摘要
目的探讨老年共病患者下肢慢性糖尿病创面的治疗方法及临床效果。方法回顾性分析2019年12月至2022年11月上海健康医学院附属崇明医院收治的患有下肢慢性糖尿病创面老年共病患者的临床资料。术前对患者进行多学科会诊、综合评估,将其基础疾病相关指标调整到手术安全范围内;及时采取创面分泌物行细菌培养和药敏试验,对创面进行换药等规范处理。根据下肢创面缺损的位置、形状、大小、深度,以及感染程度、感染时间、周围皮肤损伤程度,选择清创、负压封闭引流、减张缝合、皮片或皮瓣移植、截肢(趾)等方法进行治疗。术后继续对老年共病进行防控和护理管理,观察创面愈合情况。按照皮瓣肿胀4级(Ⅰ~Ⅳ度依次加重)评判标准,评估患者术后早期(3~12周)和后期(13~52周)小腿和足背肿胀程度;末次随访时,参考下肢踝关节周围创面修复评价标准对疗效进行综合评价(优、良、可、差),以及满意度评价(满意、一般、不满意)。结果共纳入85例患者,其中男41例,女44例;年龄65~93岁,平均71.4岁;老年共病包括高血压、冠心病、脑血管意外、肾功能不全、糖尿病、肿瘤、痛风、老年痴呆、老年神经衰弱、睡眠障碍、营养不良、大小便失禁、谵妄、抑郁等;创面持续时间为6个月至15年;创面深及肌层或骨质,缺损面积为3.5 cm×2.5 cm~22.0 cm×10.5 cm。85例患者创面分泌物细菌培养均为阳性;药敏试验结果:敏感72例,中介10例,完全耐药3例。根据药敏试验结果和抗生素使用原则进行临床用药;对于耐药的3例患者给予营养、支持等增强免疫力的治疗,同时对局部创面用0.45%~0.55%的碘伏进行换药。85例中,65例采用了负压封闭引流技术,通过减张缝合修复10例,全厚皮片移植修复19例,局部皮瓣转移修复21例,穿支蒂皮瓣修复20例,截肢(趾)15例。术后随访6~36个月,平均12.5个月。创面一期愈
Objective To explore the treatment method and clinical effect of chronic diabetic wounds of lower limbs in elderly patients with comorbidities.Methods The clinical data of elderly comorbid patients with chronic diabetic wounds of lower limbs admitted to Chongming Hospital Affiliated to Shanghai University of Medicine&Health Sciences from December 2019 to November 2022 were retrospectively analyzed.Multidisciplinary consultation and comprehensive evaluation were conducted for the patient before surgery and the indicators related to the underlying disease were also adjusted to the safe range for surgery.The wound secretions were taken in time for bacterial culture and drug sensitivity test,and the wound was treated with dressing change and other standardized treatments.According to the location,shape,size and depth of the lower limb wound defect,as well as the infection degree,duration of infection,and extent of surrounding skin damage,debridement,vacuum sealing drainage,tension-reduced suture,skin or flap transplantation,limb(toe)amputation and other method were selected for treatment.After surgery,the prevention and control of the comorbidities of the elderly and nursing management were continued,and the wound healing was observed.According to the evaluation criteria of flap swelling at grade 4(increased from gradeⅠto gradeⅣ),the swelling degree of the lower leg and dorsum of the foot was evaluated in the early stage(3 to 12 weeks)and the later stage(13 to 52 weeks).At the last follow-up,according to the evaluation criteria of the ankle joint wound repair,the curative effect was comprehensively evaluated(excellent,good,general,poor),and the satisfaction evaluation(satisfied,general,unsatisfied)was also conducted.Results A total of 85 patients were included,of which 41 were males and 44 were females;the age ranged from 65 to 93 years,with a mean of 71.4 years.Comorbidities of the elderly include hypertension,coronary heart disease,cerebrovascular accident,renal insufficiency,diabetes,tumor,gout,senile dementia
作者
林涧
张天浩
吕叶辉
王之江
王杨
熊育宵
余云兰
Lin Jian;Zhang Tianhao;Lyu Yehui;Wang Zhijiang;Wang Yang;Xiong Yuxiao;Yu Yunlan(Institute of Wound Prevention and Treatment,Shanghai University of Medicine&Health Sciences,Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine&Health Sciences,Shanghai 202150,China)
出处
《中华整形外科杂志》
CSCD
2023年第12期1284-1293,共10页
Chinese Journal of Plastic Surgery
基金
上海市科研计划项目(14411973200)
上海市卫生和计划生育委员会科研课题(201840198)
上海市卫生健康委员会专项研究基金项目(2020YJZX0143)
上海健康医学院地方高水平大学建设项目(22MC2022001)。
关键词
伤口感染
下肢
糖尿病创面
老年人共病
修复外科手术
Wound infection
Lower limbs
Diabetic wound
Older adults with comorbidity
Reconstructive surgical procedures
