糖尿病足溃疡创面治愈后复发的影响因素分析

Influencing factors of recurrences of the healed diabetic foot ulcers

摘要:

目的 探讨老年糖尿病足溃疡(DFUs)治愈后复发的相关因素。方法 随访观察2011年4月至2016年1月在贵州医科大学第三附属医院治疗并治愈出院的165例老年DFUs患者2年,根据是否复发,将患者分为复发组和未复发组,并对可能影响复发的相关因素进行分析。采用SPSS 19.0对数据进行统计分析。组间比较采用χ²检验；多因素分析采用非条件logistic回归模型。结果 随访2年,患者复发率为30.91%(51/165)。单因素分析显示, 糖尿病足病程(≥60 d)、吸烟、缺血型糖尿病足、Wagner分级(Ⅲ、Ⅳ)、多重耐药菌感染、清创不彻底、踝肱指数(＜0.9)、血糖(≥11.1 mmol/L)、血浆黏度(≥1.5 mPa·s)、血清白蛋白(＜30 g/L)、糖化血红蛋白(≥8%)与DFUs治愈后复发相关,差异均有统计学意义(P<0.05)。非条件logistic回归分析显示,吸烟[OR=2.836,5%CI 1.050~7.661；P=0.040]、缺血型糖尿病足[OR=9.796,95%CI 2.794~34.351；P=0.000]、Wagner分级(Ⅲ、Ⅳ)[OR=4.426,5%CI 1.665~11.760；P=0.003]、多重耐药菌感染[OR=2.756,95%CI 1.011~7.515；P=0.048]、≥8%糖化血红蛋白[OR=6.366,5%CI 2.362~17.157；P=0.000]及≥1.5 mPa·s 的血浆黏度[OR=3.699,5%CI 1.332~10.269；P=0.012]是DFUs治愈后复发的危险因素。结论 对患者全身与局部进行全面分级分类评估、早期诊断、早期彻底清创引流换药、有效控制血糖、合理选用抗菌药物和抗凝治疗,以及有效纠正局部缺血等综合措施可有效降低DFUs治愈后复发的风险。

Abstract:

Objective To investigate the influencing factors of the recurrences of the healed diabetic foot ulcers(DFUs) in the elderly. Methods A total of 165 elderly patients cured of DFUs from Apirl 2011 to January 2016 were observed and followed up for 2 years after discharge from the hospital. According to whether they had recurrence, the subjects were divided into recurrence group and non-recurrence group, and the related factors that may affect recurrence were analyzed. SPSS statistics 19.0 was used to perform the statistical analysis. Chi-square test was used for comparison between groups. Non conditional logistic regression analysis was carried out for multiple factors. Results The recurrence rate was 30.91%(51/165). Univariate analysis showed that the recurrence of healed DFUs was associated with the disease course (≥60 d), smoking, type of foot disease (ischemic), Wagner classification (Ⅲ,Ⅳ), multidrug resistant infection, incomplete debridement, ankle-brachial index (<0.9), blood glucose (≥11.1 mmol/L), plasma viscosity (≥1.5 mPa·s), serum albumin (<30 g/L), and glycosylated hemoglobin (≥8%). The difference was statistically significant (P<0.05). Non logistic regression analysis showed that the risk factors for the recurrence of healed DFUs included smoking [OR=2.836,5%CI 1.050-7.661; P=0.040], ischaemic diabetic foot [OR=9.796, 95%CI 2.794-34.351; P=0.000], Wagner scores (Ⅲ,Ⅳ )[OR=4.426,5%CI 1.665-11.760; P=0.003], multidrug resistant infections [OR=2.756,5%CI 1.011-7.515; P=0.048], ≥8% glycosylated hemoglobin [OR=6.366,5%CI 2.362-17.157; P=0.000], and plasma viscosity ≥1.5 mPa·s [OR=3.699,5%CI 1.332-10.269; P=0.012]. Conclusion The recurrences of the healed DFUs could be effectively reduced by thorough evaluation, classification, and grading of the patient′s condition (both general and local), early diagnosis, early debridement and drainage, effective control of blood glucose, rational use of antimicrobial agents, anticoa-gulant therapy, and effective correction of ischaemia.