股动脉药物灌注治疗糖尿病足五年随访研究

发布时间：2018-02-25 23:36

  本文关键词： 糖尿病足 溃疡 药物灌注　出处：《桂林医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察股动脉药物灌注治疗糖尿病足(diabetic foot,DF)患者五年的转归情况,并与常规组治疗组对比,评估比较远期疗效,以期为临床医生在选择DF治疗方案时提供循证医学依据。通过对新发溃疡影响因素进行分析,得出危险因素,指导患者避开危险因素,从而减少DF患者新发溃疡。方法:选取70例于2005年1月至2009年12月愈合出院的糖尿病足患者,根据治疗方式将其分为药物灌注组(DF1)35例和常规治疗组(DF2)35例,两组年龄、性别、病程、BMI,血糖等指标经方差分析无统计学差异(P0.05)。常规治疗组5年前采用的是综合治疗,按照传统局部清创换药,控制血糖,辅以静脉点滴全身活血化瘀,抗感染治疗。药物灌注组在综合治疗基础上,经股动脉穿刺,灌注溶栓剂和血管扩张剂。应用Seldinger法从患者同侧或对侧股动脉穿刺进入,对双下肢动脉进行跟踪X线数字减影血管照影,依次有股动脉、乆动脉、胫前动脉、胫后动脉、腓动脉及足背动脉,然后分批予药物匀速灌注入左、右下肢动脉:尿激酶250000u1、罂粟碱30mg、山莨菪碱10ml、低分子肝素4ml、复方丹参30ml。给药后再次照影,小血管分支增多,狭窄或闭塞部位改善,退出导管。对两组进行随访,随访记录新发溃疡、踝肱指数(ABI)、糖化血红蛋白(HbA1c)、振动觉阈值(VPT)、血清肌酐(Scr)、颈动脉斑块、吸烟、饮酒及Barthel指数。应用多因素非条件Logistic回归分析法对新发溃疡影响因素进行分析。结果:70例患者随访率为100%。两组溃疡复发率药物灌注为34.3%,常规治疗组为65.7%,两组比较有显著统计学差异(P0.05)。且药物灌注组患者日常生活能力测定Barthel指数明显优于常规治疗组(P0.05)。新发溃疡独立危险因素为ABI(1.0)、HbA1c(≥7.0%)、病程(≥10年)、颈动脉斑块形成、吸烟(P0.05)。结论:(1)股动脉药物灌注DF远期效果较常规治疗效果好,降低了DF溃疡复发率,提高DF患者的生活质量,减轻患者家庭经济负担。(2)DF患者控制HbA1c(7.0%)、ABI(≥1.0)、戒烟、降低血脂能降低溃疡的复发率。(3)临床医生在择优DF治疗方案时,可根据适应症选择股动脉药物灌注治疗,达到近期疗效显著,又可减少远期复发率提高DF患者的生活质量。
[Abstract]:Objective: to observe the outcome of femoral artery infusion in diabetic patients with diabetic foot footfoot (DFD) for 5 years, and to evaluate the long term curative effect in comparison with the control group. In order to provide evidence based medicine basis for clinicians to choose DF treatment plan, through analyzing the influencing factors of new ulcer, we can get the risk factors and guide the patients to avoid the risk factors. Methods: 70 diabetic foot patients who healed and discharged from January 2005 to December 2009 were divided into two groups according to the treatment methods: 35 cases of infusing drug group and 35 cases of routine treatment group. There was no statistical difference in BMI, blood glucose and other indexes by ANOVA. The routine treatment group was treated with comprehensive therapy five years ago, according to the traditional local debridement and dressing change, controlling blood sugar, and adding intravenous drip to promote blood circulation and remove blood stasis. Antiinfective therapy. On the basis of comprehensive treatment, the drug perfusion group received femoral artery puncture, infusion of thrombolytic agents and vasodilators. Seldinger was used to enter from ipsilateral or contralateral femoral artery puncture. The femoral artery, anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery were followed by digital subtraction angiography, followed by femoral artery, anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery. Right lower extremity artery: urokinase 2500U 1, papaverine 30 mg, anisodamine 10 ml, low molecular weight heparin 4 ml, compound salvia miltiorrhiza 30 ml. New ulcers, ankle brachial index (AFI), HbA1cP, vibrational threshold value (VPTT), serum creatinine (creatinine), carotid plaque, smoking were recorded. Alcohol consumption and Barthel index. The influencing factors of new ulcers were analyzed by multivariate conditional Logistic regression analysis. Results the follow-up rate of 70 patients with new ulcers was 100. The recurrence rate of ulcer was 34. 3% in the two groups and 65. 7 in the routine treatment group. The comparison between the two groups was made. There was a significant difference between the two groups (P 0.05), and the Barthel index of the patients in the drug perfusion group was significantly better than that in the routine treatment group. The independent risk factor of the newly developed ulcer was: ABI 1. 0 HbA1c (鈮，

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