应用物理疗法在糖尿病足溃疡治疗中的临床分析

发布时间：2018-04-11 19:32

本文选题：糖尿病足 + 糖尿病足溃疡　；参考：《蚌埠医学院》2015年硕士论文

【摘要】：WHO将糖尿病足定义为:糖尿病患者由于合并神经病变和各种不同程度的末梢血管病变而导致下肢感染、溃疡和(或)深部组织的破坏。糖尿病足(diabetes foot,DF)又称糖尿病肢端坏疽,是糖尿病常见且严重的并发症,具有很高的致残性和致死性,物理治疗作为一种简便、经济、安全可靠的辅助治疗手段,其疗效已逐渐得到大多数学者的认可。目的观察物理治疗方法(包括远红外线、半导体激光、气压循环)使用后DF患者生化指标、下肢血管超声及检测结果,分析该综合物理治疗对糖尿病足溃疡(diabetic foot ulcer,DFU)的临床疗效。方法收集2010年6月-2013年6月住院病人中80例DFU患者,均为2型糖尿病(type2 diabetic mellitus,T2DM)患者,符合1999年WHO糖尿病专家委员会提出诊断标准。将2010年6月至2012年1月收治的60例作为常规治疗组,2012年2月以后病房开展物理治疗后收治的20例患者作为物理治疗组,常规治疗组采用常规综合内科抗感染、控糖等治疗方法,物理治疗组在使用常规治疗上联合物理疗法,每天一次,采用序贯方法分别使用远红外线照射、半导体激光照射及气压循环,连续观察3周,记录两组各项生化指标、下肢血管超声、溃疡面积变化进行比较。计量资料用平均值±标准差(x±s)表示,组间比较采用t检验,计数资料以阳性例数、率表示,有效率比较采用χ2检验,P0.05为差异具有统计学意义。结果1、与治疗前比较,常规治疗组与物理治疗组治疗后血糖、血脂、CRP水平指标均不同程度下降,其中物理治疗组治疗后CRP水平显著低于常规治疗组,差异有统计学意义(P0.05)。2、80例DFU患者下肢动脉明显病变者达56例,包括动脉内膜增厚、粥样斑块形成,管腔狭窄、血流速度减慢等。治疗后,两组患者股动脉、乆动脉、及足背动脉的峰值流速均较治疗前显著好转(P0.05),平均流速也有不同程度改善;物理治疗组治疗后股动脉、足背动脉的峰值流速、平均流速均显著优于常规治疗组,差异有统计学意义(P0.05)。3、两组患者经过测量治疗前后溃疡面积比较,其中物理治疗组显效10例,有效7例,无效3例,总有效率为85.0%,常规治疗组显效23例,有效9例,无效28例,总有效率为53.3%。两组总有效率比较,差异具有统计学意义(χ2=6.34,P0.05)。结论1、常规治疗、常规治疗联合物理疗法治疗DFU均可取得一定的临床效果。2、常规控糖、抗感染等治疗同时联合物理治疗方案可改善局部血液循环,促进溃疡愈合,减轻溃疡面的炎症反应,且操作简单,成本更低,值得推广应用。
[Abstract]:WHO defines diabetic foot as lower extremity infection, ulcers and / or destruction of deep tissues due to neuropathy and various peripheral vascular lesions.Diabetic foot gangrene (DFD) is a common and serious complication of diabetes mellitus. It has high disability and mortality. Physical therapy is a simple, economical, safe and reliable adjuvant treatment.Its curative effect has gradually been recognized by most scholars.Objective to observe the biochemical indexes, ultrasound of lower extremity blood vessels and the results of physical therapy (including far infrared ray, semiconductor laser, pneumatic circulation) in DF patients, and to analyze the clinical effect of this comprehensive physical therapy on diabetic foot ulcer foot ulcerus.Methods from June 2010 to June 2013, 80 DFU patients, all of whom were type 2 diabetes mellitus type 2 diabetic mellitusus T2DM, were collected. The results were in accordance with the diagnostic criteria put forward by the 1999 WHO Diabetes expert Committee.From June 2010 to January 2012, 60 patients were treated as routine therapy group, and 20 patients treated after physical therapy in ward after February 2012 were treated as physical therapy group. The routine treatment group was treated with routine comprehensive internal medicine anti-infection, sugar control and other treatment methods.The physiotherapy group was treated with routine physical therapy once a day, followed by sequential methods of far infrared radiation, semiconductor laser irradiation and air pressure circulation. The biochemical indexes of the two groups were recorded for 3 weeks.Lower extremity vascular ultrasound, ulcer area changes were compared.The measurement data were expressed by mean 卤standard deviation (x 卤s). T test was used for the comparison between groups, the counting data was expressed as positive cases and the rate was expressed. The effective rate was compared with 蠂 2 test (P0.05).Results 1. Compared with before treatment, the levels of blood glucose, blood lipids and serum lipids in the routine treatment group and the physiotherapy group were decreased in varying degrees, and the CRP level in the physiotherapy group was significantly lower than that in the routine treatment group.The difference was statistically significant in 56 patients with obvious lesions of lower extremity arteries in 80 patients with DFU, including intimal thickening, atherosclerotic plaque formation, stenosis of lumen, and slow down of blood flow.After treatment, the peak velocities of femoral artery, body artery and dorsum pedis artery in both groups were significantly improved compared with those before treatment, and the average velocity of flow was improved to some extent, and the peak velocity of femoral artery and dorsalis pedis artery in physiotherapy group was also improved.The mean flow velocity was significantly better than that in the routine treatment group (P 0.05). The area of ulcer in the two groups was measured before and after treatment. There were 10 cases in the physical therapy group, 7 cases in the effective group, and 3 cases in the failure group.The total effective rate was 85.0. In the routine treatment group, 23 cases were effective, 9 cases were effective, and 28 cases were ineffective. The total effective rate was 53.3%.There was significant difference in the total effective rate between the two groups (蠂 ~ 2 = 6.34, P 0.05).Conclusion (1) routine therapy, conventional therapy and physical therapy can all achieve certain clinical effects in DFU. The combination of conventional glucose control and anti-infection therapy and physical therapy can improve local blood circulation and promote ulcer healing.Reduce the inflammation of ulcer surface, and simple operation, lower cost, it is worth popularizing.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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