Mehmood Khalid, Akhtar S Tehseen, Talib Abu, Talib Abu, Abbasi Badar, Naqvi Iftikhar Haider
Department of Medicine, Down University of Health Sciences and Civil Hospital, Karachi.
J Coll Physicians Surg Pak. 2008 Jul;18(7):408-12.
To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation.
Cross-sectional descriptive study.
Study was conducted at the Department of Medicine, Civil Hospital Karachi, from January 2005 to December 2006.
One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated.
A majority of subjects had type 2 diabetes (95.7%) with male predominance (66%). The mean age was 54.29 +/- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 (78.4%) patients, while rest of the 25 (22.6 %) had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 (77.7%) patients healed without amputation and 17 (14.7%) patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis (p<0.05).
Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer.
确定糖尿病足溃疡的主要危险因素及治疗效果，以预防截肢。
横断面描述性研究。
2005年1月至2006年12月在卡拉奇市民医院内科进行研究。
对116例连续的瓦格纳分级为1至4级的糖尿病足溃疡患者进行基线评估，收集人口统计学信息、详细病史、神经病变、外周脉搏及糖尿病并发症发生频率。根据糖化血红蛋白水平确定血糖控制情况。进行适当的内科及外科治疗，并对患者进行随访，直至伤口愈合或随访6个月作为研究终点。记录结果为愈合、未完全愈合及截肢。
大多数受试者患有2型糖尿病（95.7%），男性居多（66%）。平均年龄为54.29±7.71岁。大多数患者超重、血糖高且糖尿病病程超过10年。91例（78.4%）患者为神经性溃疡，其余25例（22.6%）为神经缺血性溃疡。伤口培养显示为多种微生物感染。89例（77.7%）患者的足部溃疡未截肢而愈合，17例（14.7%）患者进行了大或小截肢。糖尿病病程长、血糖控制不佳及足部溃疡类型对预后有影响（p<0.05）。
有效的血糖控制、最佳的伤口护理、积极的内科治疗及及时的外科干预可降低致残率，改善糖尿病足溃疡的治疗效果。
