Schwartz Suzanne B, Rothrock Michelanne, Barron-Vaya Yolanda, Bendell Chelsea, Kamat Ameet, Midgett Marianne, Abshire Jill, Biebighauser Kitra, Staiano-Coico Lisa F, Yurt Roger W
Department of Surgery, The Joan and Sanford I. Weill Medical College of Cornell University, New York, New York, USA.
J Burn Care Res. 2011 May-Jun;32(3):435-41. doi: 10.1097/BCR.0b013e318217f954.
Reducing diabetes mellitus complications has been a major focus for Healthy People 2010. A prior retrospective cohort of our burn center's admissions revealed worse outcomes among diabetic patients, that is, increased infection rates, grafting and graft complications, and increased length of hospital stay. Therefore, a prospective study has been designed to carefully assess wound repair and recovery of diabetic and nondiabetic burn patients. Our long-term aim is to determine the characteristics of the wound milieu along with global responses to injury that may predict poor outcome among diabetic patients. This is an initial phase of a larger observational study of in-hospital diabetic (types 1 and 2) and nondiabetic patients, prospectively matched for age (18-70 and >70 years) and burn size (<5, 5-15, and 16-25%). Time (days) to complete index wound closure, documented through serial photography, is the main outcome measure. Secondary measures compare delays in presentation, prevalence of infections, graft rates, wound and graft complications, adverse events, and length of hospital stay. Detailed history, physical, and baseline hemoglobin A1C are elicited from all subjects who are assessed daily over the initial 72 hours poststudy entry, then weekly until complete index wound closure, and finally monthly through 3 months. Forty subjects are presented herein, 24 diabetic and 16 nondiabetic patients. Time to index wound closure was significantly prolonged in diabetic patients, despite increased grafting. These findings suggest that excision and grafting in diabetic patients may not alone be sufficient to ensure rapid closure, as graft complications may contribute to protracted closure. Evaluating graft need may be more complex among diabetic patients, suggesting the need for alternative management strategies. The current prospective study confirms our previous retrospective analysis, notably manifested by significant delays in index wound closure. Our efforts continue in identifying the most important predictors of outcome, especially modifiable factors that would create a basis of intervention to improve care.
降低糖尿病并发症一直是《健康人民2010》的主要关注点。我们烧伤中心之前的一项回顾性队列研究显示，糖尿病患者的预后较差，即感染率增加、植皮及植皮并发症增多，住院时间延长。因此，我们设计了一项前瞻性研究，以仔细评估糖尿病和非糖尿病烧伤患者的伤口修复及恢复情况。我们的长期目标是确定伤口环境的特征以及对损伤的整体反应，这些可能预示糖尿病患者预后不良。这是一项针对住院糖尿病（1型和2型）和非糖尿病患者的更大规模观察性研究的初始阶段，根据年龄（18 - 70岁和>70岁）和烧伤面积（<5%、5 - 15%和16 - 25%）进行前瞻性匹配。通过连续摄影记录完成指数伤口闭合的时间（天）是主要结局指标。次要指标比较就诊延迟、感染发生率、植皮率、伤口及植皮并发症、不良事件和住院时间。从所有受试者中获取详细病史、体格检查和基线糖化血红蛋白A1C，在研究入组后的最初72小时内每天对其进行评估，然后每周评估直至指数伤口完全闭合，最后在3个月内每月评估一次。本文介绍了40名受试者，其中24名糖尿病患者和16名非糖尿病患者。尽管植皮增加，但糖尿病患者的指数伤口闭合时间显著延长。这些发现表明，糖尿病患者仅进行切除和植皮可能不足以确保快速闭合，因为植皮并发症可能导致闭合时间延长。评估糖尿病患者的植皮需求可能更为复杂，这表明需要替代管理策略。当前的前瞻性研究证实了我们之前的回顾性分析，特别是指数伤口闭合出现显著延迟。我们继续努力确定最重要的预后预测因素，尤其是可改变的因素，这将为改善护理的干预措施奠定基础。
