The Mayer Institute, Hamilton, Ontario, Canada.
Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
Can J Diabetes. 2017 Feb;41(1):26-32. doi: 10.1016/j.jcjd.2016.06.007. Epub 2016 Sep 12.
Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs.
We conducted retrospective cohort study of adult patients who had DFUs and were referred to a single Canadian advanced diabetic foot and wound care centre between January 1, 2010, and December 31, 2010. The primary outcome was the healing rate at 52 weeks. The generalized estimating equation model was used to identify potential risk factors associated with delayed healing of DFUs.
Of the 40 patients for whom there were complete follow ups, 35 (87.5%) had healing of all DFUs by 52 weeks. Predictors of poor healing were the presence of chronic ulcers, ulcer sizes >1 cm, peripheral vascular disease and multiple ulcers at first presentation. Of the patients, 7.1% required amputation, and 8.9% of patients receiving our treatment died before 52 weeks. At 52 weeks of follow up, 16 of 17 recurrent ulcers and 68 of 108 pre-existing ulcers had healed. Compared to the unadjusted healing rate of preexisting ulcers (63.0%), the unadjusted healing rate of recurrent ulcers (94.1%) was significantly higher (p=0.01).
Our findings demonstrate that patients with DFUs in Canada who receive early and continued care from specialized, outpatient, advanced wound care centres experience significantly improved rates of healing of recurrent DFUs compared to pre-existing DFUs.
有关加拿大糖尿病足溃疡（DFU）患者结局的数据有限。本研究旨在评估溃疡愈合率，并确定在出现 DFU 后接受高级伤口护理的患者结局不良的预测因素。
我们进行了一项回顾性队列研究，纳入了 2010 年 1 月 1 日至 12 月 31 日期间在加拿大一家专门的糖尿病足和伤口护理中心就诊的患有 DFU 的成年患者。主要结局为 52 周时的愈合率。使用广义估计方程模型来确定与 DFU 愈合延迟相关的潜在风险因素。
在 40 例完成了完整随访的患者中，有 35 例（87.5%）在 52 周时所有 DFU 均愈合。愈合不良的预测因素为存在慢性溃疡、溃疡面积＞1cm、周围血管疾病和初次就诊时存在多个溃疡。在这些患者中，有 7.1%需要截肢，有 8.9%接受我们治疗的患者在 52 周前死亡。在 52 周的随访中，17 例复发性溃疡中有 16 例和 108 例既往存在的溃疡中有 68 例已经愈合。与未调整的既往存在溃疡愈合率（63.0%）相比，未调整的复发性溃疡愈合率（94.1%）显著更高（p=0.01）。
我们的研究结果表明，在加拿大，接受专门的、门诊、高级伤口护理中心的早期和持续护理的 DFU 患者，其复发性 DFU 的愈合率明显高于既往存在的 DFU。
