糖尿病足感染下肢截肢的预测因素。

Q1 Health Professions Diabetic Foot & Ankle Pub Date : 2011-01-01 Epub Date: 2011-09-20 DOI:10.3402/dfa.v2i0.7463
Zameer Aziz, Wong Keng Lin, Aziz Nather, Chan Yiong Huak
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引用次数: 72

摘要

本研究的目的是评估糖尿病足感染(dfi)的流行病学及其对下肢截肢的预测因素。本研究于2005年1月至2005年6月期间招募了在新加坡国立大学医院接受治疗的100名DFIs患者进行前瞻性研究。设计了一个方案来记录患者的人口统计学、DFI类型、神经病变和/或血管病变的存在及其最终结果。采用单因素和逐步logistic回归分析确定肢体丧失的预测因素。研究人群平均年龄59.8岁,男女比例约为1:1,平均随访时间约为24个月。所有患者均患有2型糖尿病。常见的DFIs包括脓肿(32%)、湿性坏疽(29%)、感染性溃疡(19%)、骨髓炎(13%)、坏死性筋膜炎(4%)和蜂窝织炎(3%)。保守治疗13例,手术清创或远端截肢59例。28例患者进行了大截肢(膝盖以下或膝盖以上)。48%的人有单微生物感染,52%的人有多微生物感染。在所有感染中(单微生物和多微生物)最常见的病原体是金黄色葡萄球菌(39.7%)、脆弱拟杆菌(30.3%)、铜绿假单胞菌(26.0%)和无乳链球菌(21.0%)。60岁以上、坏疽、踝臂指数(ABI)是导致肢体丧失的重要单因素预测因素。
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Predictive factors for lower extremity amputations in diabetic foot infections.

The objective of this study was to evaluate the epidemiology of diabetic foot infections (DFIs) and its predictive factors for lower extremity amputations. A prospective study of 100 patients with DFIs treated at the National University Hospital of Singapore were recruited in the study during the period of January 2005-June 2005. A protocol was designed to document patient's demographics, type of DFI, presence of neuropathy and/or vasculopathy and its final outcome. Predictive factors for limb loss were determined using univariate and stepwise logistic regression analysis. The mean age of the study population was 59.8 years with a male to female ratio of about 1:1 and with a mean follow-up duration of about 24 months. All patients had type 2 diabetes mellitus. Common DFIs included abscess (32%), wet gangrene (29%), infected ulcers (19%), osteomyelitis (13%), necrotizing fasciitis (4%) and cellulitis (3%). Thirteen patients were treated conservatively, while surgical debridement or distal amputation was performed in 59 patients. Twenty-eight patients had major amputations (below or above knee) performed. Forty-eight percent had monomicrobial infections compared with 52% with polymicrobial infections. The most common pathogens found in all infections (both monomicrobial and polymicrobial) were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeruginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictive factors for limb loss included age above 60 years, gangrene, ankle-brachial index (ABI) <0.8, monomicrobial infections, white blood cell (WBC) count ≥ 15.0×10(9)/L, erythrocyte sedimentation rate ≥100 mm/hr, C-reactive protein ≥15.0 mg/dL, hemoglobin (Hb) ≤10.0g/dL and creatinine ≥150 µmol/L. Upon stepwise logistic regression, only gangrene, ABI <0.8, WBC ≥ 15.0×10(9)/L and Hb ≤10.0g/dL were significant.

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来源期刊
Diabetic Foot & Ankle
Diabetic Foot & Ankle ENDOCRINOLOGY & METABOLISM-
CiteScore
4.80
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