糖尿病足截趾患者的转归——5年的随访研究  

The outcomes of toe amputations in diabetic patients： a 5-year follow-up study

作　　者：孙好杰[1] 王鹏华[1] 丁敏[1] 徐俊[1] 郑志魁[1] 逯海波[1] 

机构地区：[1]天津医科大学代谢病医院,卫生部激素和发育重点实验室,糖尿病足科,300070

出　　处：《中华内分泌代谢杂志》2012年第3期201-206,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的观察糖尿病截趾患者的转归情况，并对影响因素进行分析。方法根据截趾后愈合情况，将245例糖尿病截趾患者分为愈合组（n=202）和未愈合组（n=43），分析影响愈合的因素。并对愈合组进行随访，记录患者足部新发溃疡、再截肢、死亡情况及日常生活能力状况，对影响因素进行相关分析。结果截趾后愈合率为82．4％。愈合组随访率为91．6％。1、3和5年的累积新发溃疡率为27．3％、57．2％和76．4％；1、3和5年的累积再截肢率为17．5％、22．3％和47．1％；1、3和5年的累积死亡率为3．8％、15．1％和32．7％，死亡患者平均生存期为3．8（95％C13．4—4．1）年。多因素分析：HbA1C（〉9％）是截趾术后愈合、新发溃疡和再截肢的危险因素；年龄（〉70岁）是再截肢、死亡和日常生活能力受损的危险因素。结论截趾术后愈合效果好，但愈合后长期随访结果并不乐观。高龄患者预后差，良好的血糖控制可改善预后。Objective To observe the outcomes of toe amputations in diabetic patients and to analyze the affecting factors. Methods Two-hundred and forty-five patients were divided into 2 groups： 202 cases with the wound healed after toe amputation, and 43 patients whose wound did not heal after toe amputation. The factors related to healing were analyzed. Patients with healed wounds after toe amputations （ n = 202 ） were followed, regarding reappearance of new ulcers, reamputations, mortality, activities of daily life, and the affecting factors. Results The rate of wound healing was 82. 4%. The rate of follow-up in the healed group was 91.6%. The rates of reappearance of new ulcers after 1,3, and 5 years of observation were 27.3% ,57.2%, 76. 4%, respectively. The rates of reamputations after 1,3, and 5 years of observation were 17.5%, 22. 3%, 47. 1%, respectively. The mortality rates by 1,3, and 5 years after the toe amputations were 3.8%, 15. 1% ,32. 7%, respectively. Mean survival time of the fatal cases after the first amputation was 3. 8 （95% CI 3.4-4. 1 ）years. Multivariate analysis showed that HbA1c （〉9%）was an independent predictor of wound healing, reappearance of new ulcers, and reamputations after toe amputations, and age （ 〉 70 years） was an independent predictor of reamputations, mortality, and hampered daily activities. Conclusion Despite a satisfactory initial healing process after the first amputation, the long-term outcomes of the followed-up patients are not optimistic. Senile patients are often with poor prognosis, and good blood glucose control may improve the prognosis.

关 键 词：糖尿病足 溃疡 截趾 死亡 

分 类 号：R587.1[医药卫生—内分泌] R658.3[医药卫生—内科学]