foot, the illness is lighter, the total protein (TP) was higher than that of other groups; Qi and yin deficiency was more common in diabetic foot late, severe illness, occurrence of amputation rate is higher. (3) infection, lower limb arterial occlusion rate is dangerous factors of severe diabetic foot foot necrosis, lower extremity arterial occlusion increased the risk of amputation.

【學位授予單位】：山東中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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