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[糖尿病足溃疡感染的多学科管理]

[Multidisciplinary management of diabetic foot ulcer infection].

作者信息

Blanchette V, Brousseau-Foley M

机构信息

Université du Québec à Trois-Rivières, programme de médecine podiatrique, département des sciences de l'activité physique, 3351, boulevard des Forges, CP 500, G9A 5H7 Trois-Rivières, Québec, Canada.

Université du Québec à Trois-Rivières, programme de médecine podiatrique, département des sciences de l'activité physique, 3351, boulevard des Forges, CP 500, G9A 5H7 Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affilié à l'Université de Montréal, Faculté de Médecine, Groupe de médecine familiale universitaire de Trois-Rivières, G9A 1X9 Trois-Rivières, Québec, Canada.

出版信息

Rev Med Interne. 2021 Mar;42(3):193-201. doi: 10.1016/j.revmed.2020.09.004. Epub 2021 Jan 12.

DOI:10.1016/j.revmed.2020.09.004
PMID:33451819
Abstract

Infection is one of the most common complications of diabetic foot ulceration resulting in lower extremity amputations and early mortality in this population. Several factors influence the course of diabetic foot ulceration infection and in that context, integrated multidisciplinary management is required as soon as possible. In fact, a holistic interdisciplinary approach should be the standard of care. Whether the infection is categorized as mild, moderate or severe, with or without bone infection, the overall individual's characteristics must be addressed, in addition to local wound care, offloading and antibiotic therapy. Some severe infections have potential indications for hospitalization and are considered as surgical emergencies. In some DFU cases, surgical revascularization of the limb is mandatory to treat the infection. However, surgical interventions and amputations, are sometimes inevitable, they are predictors of bad prognosis. Although some adjuvant therapies are effective to promote wound healing, their use is not recommended to treat diabetic foot ulcer infection. Infection management can be divided into three general interventions: proper clinical diagnosis, microbiological and imaging investigations, and treatment. This review is an update on the up-to-date evidences in scientific literature and includes the latest recommendations from the International Working Group on the Diabetic Foot (IWGDF).

摘要

感染是糖尿病足溃疡最常见的并发症之一,可导致该人群下肢截肢和早期死亡。多种因素影响糖尿病足溃疡感染的病程,在此背景下,需要尽快进行综合多学科管理。事实上,全面的跨学科方法应成为护理标准。无论感染被分类为轻度、中度还是重度,有无骨感染,除了局部伤口护理、减压和抗生素治疗外,还必须考虑个体的整体特征。一些严重感染有住院的潜在指征,被视为外科急症。在一些糖尿病足溃疡病例中,肢体的外科血管重建对于治疗感染是必不可少的。然而,手术干预和截肢有时是不可避免的,它们是预后不良的预测因素。尽管一些辅助治疗对促进伤口愈合有效,但不建议用于治疗糖尿病足溃疡感染。感染管理可分为三项一般干预措施:正确的临床诊断、微生物学和影像学检查以及治疗。本综述是对科学文献中最新证据的更新,并纳入了国际糖尿病足工作组(IWGDF)的最新建议。

相似文献

1
[Multidisciplinary management of diabetic foot ulcer infection].[糖尿病足溃疡感染的多学科管理]
Rev Med Interne. 2021 Mar;42(3):193-201. doi: 10.1016/j.revmed.2020.09.004. Epub 2021 Jan 12.
2
Diagnosis and treatment of diabetic foot infections.糖尿病足感染的诊断与治疗
Plast Reconstr Surg. 2006 Jun;117(7 Suppl):212S-238S. doi: 10.1097/01.prs.0000222737.09322.77.
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Diagnosis and management of infection in the diabetic foot.糖尿病足感染的诊断与治疗。
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Adjuvant antibiotic loaded bio composite in the management of diabetic foot osteomyelitis - A multicentre study.载抗生素生物复合材料辅助治疗糖尿病足骨髓炎——一项多中心研究
Foot (Edinb). 2019 Jun;39:22-27. doi: 10.1016/j.foot.2019.01.005. Epub 2019 Jan 11.
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[Prevention of diabetic foot].[糖尿病足的预防]
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Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study.糖尿病足溃疡住院患者的伤口愈合影响因素:MEDFUN 研究结果。
Endocr Regul. 2020 Jul 1;54(3):207-216. doi: 10.2478/enr-2020-0023.
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Surgical management of diabetic foot infections and osteomyelitis.糖尿病足感染与骨髓炎的外科治疗
Clin Podiatr Med Surg. 2007 Jul;24(3):469-82, viii-ix. doi: 10.1016/j.cpm.2007.04.001.
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Diagnostics and treatment of the diabetic foot.糖尿病足的诊断与治疗。
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Prospective Validation of the Value of Adding Osteomyelitis to Moderate and Severe Categories of Diabetic Foot Infections.前瞻性验证将骨髓炎添加到糖尿病足感染的中度和重度类别中的价值。
Int J Low Extrem Wounds. 2022 Dec;21(4):651-657. doi: 10.1177/15347346221116740. Epub 2022 Aug 4.
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Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study.糖尿病足溃疡患者下肢截肢的预测因素:来自多中心观察性研究 MEDFUN 的结果。
J Foot Ankle Res. 2019 Jun 14;12:34. doi: 10.1186/s13047-019-0345-y. eCollection 2019.

引用本文的文献

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Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management.糖尿病足溃疡与神经病变综合综述:治疗、预防与管理
World J Diabetes. 2025 Mar 15;16(3):100329. doi: 10.4239/wjd.v16.i3.100329.
2
Association between DASH and novel atherogenic risk factors, anthropometric indices and foot ulcer indicators in type 2 diabetic patients with foot ulcer: a cross-sectional study.2型糖尿病足溃疡患者中DASH与新型动脉粥样硬化风险因素、人体测量指标及足部溃疡指标之间的关联:一项横断面研究
J Diabetes Metab Disord. 2024 Apr 16;23(1):1315-1327. doi: 10.1007/s40200-024-01427-1. eCollection 2024 Jun.
3
Epalrestat is effective in treating diabetic foot infection and can lower serum inflammatory factors in patients.
依帕司他对治疗糖尿病足感染有效,且能降低患者血清炎症因子水平。
Am J Transl Res. 2023 Oct 15;15(10):6208-6216. eCollection 2023.
4
Advances in traditional Chinese medicine as adjuvant therapy for diabetic foot.中医作为糖尿病足辅助治疗的进展
World J Diabetes. 2022 Oct 15;13(10):851-860. doi: 10.4239/wjd.v13.i10.851.