One question and one answer: screening and prevention of grass -roots diabetes foot
Diabetes Foot (DF) is one of the most serious complications of diabetes. Studies have shown that patients with diabetic patients in their lives are as high as 25 %, of which 14 % -24 % of patients with foot ulcers need amputation, and every 20 seconds in the world can be amputated. A patient with diabetes lost his lower limbs, and the mortality rate of 5 years after his amputation reached 50%. Therefore, it is very important to do DF’s prevention and control work. More than 80%of Chinese diabetic patients are diagnosed at district and county -level medical institutions. Therefore, grass -roots medical institutions are indispensable in the early prevention and treatment of DF.
Recently, the China Micro Circular Society of Diabetes and Microcirculation Professional Committee, and the Chinese Research Hospital Society Wound Control and Damage Organization Repair Professional Committee jointly released the “Consensus and Prevention of Diabetes and Footwear Screening and Prevention”. The indicators and equipment configuration suggestions, the yellow is recommended, and the grass -roots medical institutions may be equipped; red is the recommended equipment and may need to be purchased; green is a recommended delivery or referring to the higher -level hospital for inspection.
In response to the screening and prevention consensus of grass -roots diabetes, the editor compiled the relevant questions and presented it to readers in the form of a question and answer.
1
How long should I conduct a screening of diabetic foot?
Answer: Diabetes peripheral neuropathy (DPN) is an important risk factor for the occurrence of diabetic foot. In addition, microvascular lesions and microcirculation disorders accompanied by diabetic patients, reduce blood flow from the lower limbs, insufficient tissue hypoxia and nutritional supplies, and the lower limb hair occurs. Cold, pain and intermittent clamor also increase the occurrence of diabetic foot ulcers. Therefore, diabetic foot disease screening requires regular screening of peripheral neuropathy and peripheral vascular lesions of diabetes. See Table 2 for the specific screening frequency.
2
How to classify diabetic foot?
Answer: Grading according to the condition of DF is the key to diagnosis of DF. At present, clinical commonly used classification methods include Wagner, Texas systems, and PEDIS grading. Among them See Table 3, Table 4 for details.
In addition, the PEDIS grading system has classified DF infection, which is level 1 (no infection signs): symptoms and signs without infection. Level 2 (mild infection): At least 2 abnormalities in the skin or superficial tissue, purulent, redness, and hard constraints; honeycomb wovenitis or erythema around ulcers ≤2cm; local tenderness or pain; increased skin temperature. Level 3 (moderate infection): with the following one or more, honeycomb wovenitis or erythema> 2 cm, lymphatic vesselitis, extensive fascia or deep tissue (muscle, bone joints, etc.) occur in pus. But no systemic inflammatory reaction syndrome (SIRS). Level 4 (severe infection): Local infection accompaniment has at least two types of systemic inflammatory response syndrome, namely fever, tachycardia, blurred consciousness, hypotension, etc. Among them, SIRS refers to: T ＞ 38 ° C or 90 times/min; RR> 20 times/min; Paco2 12 × 10^9/L or <4 × 10^9/ L.
3
What situations need to transfer patients to medical institutions at the higher level?
Answer: my country’s class diagnosis and treatment service goals and referral mechanisms are as follows, which will gradually form a hierarchical diagnosis and treatment model of “first -level first -level diagnosis, two -way referral, rapid division of treatment, and upper and lower linkage” to comprehensively improve the ability of hierarchical diagnosis and treatment services.
At present, grass -roots medical and health institutions mainly undertake first -level prevention work of DF risk factors intervention, becoming the main force of DF screening, rehabilitation, foot protection knowledge mission, and long -term follow -up. The daily DF education and screening work in the secondary hospital is focusing on the diagnosis and treatment of foot disease diagnosis, wound treatment, complications and complications, and played a linkage between tertiary hospitals and grassroots hospitals. The third -level hospital is responsible for coordinating the establishment of the DF diagnosis and treatment center, implemented a multidisciplinary cooperation diagnosis and treatment model, and conducted comprehensive evaluation, systematic treatment and full -process management of patients with urgency and critical condition. Active patients) referred to the grass -roots medical and health institutions in a timely manner for rehabilitation, and at the same time responsible for conducting professional knowledge training and guidance to grass -roots hospitals.
4
How to deal with DF wound?
Answer: (1) All wounds need sterile bandaging. (2) Non -surgical treatment. Wagner 1-2 wounds are feasible and proclaimed. Pay attention to avoid active bleeding and excessive losses of health organizations. The wound -changing medicine can be performed, and the method and frequency of the drug change are determined according to the degree of wound infection and the amount of exudation. The wound surface is mild infection as the main person can apply iodine and other disinfectants to strengthen the frequency of drug replacement. If the wound necrotic tissue has been dissolved, the base granulation tissue began to proliferate, and the disinfection and sterilization drugs can be selected and the composite use of growth drugs can be used. In the dressing selection, priority choices have sterilization, adsorption exudation, maintaining moderate wetness of wounds, anti -adhesion and other composite and cost -effective wound dressing. It can also choose a variety of single -function dressings according to the wound conditions. For the primary medical institutions of wounds above the 3rd level of WAGNER, they can be sterilized and transferred to the higher -level hospital for treatment in time.
5
How to choose antibiotics in DF antichams?
Answer: Infection is judged according to clinical manifestations and systemic signs and inflammatory symptoms. Wounds that do not occur without clinical infection do not need to use antibiotics.Before selecting antibiotics to control infection, the conditional ulcer wound bacterial culture and drug sensitivity test should be performed. The bacterial culture method can choose the cotton swab and pathological tissue cultivation after strict debridement.The first choice of antibiotics in the wound is antibacterial-positive bacteria drugs; antibacterial <!-2586: diabetic terminal page
Those who have poor effects in the treatment must refer to the higher -level hospital for treatment in time.
