循征医学在糖尿病足治疗中的应用  

Application of evidence based medicine for diabetic foot

作　　者：王润秀[1] 宋振强[1] 

机构地区：[1]广西医科大学第一附属医院烧伤整形康复中心,广西壮族自治区南宁市530021

出　　处：《中国临床康复》2005年第35期138-140,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的：分析循证医学在糖尿病足治疗中应用的必要性，总结目前治疗糖尿病足的减压肢具，敷料，生物制剂，外科手术的系统评价和随机对照研究现状。 资料来源：应用计算机检索Medline 1985-01／2005-03有关糖尿病足治疗方面系统评价和随机对照实验的文章，检索词“diabetic foot or diabetic wound and(review or RCT)”，限定试验对象为人，语种为英文。 资料选择：对资料进行初筛，选择与糖尿病足治疗相关的文章，通过PML，OVID，EBSCO，Springer，Blackwell，Science direct等数据库或联系作者查找原文，去除重复文献及仅有文摘的文献。 资料提炼：共收集327篇，其中获得全文48篇，9篇为重复同一研究，入选39篇，其中Cochrane系统评价2篇。 资料综合：循征医学在糖尿病足治疗中应用的必要性主要体现为3个方面：循征医学提供了最佳的治疗方法；循证医学是有效治疗方法的甄别手段；循证医学有助患者参与临床决策。糖尿病足的分级目前国际上通用的是Wagner分级法和Texas大学糖尿病创面分级法。一般认为对于Wagner分级I～II的糖尿病创面采用换药，清创，和减压肢具。对于伴临床感染的患者给予广谱抗感染药物。对于Wagner分级III～V的糖尿病创面采用植皮、皮瓣转移修补创面，针对骨髓炎的治疗，改善循环(动脉搭桥手术)，应用静脉广谱抗感染药物和截肢。对糖尿病足治疗的各种策略(减压肢具、敷料、创面收缩、外科手术)进行概述分析。 结论：目前糖尿病足的治疗缺乏规范指导，循证医学可以提供最有效的证据，帮助临床制定最佳治疗方案。通过系统评价和随机对照试验得出的糖尿病足治疗方案可信度较高。但是目前糖尿病足治疗的随机对照研究仍存在样本较小的问题，部分研究由制造商赞助或实施，故仍需大样本的随机对照试验作为糖尿病足治疗决�AIM： To analyze the necessity of evidence based medicine （EBM） in the therapy of diabetic foot, and to sum up the system evaluation and controlled investigative actuality of off-loading cast, dressing, biological agent and surgical operation in the treatment of diabetic foot at present. DATA SOURCES： We searched tbe Medline for the related articles on the system evaluation and randomized controlled trial of diabetic foot with the key words ＂diabetic foot or diabetic wound and （review or RCT）＂ and limited the experimental objects to human, and the language limited to English. STUDY SELECTION： After the primary screening, the articles about diabetic foot therapy were selected and the full texts were found by using PML,OVID,FBSCO,Springer,Blackwell,Scicnce direct database etc. or asking for the authors. The articles with repeated experiments or without full texts were filtered. DATA EXTRACTION： 327 articles were collected, in which 48 full texts were obtained including 9 repeated experiments on the same one. Tirty-nine articles were included containing 2 Cochrane system evaluations. DATA SYNTHESIS： The necessity of EBM in the treatment of diabetic foot mainly showed in 3 aspects： The EBM provided the best therapeutical approaches; It was the discriminating method of effective treatment; It was helpful that the patients couht take part in the clinical decision. The universal grades of diabetic foot were Wagner grading and diabetes wound grading of Texas University in the world at present. General thinking, Ⅰ - Ⅱ grade diabetic wound of Wagner used dressing change, debridement and off-loading cast. The patients with clinical infection were treated with broadspectrum anti-infective drug, Ⅲ-Ⅴ grade diabetic wound of Wagner used dermatoplasty, transformation of skin flap to repair wound. For the treatment of osteomyelitis, the broad-spectrum anti-infective drugs in vein and amputated extremity were used to improve circulation （artery bypass surgery）. The overview analysis was performed

关 键 词：循证医学 糖尿病足/治疗 综述文献 

分 类 号：R587.1[医药卫生—内分泌]