Diabetes foot control 5 major problems, Professor Xu Zhangrong proposed precise countermeasures ｜ CDS2018
Speaker 丨 Xu Zhangrong No. 306 Hospital of the People’s Liberation Army of the Chinese People’s Liberation Army
Organize 丨 Xu Najia
Source 丨 Medical Circles Endocrine Channel
Diabetic foot disease is one of the chronic complications of severe diabetes. The cost of treatment is high, and severe cases can lead to amputation and death. The cost of sufficient disease treatment accounts for 12%to 15%of the total cost of diabetes treatment, and the amputation of lower limbs will increase the risk of death of patients with diabetes. Popular disease data shows that the prevalence of diabetic -related amputa is 1.3%to 7.0%, while 50%~ 70%non -traumatic amputation occurs in patients with diabetes.
The situation is so severe, but there are still insufficient diabetes management. As a clinician, how can you face up to these deficiencies and improve it? At the CDS2018 meeting, Professor Xu Zhangrong of the Endocrine Department of the 306 Hospital of the Chinese People’s Liberation Army pointed out that the shortcomings existing in the prevention and control of diabetes in my country and proposed specific countermeasures.
Poor awareness and inadequate understanding
According to statistics, 85%of diabetes -related amputation is caused by foot ulcers. However, 25%of patients with foot ulcers did not admit that they had ulcers during the consultation, and half of patients with foot ulcers were not found to be sick during the doctor. Moreover, the proportion of developing countries is higher. At the same time, the risk factors of diabetic foot lack the necessary screening, and some grass -roots medical personnel have insufficient understanding of the severity, complexity, refractoryness and danger of diabetes.
Countermeasure
Preventing foot ulcers can significantly reduce amputation and mortality. The feet of all patients with diabetes should be conducted regularly, including whether there are malformations, 胼胝, ulcers, and skin color changes; the foot of the foot of the foot and the posterior tibial arteries, the skin temperature, and the sensory abnormalities. If there are the above factors, you should identify as soon as possible, and instruct them to wear appropriate shoes and socks to remove factors that are likely to cause ulcers, such as improper trimmed toenails. The more the ulcers are more to prevent recurrence.
Diabetes lower limb atherosclerosis (Lead) can also cause lower limb ischemic ulcers and amputation, correct patients with bad lifestyles, control weight, strictly control blood sugar, blood pressure, and blood lipids, helping to prevent or delay the occurrence of Lead.
In addition, it is necessary to realize that the infection of diabetes and feet requires emergency treatment, otherwise the amputation rate is even endangered.
The judgment is inaccurate and the treatment is unprofessional
The ischemia of the foot ulcer is sometimes not solved, resulting in gangrene or even amputation. Faced with the combined infection of diabetic feet, surgeons often require internal medicine doctors to control high blood sugar before surgical treatment; internal medicine doctors often pay attention to the application of the whole body antibiotics without completely effectively handling the local wounds, resulting in the loss of their limbs.
Countermeasure
50%of patients with diabetic foot ulcers have peripheral artery diseases. Doctors should evaluate their lower limbs vascular status and find ischemia signs. After the foot ulcer, it takes 3 times that the blood that usually maintains the blood supply can heal the ulcer. Therefore, feasible internal medicine treatment, intervention therapy, or vascular surgery surgery increases lower limb blood supply. For the combined infection of diabetic foot, while actively carrying out high blood sugar and anti -infection, it is necessary to actively treat foot infection locally and perform debride surgery.
The referral is not timely, the cooperation is not close
In the process of diabetic foot disease diagnosis and treatment, there is a time turning point, that is, the disease is reversible and irreversible, and the standard of emergency treatment is limited accordingly. Ischemia necrosis, infection accumulate deep tissue and neurotrane diseases, these lesions have reached irreversible. At this time, the treatment delay will cause severe destruction of foot tissue, and this destruction is proportional to the time to delay consultation. Large sample studies have confirmed that timely surgery is related to the number and level of amputation. The delay can increase the risk of higher levels of amputation by 61%by a day.
Countermeasure
Time is the key element of diabetic foot disease treatment. Emergency treatment of patients with diabetic foot disease should be dependent on patients with acute myocardial infarction. Intervention plays an important role in the first and secondary prevention of diabetes acute ulcer, which can make the ending different. Medical staff should identify patients who need to be treated urgently early, so that they should be referred in time. Multi -disciplinary cooperation, such as diabetes, vascular surgery, anesthesia, and orthopedics. Before large amputations, consider vascular reconstruction and discuss with multidisciplinary teams. Timely referring or multi -disciplinary collaboration and treatment can help increase the healing rate of ulcers, reduce amputation rates and reduce medical expenses.
If the communication is not in place, the medical dependence is poor
Patients with diabetic foot disease have severe psychological disorders, stubbornness, and poor medical compliance. Clinically, patients often refuse to treat early debridement or vascular surgery, which may lead to the development of foot ulcers to amputation, affecting the quality of life and expected life expectancy.
Countermeasure
The communication between doctors and patients and the compliance of patients is important in the treatment of diabetes and foot disease. Doctors should let patients and their families accept scientific and correct medical orders. Let patients and family members understand how to achieve the best treatment effect and improve the quality of life. Communication does not mean to obey the opinions of patients and family members.
Tiered management is to be implemented, and medical services need to be improved
Patients with diabetic foot disease have been diagnosed in different departments for a long time. The treatment time, high risk, and high spending. Some patients cannot be treated with reasonable treatment and cannot even be hospitalized in time. Therefore, the management of diabetic foot often requires grading, and related services need to be improved.
Countermeasure
The hierarchical management system of primary, secondary and third -level models should be established. The first -level model is positioned in the community and is responsible for the screening, treatment and prevention of risk factors of diabetes and foot disease; the secondary model is positioned in secondary hospitals, which is responsible for treating non -ischemic foot disease, decompression, moderate infection and emergency referral Task; the third -level model is positioned in the teaching hospital, which can handle ischemia and severe infection, and perform vascular reconstruction and surgery. In addition, it is necessary to further improve medical services, such as establishing a quick referral passage and foot disease diagnosis and treatment room, joint outpatient clinic for multidisciplinary cooperation, with patients as the center, diabetic specialist, surgeon, intervention doctor, foot disease doctor, orthopedic department, orthopedic department, orthopedic department, orthopedic department Doctors, radio doctors and nurses cooperate together to establish a clinical system. summary
<!-2586: Diabetic terminal page
The situation of diabetic foot disease is severe and requires scientific comprehensive management. Actively prevent, early screening, timely identification and treatment and referral, advocate multi -disciplinary cooperation, strengthen communication between doctors and patients, and improve patient compliance. At the same time, the hierarchical management system of diabetic foot is established to improve the quality of medical services. Prevention, specialized control, multi -disciplinary cooperation is the key to reducing the amputation rate of diabetes foot.
(This article is organized from the CDS2018 Conference of the Chinese People’s Liberation Army 306 Hospital Professor Professor Xu Zhang Rong’s lecture PPT and recording)
