糖尿病患者足部浅Ⅱ度烧伤的临床特点及治疗方法  

Clinical characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet

作　　者：凌翔伟[1] 张婷婷 戴文统 夏卫东[1] 林才[1] Ling Xiangwei;Zhang Tingting;Dai Wentong;Xia Weidong;Lin Cai(Department of Burns, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China)

机构地区：[1]温州医科大学附属第一医院烧伤科,温州325000

出　　处：《中华烧伤杂志》2019年第1期25-30,共6页Chinese Journal of Burns

基　　金：温州市科技计划(Y20160328).

摘　　要：目的分析糖尿病患者足部浅Ⅱ度烧伤的临床特点及治疗方法。方法2011年1月-2017年12月,笔者单位收治足部浅Ⅱ度烧伤患者83例,其中男46例、女37例,年龄(60±11)岁,烧伤足数119只,回顾分析其病历资料。根据是否合并糖尿病,将患者分为糖尿病组41例(60只足)和非糖尿病组42例(59只足)。糖尿病组和非糖尿病组患者均给予全身治疗和创面换药治疗。根据患者意愿和治疗方式,将37例足部创面转化为深Ⅱ度的糖尿病患者分为削痂组14例和非削痂组23例。削痂组患者采取早期手术削痂,非削痂组患者给予创面换药。统计糖尿病组和非糖尿病组患者住院时间、住院治疗费用,入院后即刻足背动脉及胫后动脉搏动情况,治疗期间足部创面加深情况和创面愈合率,以及削痂组和非削痂组患者入院后即刻足背动脉及胫后动脉搏动情况,治疗期间足部创面加深情况、创面细菌及真菌检出率、创面愈合率。对数据行χ2检验、t检验、Fisher确切概率法检验、Mann-WhitneyU检验。结果糖尿病组患者住院时间为(29±20)d,长于非糖尿病组的(19±13)d,t=2.730,P<0.01。糖尿病组患者住院治疗费用为(46988±41322)元,明显高于非糖尿病组的(29106±24813)元,t=2.396,P<0.05。糖尿病组患者足背动脉及胫后动脉搏动明显弱于非糖尿病组(Z=3.278、2.194,P<0.05或P<0.01)。糖尿病组患者足部创面加深为深Ⅱ度、Ⅳ度百分比为88.3%(53/60)、23.3%(14/60),明显高于非糖尿病组的47.5%(28/59)、1.7%(1/59),χ2=22.867、12.644,P<0.01。糖尿病组患者足部创面愈合率为78.3%(47/60),明显低于非糖尿病组的100.0%(59/59),χ2=14.351,P<0.01。削痂组患者共21只足,非削痂组患者共32只足。削痂组与非削痂组患者足部足背动脉及胫后动脉搏动情况比较,差异无统计学意义(Z=0、0.453,P>0.05)。非削痂组患者足部创面加深为Ⅳ度百分比为43.8%(14/32),明显高于削痂组的0(χ2=12.486,P<0.01)�Objective To analyze the characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet. Methods Eighty-three patients with superficial partial-thickness burn on 119 feet were hospitalized in our unit from January 2011 to December 2017. The medical records of the patients with 46 men and 37 women, aged 60±11 were retrospectively analyzed. The patients were divided into diabetes group and non-diabetes group according to whether they had diabetes or not, with 41 patients (60 burn feet) in diabetes group and 42 patients (59 burn feet) in non-diabetes group. Patients in diabetes group and non-diabetes group were given systemic treatment and wound dressing change. Thirty-seven diabetic patients whose wounds deepened to deep partial-thickness were divided into eschar shaving group and non-eschar shaving group according to patients′ willingness and the treatment, with 14 patients in eschar shaving group and 23 patients in non-eschar shaving group. Patients in eschar shaving group were given eschar shaving operation at early stage, and patients in non-eschar shaving group were given wound dressing change. The length of hospital stay, hospitalization treatment expenses, pulse of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, and rates of wound healing on feet of patients in diabetes group and non-diabetes group were observed and calculated. Pulses of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, positive rates of bacteria and fungus in wounds on feet, and rates of wound healing on feet of patients in eschar shaving group and non-eschar shaving group were observed and calculated. Data were processed with chi-square test, t test, Fisher′s exact propability method, and Mann-Whitney U test. Results The length of hospital stay of patients in diabetes group was (29±20) d, which was significantly longer than that of patients in

关 键 词：烧伤 糖尿病足 削痂 

分 类 号：R587.1[医药卫生—内分泌]