Záhumenský E, Rybka J, Adamíková A
Interní klinika IPVZ, Zlín.
Vnitr Lek. 1995 Aug;41(8):531-4.
Ischaemia, neuropathies and infections are predisposing factors for the development of ulceration of the diabetic foot. Diabetics have evidently a disposition for affections of the peripheral circulation and impaired regulation of the microcirculation as a result of autonomic neuropathy. The lower the driving pressure (in critical ischaemia), the more important are rheological factors and drugs which can influence them. These preparations include e.g. Trental (pentoxiphilline), Prostavasin (prostaglandin E1), Vessel due F (sulodexide). In advanced stages of ischaemic extremities oedema is a very adverse factor. Non-cardiac oedema can be very effectively handled by manual lymphatic drainage combined with intermittent one-segment pneumatic compression which was successfully used by the authors in ulcerations of the diabetic foot. One of the main general protective measures is adequate care of the foot and protective footwear for diabetics. After 3.5 years' use of protective footwear the authors recorded, consistent with data in the literature, a 50% reduction of relapses of ulcerations (and amputations). By examination on an EMED II apparatus abnormally high local pressures on the sole of risk patients can be detected and at the some time the protective effect of materials used for protective insoles can be tested. Active pharmacological and generally protective care of diabetic foot leads to a reduced number of amputations, in particular supracondylar ones by 50 or more per cent.
缺血、神经病变和感染是糖尿病足溃疡形成的诱发因素。糖尿病患者显然易患外周循环疾病，且由于自主神经病变导致微循环调节受损。驱动压力越低（在严重缺血时），流变学因素以及能够影响这些因素的药物就越重要。这些制剂包括例如曲克芦丁（己酮可可碱）、前列地尔（前列腺素E1）、舒洛地特。在缺血性肢体的晚期，水肿是一个非常不利的因素。非心源性水肿可通过手动淋巴引流结合间歇性单节段气压疗法得到非常有效的处理，作者已成功将其用于糖尿病足溃疡的治疗。主要的一般防护措施之一是对糖尿病患者的足部进行充分护理并提供防护鞋。在使用防护鞋3.5年后，作者记录到，与文献数据一致，溃疡复发（以及截肢）减少了50%。通过使用EMED II仪器进行检查，可以检测出高危患者足底异常高的局部压力，同时还可以测试用于防护鞋垫的材料的防护效果。对糖尿病足进行积极的药物治疗和一般防护护理可减少截肢数量，尤其是髁上截肢减少50%或更多。
