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墨西哥一家三级医院感染性糖尿病足溃疡的临床和外科特征

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico.

作者信息

Cervantes-García Estrella, Salazar-Schettino Paz María

机构信息

Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.

出版信息

Diabet Foot Ankle. 2017 Sep 6;8(1):1367210. doi: 10.1080/2000625X.2017.1367210. eCollection 2017.

Abstract

: The objective of this study was to determine the clinical and surgical characteristics of diabetic foot ulcers in a tertiary level hospital in Mexico. : We performed a longitudinal, descriptive study from July, 2012 to August, 2015 on a sample composed of 100 patients with type 2 diabetes mellitus and infected diabetic foot ulcers. We analyzed socio-demographic variables, comorbidities, characteristics of ulcers, and the applied treatment. : We found that the most affected areas were the forefoot (48%) and the plantar region (55%) of the foot. Also, most of the patients arrived with advanced stages of diabetic foot ulcers, since 93% of the lesions were of grades III-V according to the Wagner classification. Moreover, lesions usually present with advanced states of infection, since 60% of the lesions were of grades 3-4 in the PEDIS scale. In addition, the great majority of the patients are prone to complications because we found that 43% of the patients suffered from hypertension, 47% of the patients had chronic kidney disease, and 45% reported smoking. In fact, 45% of the patients eventually suffered an amputation. We also found that the situation is more difficult because the great majority of the patients (96%) have a low level of education and very low income and they do not have any health insurance. Nevertheless, we also found that an efficient treatment can help in avoiding amputations, since 53% of grade IV and 25% of grade V lesions according to the Wagner system did not suffer an amputation. : Therefore, an effective antibiotic treatment and an education of the patient on the adequate care of their lesions are essential in increasing the welfare of patients, especially when they have a low level of education.

摘要

本研究的目的是确定墨西哥一家三级医院中糖尿病足溃疡的临床和手术特征。我们于2012年7月至2015年8月对100例2型糖尿病合并感染性糖尿病足溃疡患者进行了纵向描述性研究。我们分析了社会人口统计学变量、合并症、溃疡特征及应用的治疗方法。我们发现足部受影响最严重的区域是前足(48%)和足底区域(55%)。此外,大多数患者就诊时糖尿病足溃疡已处于晚期,因为根据瓦格纳分类,93%的病变为III - V级。而且,病变通常伴有严重感染,因为在PEDIS量表中60%的病变为3 - 4级。此外,绝大多数患者容易出现并发症,因为我们发现43%的患者患有高血压,47%的患者患有慢性肾病,45%的患者有吸烟史。事实上,45%的患者最终接受了截肢手术。我们还发现情况更为严峻,因为绝大多数患者(96%)教育程度低、收入极低且没有任何医疗保险。然而,我们也发现有效的治疗有助于避免截肢,因为根据瓦格纳系统,IV级病变中有53%以及V级病变中有25%未接受截肢手术。因此,有效的抗生素治疗以及对患者进行关于其伤口适当护理的教育对于提高患者的福祉至关重要,尤其是当他们教育程度较低时。

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