糖尿病足综合征患者手术后失败的危险因素
Helen Anwander1, David Vonwyl1, Verena Hecht1
1Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Foot & ankle orthopaedics
|July 12, 2023
概括
糖尿病足综合征的再手术率很高,超过四分之一的患者需要进一步手术. 失败的关键风险因素包括多重,外围动脉疾病,高CRP,神经病变和缺失脚脉冲.
科学领域:
- 足部医学和外科手术
- 糖尿病学 糖尿病学
- 这是血管外科手术.
背景情况:
- 糖尿病足综合征带来了重大挑战,往往需要手术干预,如脱bridement或截肢.
- 在60天内重新进行手术是这些患者手术失败的关键指标.
- 确定手术成功的预测因素对于优化患者的治疗结果至关重要.
研究的目的:
- 确定糖尿病足综合征患者下肢脱bridement或截肢后的再手术相关的独立风险因素.
- 开发一个结合这些风险因素的预测模型,以估计各种截肢水平的成功率.
主要方法:
- 一项前性观察队列研究,涉及105名糖尿病足综合征患者 (174次手术).
- 评估解压/截断水平,重新启动状态,时间和潜在的风险因素.
- 考克斯回归分析用于确定失败的独立风险因素 (在60天内重新操作).
主要成果:
- 确定了五个独立的失败风险因素:多于一个 (HR 3.8),外围动脉疾病 (PAD,HR 3.1),C反应蛋白 (CRP) >100 mg/L (HR 2.9),糖尿病外围神经病变 (HR 2.9) 和非触觉足脉冲 (HR 2.7).
- 没有或有一个风险因素的患者,无论截肢程度如何,都表现出高的成功率.
- 随着存在的风险因素的数量,需要进一步手术的可能性显著增加,影响截肢水平的选择.
结论:
- 在糖尿病足综合征中,重新手术很常见,约有25%的病例发生.
- 已确定的风险因素 (多种,PAD,CRP升高,神经病变,非触觉脉冲) 对于预测手术结果至关重要.
- 由于存在多种风险因素,需要采取更具侵略性的手术方法,如下腿截肢,以达到更高的成功率.
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