The Study On The Evolution Law Of Different Patterns Of Traditional Chinese Medicine In Diabetic Foot

【Objectives】To investigate the frequency of Diabetic foot. Summarize the characteristics of pathogens and the germs type of the wound infection of Diabetic foot patients. Observe the differences between the treatment with Traditional Chinese Medicine (TCM) and the treatment with western medicine only on mortality rate and amputation rate. Investigate the law of the distribution and evolution of patterns, and the correlation between the different patterns, the course of disease, pathogens and complications. Find out the advantages and disadvantages in the treatment of TCM, providing basis for the further treatment in clinic and research of TCM【Methods】The patients in the Guangzhou Hospital of TCM, during the period from JAN 12003 to DEC 31 2008, were retrospective analyzed, concluding the course of disease, the patterns of TCM, Wagner s classification, pathogens, susceptibility results, mortality, amputation, the evolution law of different patterns and dominant complications, such as Coronary Heart Disease, Cerebrovascular Disease, Hypertension, Dyslipidemia, Diabetic nephropathy Diabetic retinopathy. All data in this study would be analyzed by statistics software SPSS15.0【Results】165 Diabetic foot patients were hospitalized, including 329 cases in total. Among these patients,74 are male and 91 are female. There are 17 death cases, and the mortality rate is 10.30%. There are 8 amputation cases, and the amputation rate is 2.43%. There 32 cases that had to have the toe cut-off, and the rate is 9.73%. As for all the cases, the average age is (70.67±9.68) years old, with Diabetes mellitus for average (10.25±8.11) years, with Diabetic foot for average (5.24±10.06)months. The average level of Glycosylated hemoglobin is (7.95±2.36)%. The main classification varies from class 1 to class 4. The prevalence of the complications is Hypertension of 75.98%, Diabetic nephropathy of 37.08%, Dyslipidemia of 30.09%, Coronary Heart Disease of 28.57%, Cerebrovascular Disease of 23.40%, Diabetic retinopathy of 18.84%.228 secretion cultures were found, including 170 strains of bacteria,8 strains of fungi,41 negative and 9 polluted. Among the pathogens, Gram-negative bacteria (G-bacteria) is majority, including 15 species and 110 strains in total, while the Gram-positive bacteria (G+ bacteria) includes 15 species and 60 strains in total. Among the G-bacteria, the Escherichia coli and the Pseudomonas aeruginosa are the dominant species. Among the G+bacteria, the Slow aureus is the dominant species. The sensitivity of the common antimicrobial drugs, such as Penicillins, Cephalosporins and 4-quinolones, has dropped, especially the G+bacteria. The most sensitive antimicrobial drugs to the G+bacteria is Vancomycin, the next ones are Teicoplanin and Nitrofurantoin. The most sensitive antimicrobial drugs to the G-bacteria are Imipenem and Meropenem, the next one is Amikacin. No obvious differences of age, Glycosylated hemoglobin and the pathogens was found among all patterns, while some differences of the course of Diabetes mellitus, the course of Diabetic foot and complications were found. In the " Patterns of Deficient Spleen and Kidney Yang, Mucus and Congealed Blood Obstructing the Woof ", the course of Diabetes mellitus is longer, with more Coronary Heart Disease and Cerebrovascular Disease than other patterns. In the " Patterns of Deficient Liver and Kidney Yin, Woof Obstructed by Congealed Blood ", the course of Diabetic foot is longer, with more Diabetic retinopathy than other patterns. In the "Patterns of Dampness and Heat Reserves Toxin, Tendon and Muscle Rot ", the course of Diabetic foot is shorter than other patterns. In the " Patterns of Deficient Yang and Congealed Blood", more Dyslipidemia than other patterns. The " Patterns of Deficient Qi and Blood, Congealed Blood Obstructing the Woof " mostly appears in the process of the evolution of other patterns[Conclusion] Diabetic foot tends to happen in the older patients with long course of Diabetes mellitus and high level of Glycosylated hemoglobin. The treatment of integrating TCM and Western Medicine can get a lower amputation rate, and the combination of internal and external treatment can further reduce amputation rate.The majority of pathogens in the Diabetic foot infection is G-bacteria. It is very important to monitor the pathogens of Diabetic foot infection and its drug resistance. The evolution law of different patterns of Traditional Chinese Medicine in Diabetic foot might be: In the early stage, the "Patterns of Dampness and Heat Reserves Toxin, Tendon and Muscle Rot " is the majority. Then the pattern evolved to the "Patterns of Deficient Spleen and Kidney Yang, Mucus and Congealed Blood Obstructing the Woof ", while the course of Diabetes mellitus becoming longer or being complicated by Coronary Heart Disease and Cerebrovascular Disease; or evolved to the "Patterns of Deficient Liver and Kidney Yin, Woof Obstructed by Congealed Blood ", while the course of Diabetic foot becoming longer or being complicated by Diabetic retinopathy. The " Patterns of Deficient Qi and Blood, Congealed Blood Obstructing the Woof " would appear in the process of the evolution of other patterns. The " Patterns of Deficient Yang and Congealed Blood " would penetrate the hole course of Diabetic foot. Paying more attention to the medical records, completing the related test of patients and searching the perfect standard of patterns distinguishing are critical to the clinical and research of TCM in the future...