一站式治疗重症缺血性糖尿病足感染15例

发布时间：2018-03-24 18:28

本文选题：重症缺血　切入点：糖尿病足　出处：《介入放射学杂志》2017年07期

【摘要】：目的总结重症缺血性糖尿病足感染创面的一站式治疗经验。方法回顾性分析2015年6月至2016年4月收治的15例重症缺血性糖尿病足坏疽患者(15条患肢)临床资料。对所有患者采用腔内修复术(EVR)开通闭塞段血管、手术清创及创面封闭负压引流(NPWT)、抗菌保湿伤口敷料进行一站式序贯治疗,评价感染创面愈合率及患肢保肢率。结果 15例患者中下肢动脉造影显示下肢多节段病变13例,单纯小腿病变2例;泛大西洋学会联盟(TASC)Ⅱ分级D级小腿动脉病变13条,C级病变2条。EVR术后,14条患肢至少开通1支小腿流出道;足底动脉环路(PPL)呈完整弓6例,半弓7例,无弓2例;清创后应用带自制冲洗设备NPWT,创面感染控制时间为(7.85±2.84)d。出院后每3~4日随访,并以抗菌保湿的磺胺嘧啶银脂质水胶伤口敷料换药,结果显示创面愈合12例,平均愈合时间(3.70±0.87)个月,3例未愈合,其中2例小腿截肢(13.3%,足部均为PPL无弓),1例死于心血管事件;创面愈合组PPL病变情况与未愈合组比较,差异有显著统计学意义(P=0.006 7)。结论重症缺血性糖尿病足感染治疗较复杂。EVR、带自制冲洗设备NPWT及抗菌保湿创面敷料一站式联合治疗,可作为首选方法有效增加患肢血供,缩短感染控制时间,降低截肢率。
[Abstract]:Objective to summarize the experience of one-stop treatment for severe ischemic diabetic foot infection. Methods the clinical data of 15 patients with severe ischemic diabetic foot gangrene from June 2015 to April 2016 were retrospectively analyzed. All patients were treated with endovascular repair (EVR) to open the occluded vessels. Surgical debridement and wound sealing negative pressure drainage with NPWTG, one stop sequential treatment with antibacterial wound dressing were performed to evaluate the healing rate of infected wound and limb salvage rate. Results in 15 patients, 13 cases of lower extremity multisegmental lesions were found by arteriography of lower extremity. There were 2 cases of simple leg disease, 2 cases of D grade D grade leg artery lesions, 2 cases of C grade lesions. 14 limbs had at least one leg outflow tract opened after EVR, 6 cases had complete arch, 7 cases had hemiarch, and 6 cases had complete arch and 7 cases had hemiarch. After debridement, the wound infection control time was 7.85 卤2.84 days, followed up every 3 ~ 4 days after debridement, and treated with sulfadiazine silver lipids gel dressing. The results showed that 12 cases were healed. The mean healing time was 3.70 卤0.87 months and 3 cases were not healed, among which 2 cases had leg amputation and 13.3 cases, 1 case died of cardiovascular events in foot without arch, the PPL lesion in wound healing group was compared with that in non-healing group, and the average healing time was 3.70 卤0.87 months, and the mean healing time was 3.70 卤0.87 months. Conclusion the treatment of severe ischemic diabetic foot infection is more complicated. Combined treatment with self-made washing equipment NPWT and antibacterial and moisturizing wound dressing can be used as the first choice to effectively increase the blood supply of affected limbs. The infection control time was shortened and the amputation rate was reduced.
【作者单位】：上海交通大学医学院附属仁济医院血管外科;
【分类号】：R587.2

【参考文献】