2017,
Journal of the Royal Society of Medicine.
DOI:
10.1177/0141076816688346
Prevention and treatment of diabetic foot ulcers
Jonathan Zhang Ming Lim, Natasha Su Lynn Ng, Cecil Thomas
Abstract:
The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.
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#paper doi:10.1177/0141076816688346 Prevention and treatment of diabetic foot ulcers
糖尿病足是糖尿病最常见且危害很大的并发症之一，表现为足底溃疡坏死，严重者需要截肢。本文综述了糖尿病足的预防和治疗。病因方面，大致可理解为异常的糖代谢产物诱发神经细胞氧化应激，这些受损的神经元引起了异常的足底压力分配、负重、步态、痛觉敏感性、汗腺功能、脚型等。干预的主要措施是预防，包括医护人员对足部护理的投入程度，以及患者自身被教育的程度。治疗方面，控制血糖是根本，以及及时有效的清创术（清除浅表及深部的坏死及过度角化组织）、药物治疗、各种各样促进伤口愈合的敷料、负压抽吸伤口组织液以改善灌注和促进肉芽形成、用蛆去除坏死组织、使用生长因子促进组织愈合等。