Carrington A L, Abbott C A, Griffiths J, Jackson N, Johnson S R, Kulkarni J, Van Ross E R, Boulton A J
Diabetes Foot Clinic, Disablement Services Centre, Withington Hospital, Manchester, UK.
Diabetes Care. 2001 Feb;24(2):216-21. doi: 10.2337/diacare.24.2.216.
To assess the efficacy of a specialist foot care program designed to prevent a second amputation and to assess peripheral vascular disease (PVD) and peripheral neuropathy in diabetic unilateral lower-limb amputees.
Investigations were carried out in 143 diabetic lower-limb unilateral amputees referred to a subregional rehabilitation center for prosthetic care from a catchment area of approximately 3 million people. Peripheral vascular and nerve assessment, education, and podiatry were provided for each patient.
For the patients referred to the foot care program, there were no baseline differences between the patients who proceeded to a bilateral amputation (n = 22) and those who remained as unilateral amputees (n = 121) in their level of foot care knowledge and mean neuropathy scores. Mean ankle-brachial pressure index was significantly lower for the bilateral amputees (0.75 +/- 0.04) compared with the unilateral amputees (0.90 +/- 0.03, mean +/- SEM, P < 0.05), but there was no difference in the level of oxygen in the skin. However, the level of carbon dioxide was significantly lower in patients with bilateral amputation (24.21 +/- 2.16 vs. 31.20 +/- 0.85 mmHg, P < 0.03). Overall, the establishment of a specialist foot care program made no impact on contralateral limb amputation (22 of 143, 15.4%) compared with matched patients without the program (21 of 148, 14%) over a 2-year outcome period for each patient.
PVD is more closely associated with diabetic bilateral amputation than neuropathy or level of foot care knowledge. Preventative foot care programs for diabetic unilateral amputees should therefore place greater emphasis on peripheral vascular assessment to identify patients at risk and on the development of timely intervention strategies.
评估一项旨在预防再次截肢的专科足部护理计划的疗效，并评估糖尿病单侧下肢截肢患者的外周血管疾病（PVD）和外周神经病变。
对143例糖尿病下肢单侧截肢患者进行了调查，这些患者来自一个约有300万人口的集水区，被转介到一个地区性康复中心接受假肢护理。为每位患者提供了外周血管和神经评估、教育以及足病治疗。
对于被转介到足部护理计划的患者，在足部护理知识水平和平均神经病变评分方面，进行双侧截肢的患者（n = 22）和仍为单侧截肢的患者（n = 121）之间在基线时没有差异。与单侧截肢患者（0.90 +/- 0.03，平均值 +/- 标准误，P < 0.05）相比，双侧截肢患者的平均踝肱压力指数显著更低（0.75 +/- 0.04），但皮肤中的氧水平没有差异。然而，双侧截肢患者的二氧化碳水平显著更低（24.21 +/- 2.16对31.20 +/- 0.85 mmHg，P < 0.03）。总体而言，在每位患者为期2年的观察期内，与没有该计划的匹配患者（148例中的21例，14%）相比，专科足部护理计划的设立对侧肢体截肢情况没有影响（143例中的22例，15.4%）。
PVD与糖尿病双侧截肢的关联比神经病变或足部护理知识水平更为密切。因此，针对糖尿病单侧截肢患者的预防性足部护理计划应更加强调外周血管评估，以识别有风险的患者，并制定及时的干预策略。
