强化管理在糖尿病足高危患者保肢治疗中的意义  

Significance of reinforcing management on limb salvage therapy in patients at high risk for diabetic foot

作　　者：陈永松[1] 许文灿[1] 林少达[1] 黄少薇[1] 李冬英[1] 

机构地区：[1]汕头大学医学院第一附属医院内分泌科,广东省汕头市515041

出　　处：《中国临床康复》2003年第18期2556-2557,共2页Chinese Journal of Clinical Rehabilitation

基　　金：广东省卫生厅医学科研课题立项资助项目(B2001066)~~

摘　　要：目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。Aim To evaluate the efficacy of the comprehensive reinforcing managem en t and medical therapy to reduce amputation incidence and promote quality of life in diabetic patients at high risk for diabetic foot(DF).Methods 123 diabetic pa tients at high risk for diabetic foot were employed to participate in a 2-year prospective study.All of them received a routine education and foot care program for type 2 diabetes in Diabetic Care Center, and were randomly divided into two sex and age-matched groups: reinforcing management group(n=65,group A) and sta ndard management group(n=58, group B).Diabetic education questionnaire were cond ucted in all the patients before and after education. At the end of the investig ation, the differences between group A and group B were evaluated in the diabeti c knowledge, foot care knowledge, blood sugar control and incidence of diabetic foot ulcer and amputation. Results There was an insignificant difference between the general and foot care knowledge of the group A and B before and after 1 mon th intervention (P >0.05), but a significant difference between the two groups a fter 1-2 year intervention(P< 0.001).The concentration of HBA1c in the group A was (7.1±2.3)%, significantly lower than that of the group B [(8.5±4.2)%,t=2 .310,P< 0.05]. The average systolic pressure and diastolic pressure of the group A were (142±10)mmHg and (80±10)mmHg respectively, significantly lower than those of the group B [(158±9)mmHg and (92±10)mmHg respectively,t=9.019, 6.647 ,P< 0.05].The concentrations of total cholesterol and triacylglycerol in the gro up A were(4.4±1.1)mmol/L and (1.8±0.9)mmol/L respectively, significantly lower than those in the group B (5.6±2.6)mmol/L and (2.5±1.8)mmol/L respectively,t= 2.804, 2.745,P< 0.05].The DF incidence and amputated the group A were. 7.7% and 3.1% respectively,significantly olwer than sthose of the group B(20.7% and 13.8% repectively,t=4.347,4.712,p<0.05).Conclusion The reinforcing management was beneficial to reduce the incidence of diabeti

关 键 词：糖尿病足 高危 保肢治疗 综合强化管理 生活质量 随访 健康教育 

分 类 号：R587.2[医药卫生—内分泌] R473.5[医药卫生—内科学]