| Background and objectiveWith the development of economy, the improvement of people’s living standard and the aging of the population, the morbidity of type2diabetes is increasing year by year in the global scope. Diabetic foot, one complication of type2diabetes, is one of the important reasons for the disability and death of the mid-term and advanced patients with type2diabetes. According to Khanolkar, diabetic patients have15～40times more chances of lower limb amputation than general population, of whom elderly diabetic patients have higher risk.15%～18%of Chinese patients with type2diabetes have foot complications, the amputation rate of whom reaches up to20%-30%. Diabetic foot is caused by many factors like the infection of the nerve of blood vessel, which adds to the difficulty of treatment. Healing in diabetic foot depends on many factors, including infection control, revascularization, treatment of neuropathy and debridement dressing and so on, all of which can influence and promote wound healing. This research focuses on multidisciplinary sequential therapy in the treatment of diabetic foot, the observation of its effect, and the analysis of the factors for promoting diabetic foot patients’wound healing as well as the search for them. Method120patients selected, who were being treated in our hospital because of diabetic foot from2010May to2012August, were in accordance with WHO diagnosis standard in1999, and diagnosed with type2diabetes, with patients with diabetic foot0lesions excluded.120patients selected had single or double foot ulcer, including72cases of single foot ulcer,48cases of double foot ulcer,67cases of superficial ulcer such as the blisters of grade1-2(friction injury, spontaneous bulla, burns, frostbite) callosum and cold injury,30cases of ulcer of grade3as deep as muscle tendon,17cases of the local gangrene of grade4,6cases of full foot gangrene of grade5, with34cases of the wet gangrene,63cases of mixed gangrene, and23cases of dry gangrene. During the first day after their hospitalization all of these patients underwent the fasting blood determination to mensurate their fasting blood glucose (FBG), postprandial blood glucose (2hBG)2hours after eating, glycosylated hemoglobin (HbAlc), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP) and ankle brachial index (ABI), the measurement of their skin temperature, the nerve EMG check which helps to diagnose diabetic peripheral neuropathy, and the color Dopplar ultrasound check of lower extremity artery which helps to diagnose lower extremity vascular disease, all of which were checked again after treatment. Sequential therapy was used for three months to treat these patients, which includes bringing high blood pressure down, lowering blood fat and sugar, maintaining nerve nutrition, improving circulation and giving anti-infection debridement dressing treatment, selecting further examination, treating some patients by using interventional therapy and suction drainage, and comparing the general condition and wound growth before and after treatment.ResultAfter3months of multidisciplinary treatment,71of120patients (59.17%) recovered completely, with the ineffective treatment of only2patients (1.67%).Comparing the biochemical indicators before and after treatment, I have found that FPG,2hPG, HbAlc, SBP, LDL-C, ABI, skin temperature all changed obviously before and after treatment (P＜0.05), which shows that the good control of blood glucose, SBP and LDL-C, together with increasing ABI and skin temperature is beneficial to the healing of diabetic foot ulcer. Comparing the numbers of patients with neurological or vascular lesions before and after treatment, I have found no significant difference between these two numbers (P＞0.05). Diabetic foot is a serious complication caused by infection and vascular neuropathy as the foundation. This research of treating by controlling the infection, improving circulation and maintaining the nerves, some with the further treatment of interventional therapy and suction drainage, led to the result that59.17%of120patients with diabetic feet fully recovered and23.33%improved obviously while only1.67%didn’t recover. Diabetic foot ulcers are mostly concurrent infection, most of which can be controlled by treating infection, with the ineffective control of the infection by the anti medicine germs leading to cutting legs. Secretion culture and drug sensitivity test can not be fully representative of the drug sensitivity of human body, so it can not be used as the only standard of antibiotic application. The treatment should be based on the clinical experience of symptoms and signs, and the appropriate antibiotics should be selected with the reference of the results of drug sensitivity.ConclusionThis research of treating diabetic foot by using multidisciplinary therapy is feasible and effective. |
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