糖尿病足:一个综述
David G Armstrong1, Tze-Woei Tan1, Andrew J M Boulton2
1Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles.
JAMA
|July 3, 2023
概括
糖尿病足影响全球数百万人,导致截肢和死亡率增加. 早期的多学科护理和干预措施,如除血和减压, 显著改善结果并降低截肢率.
科学领域:
- 糖尿病学
- 伤口护理
- 公共卫生
背景情况:
- 糖尿病足每年影响全球1860万人,占糖尿病患者下肢截肢的80%.
- 这种疾病与较高的死亡率有关,五年死亡率约为30%,大截肢后超过70%.
- 存在差异,在黑人,西班牙裔和美洲原住民中观察到更高的DFU和截肢率,以及那些具有较低社会经济地位的人.
研究的目的:
- 总结糖尿病足的全球影响,风险因素和有效管理策略.
- 强调早期发现和干预对于预防截肢和死亡等严重并发症的重要性.
- 强调多学科管理的好处.
主要方法:
- 对DFU流行率和相关死亡率的流行病学数据的审查.
- 包括神经,血管和生物力学因素在内的贡献因素的分析.
- 评估各种干预措施,包括鞋类,卸载,除菌,感染控制和多学科护理.
主要成果:
- 诸如减压鞋和卸载热点等干预措施显著降低了发作的风险.
- 第一线治疗包括手术除血,降压,治疗缺血和感染.
- 与常规护理相比,多学科护理的截肢率显著降低 (3.2%对4.4%).
结论:
- 缺血症是全球严重的健康问题,截肢率和死亡率很高.
- 有效的管理依赖于除菌,减压,感染控制和及时多学科团队的参与.
- 为了减少糖尿病足的负担,继续研究和实施基于证据的策略至关重要.
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