创面-缺血-足部感染分级预估糖尿病肢体动脉闭塞症腔内治疗术后截肢的临床研究  

Clinical research on predicting the outcome of amputation of diabetic arterial occlusion by WIFi classification after endovascular therapy

作　　者：王建国 孟祥红 孙岩[3] 王玉涛 Wang Jianguo;Meng Xianghong;Sun Yan;Wang Yutao(Department of Interventional Therapy,Zhanhua District People’s Hospital of Binzhou City,Binzhou 256800,China;Department of Health and Physical Examination,Zhanhua District People’s Hospital of Binzhou City,Binzhou 256800,China;Department of Vascular Surgery,Shandong Provincial Hospital,Jinan 250012,China;Department of Peripheral Vascular Surgery,Jinan Municiple Hospital of Traditional Chinese Medicine,Jinan 250012,China)

机构地区：[1]滨州市第二人民医院滨州市沾化区人民医院介入科,256800 [2]滨州市第二人民医院滨州市沾化区人民医院健康体检科,256800 [3]山东大学附属山东省立医院血管外科,济南250012 [4]济南市中医医院周围血管病科,250012

出　　处：《中华普通外科学文献（电子版）》2020年第1期35-38,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：山东省医药卫生科技发展计划(2018WS273,2018WS478);济南市第二届优秀卫生计生人才培养项目(济卫科外发〔2018〕8号);济南市第三批“薪火传承231工程”培养项目(济中医药发〔2017〕11号);济南市卫生健康系统青年岗位能手培养项目(济卫发〔2019〕1号)

摘　　要：目的探讨创面-缺血-足部感染(WIFi)分级预估糖尿病肢体动脉闭塞症(DAO)患者腔内治疗术后发生截肢的临床意义。方法回顾性分析2015年7月至2018年7月山东省立医院、济南市中医医院和滨州市沾化区人民医院收治的DAO患者80例,根据是否截肢分为截肢组(44例)和未截肢组(36例),运用Logistic回归分析患者术后发生截肢的独立危险因素。结果两组患者在性别(χ^2=1.678,P=0.195)、年龄(t=1.697,P=0.094)、糖化血红蛋白(t=-0.419,P=0.677)、体质指数(t=-0.236,P=0.814)、入院空腹血糖(t=-0.640,P=0.524)、糖尿病病程(t=-0.732,P=0.466)、高血压病史(χ^2=1.347,P=0.466)等方面差异无统计学意义。截肢组W、I、Fi高级别的患者较未截肢组多,差异均有统计学意义(χ^2=27.963、30.901、19.140,均P<0.001)。Logistic回归分析显示,W、I、Fi均为DAO患者腔内治疗术后发生截肢的独立危险因素(95%CI:0.022~0.309,0.020~0.319,0.073~0.900,P<0.001、<0.001、0.034)。结论下肢缺血程度、下肢创面或坏疽以及感染等情况是影响DAO腔内治疗后截肢的独立危险因素,WIFi分级可有效预测DAO腔内治疗后截肢情况。Objective To evaluate the clinical significance of wound-ischemia-foot infection(WIFi)classification in predicting the occurrence of amputation after endovascular therapy in patients with diabetic arterial occlusion(DAO).Methods Eighty patients with DAO in Shandong Provincial Hospital,Jinan Municiple Hospital of Traditional Chinese Medicine and Zhanhua District People’s Hospital from July 2015 to July 2018 were divided into two groups according to be amputated or not.Forty-four patients were included in the amputation group while 36 patients in the non-amputation group.The clinical data and WIFi grading after endovascular therapy were analyzed retrospectively.The independent risk factors of amputation in DAO patients were analyzed by Logistic regression.Results There were no significant differences in sex(χ^2=1.678,P=0.195),age(t=1.697,P=0.094),glycosylated hemoglobin(t=-0.419,P=0.677),body mass index(t=-0.236,P=0.814),fasting blood glucose(t=-0.640,P=0.524),duration of diabetes mellitus(t=-0.732,P=0.466)and history of hypertension(χ^2=1.347,P=0.466)between the two groups.The number of high-grade patients with woud(W),ischemia(I)and foot infection(Fi)in the amputation group was significantly higher than that in the non-amputation group(χ^2=27.963,30.901,19.140,all P<0.001).Logistic regression showed that W,I and Fi were independent risk factors for amputation in patients with DAO after intracavitary treatment(95%CI:0.022-0.309,0.020-0.319,0.073-0.900,P<0.001,<0.001,0.034).Conclusions The degree of lower limb ischemia,wound or gangrene of lower limb and foot infection are independent risk factors for amputation after intracavitary treatment of DAO.WIFi grade can effectively predict amputation after endovascular therapy of DAO.

关 键 词：糖尿病 动脉闭塞性疾病 截肢术 危险因素 WIFi分级 

分 类 号：R587.2[医药卫生—内分泌] R654.4[医药卫生—内科学]