老年糖尿病足截肢相关因素分析  

Analysis of relative factors of diabetic foot amputation in elderly patients

作　　者：邓武权[1] 余琼武[2] 陈兵[1] 艾智华[1] 刘颖[1] 王富华[1] 

机构地区：[1]第三军医大学西南医院内分泌科,重庆市400038 [2]第三军医大学西南医院眼科,重庆市400038

出　　处：《实用老年医学》2009年第3期183-186,共4页Practical Geriatrics

基　　金：国家十一五攻关课题(2006BAI02B08)

摘　　要：目的分析老年糖尿病足住院患者的临床特点和截肢的相关因素。方法通过我院检索系统收集2000～2007年收治的220例≥60岁的糖尿病足患者,按其住院期间是否实施截肢手术分成:截肢组58例,未截肢组162例。回顾性分析其临床特征与截肢之间的关系。结果老年糖尿病足的截肢率为26.4%。截肢组的入院血糖、糖化血红蛋白及白细胞计数均高于未截肢组(P<0.05或P<0.01),而血红蛋白低于未截肢组(P<0.05);低蛋白血症、糖尿病周围血管病变、骨髓炎、坏疽以及高Wanger分级者多于未截肢组(P<0.05或P<0.01)。多因素非条件Logistic回归分析显示:糖化血红蛋白(OR=1.69,P=0.007)、低蛋白血症(OR=4.71,P=0.006)、坏疽(OR=3.24,P=0.043)、糖尿病足Wanger分级(OR=1.18,P=0.001)是老年住院糖尿病足患者截肢的独立危险因素,而血红蛋白(OR=0.85,P=0.03)是独立保护性因素。结论老年糖尿病足住院患者有很高的截肢率,积极控制血糖,改善营养状态,尤其是早期及时多科协作治疗是避免糖尿病足截肢的关键。Objective To evaluate the relationship between clinical characteristics and amputation in elderly patients with diabetic foot （DF）. Methods A total of 220 consecutive patients aged ≥ 60 years with DF were included from 2000 to 2007 with NO. 1 Military Medical Project. According to whether undergoing in-hospital amputation, patients were divided into amputation group（n = 58） and non-amputation group （n = 162）. The relationship between clinical characteristics and amputation were retrospectively analyzed. Results Compared with non-amputation group, the level of blood glucose on admission and the level of HbA1 c, peripheral blood WBC count were higher in amputation group, while the level of haemoglobin was lower in amputation group. Low proteinemia, diabetic peripheral arterial disease, osteomyelitis, gangrene and high Wanger grades were more frequent in amputation group than those in non-amputation group. Multifactorial unconditional Logistic regression analysis showed that HbAI c value, low proteinemia, gangrene, high Wanger grades were the independent risk factors of in-hospital amputation in elderly patients with DF,but haemoglobin was the independent pro- tective factor. Conclusions The elderly patients with DF have high rate of amputation in hospital. Actively controlling blood glucose, improving nutritional state, especially earlier and interdisciplinary treatment are Critical for avoiding ampulation.

关 键 词：糖尿病足 老年人 截肢 

分 类 号：R587.1[医药卫生—内分泌]