治疗4周后面积缩小50%是愈合的可靠指标——对704例糖尿病患者的单中心队列分析

Fifty percent area reduction after 4 weeks of treatment is a reliable indicator for healing--analysis of a single-center cohort of 704 diabetic patients.

作者信息

Coerper Stephan, Beckert Stefan, Küper Markus A, Jekov Martin, Königsrainer Alfred

机构信息

Department of General and Transplant Surgery, University Hospital Tübingen, Germany.

出版信息

J Diabetes Complications. 2009 Jan-Feb;23(1):49-53. doi: 10.1016/j.jdiacomp.2008.02.001. Epub 2008 Apr 3.

DOI:10.1016/j.jdiacomp.2008.02.001

PMID:18394932

Abstract

INTRODUCTION

The aim of the study was to investigate whether an area reduction greater than 50% within the first 4 weeks of treatment is associated with a higher long-term probability of healing.

PATIENTS AND METHODS

We treated diabetic foot ulcers according to a comprehensive interdisciplinary wound care protocol. Follow-up was documented through a special wound documentation system. Data were entered into SPSS for statistical analysis to calculate the probability of healing according to the Kaplan-Meier method. Results were expressed as median (minimum-maximum), and the percentage of area reduction (PA) was defined as [(area(4 weeks)/area(baseline))x100)/area(baseline). Patients were divided into responders when PA reached at least 50% and nonresponders when PA was less than 50%. Healing was defined as PA=100%.

RESULTS

In total, 704 patients were included into the analysis. Median time of follow-up was 71 (2-365) days. Wound duration was 31 (1-4018) days, and the initial wound size was calculated to be 1.18 (0.1-99) cm(2). In 27.8%, there was a positive probing to bone; in 64.5%, both pedal pulses were not palpable. Major amputation rate was 2.8% and minor amputation rate was 10.2%. The overall probability of healing was 35% after 12 weeks, 41% after 16 weeks, and 73% after 1 year. The surrogate visit (4 weeks) was performed after a median of 27 (14-42) days without a difference between responders and nonresponders. There were 334 (47%) responders and 370 (53%) nonresponders. Responders had a significantly higher probability of healing compared with nonresponders (12 weeks: 52.3% vs. 18.4%, P=.0001; 16 weeks: 46.7% vs. 26.5%, P=.0001; 1 year: 82.5% vs. 64.9%, P=.0001).

CONCLUSIONS

The calculation of the percentage of area reduction after 4 weeks of treatment is a valid tool to estimate the probability of healing. In clinical practice, a reevaluation of the treatment schedule is recommended for wounds that do not reach 50% area reduction within the first 4 weeks of therapy.

摘要

引言

本研究的目的是调查治疗开始后4周内面积缩小超过50%是否与更高的长期愈合概率相关。

患者与方法

我们根据全面的跨学科伤口护理方案治疗糖尿病足溃疡。通过一个特殊的伤口记录系统记录随访情况。将数据录入SPSS进行统计分析，根据Kaplan-Meier方法计算愈合概率。结果以中位数（最小值 - 最大值）表示，面积缩小百分比（PA）定义为[（4周时的面积/基线面积）×100]/基线面积。当PA至少达到50%时患者被分为反应者，当PA小于50%时为无反应者。愈合定义为PA = 100%。

结果

总共704例患者纳入分析。中位随访时间为71（2 - 365）天。伤口持续时间为31（1 - 4018）天，初始伤口大小经计算为1.18（0.1 - 99）平方厘米。27.8%的患者骨探针检查呈阳性；64.5%的患者双侧足背动脉搏动未触及。大截肢率为2.8%，小截肢率为10.2%。12周后总体愈合概率为35%，16周后为41%，1年后为73%。中位27（14 - 42）天后进行替代访视（4周），反应者与无反应者之间无差异。有334例（47%）反应者和370例（53%）无反应者。与无反应者相比，反应者的愈合概率显著更高（12周：52.3%对18.4%，P = 0.0001；16周：46.7%对26.5%，P = 0.0001；1年：82.5%对64.9%，P = 0.0001）。