糖尿病患者足部浅Ⅱ度烧伤的临床特点及治疗方法

凌翔伟; 张婷婷; 戴文统; 夏卫东; 林才

doi:10.3760/cma.j.issn.1009-2587.2019.01.006

糖尿病患者足部浅Ⅱ度烧伤的临床特点及治疗方法

doi: 10.3760/cma.j.issn.1009-2587.2019.01.006

温州医科大学附属第一医院烧伤科 325000

基金项目:

温州市科技计划（Y20160328）

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出版历程
- 收稿日期: 2017-12-18
- 网络出版日期: 2021-10-28
- 刊出日期: 2019-01-20

Clinical characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet

Department of Burns, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China

摘要

摘要: 目的分析糖尿病患者足部浅Ⅱ度烧伤的临床特点及治疗方法。方法 2011年1月—2017年12月，笔者单位收治足部浅Ⅱ度烧伤患者83例，其中男46例、女37例，年龄(60±11)岁，烧伤足数119只，回顾分析其病历资料。根据是否合并糖尿病，将患者分为糖尿病组41例(60只足)和非糖尿病组42例(59只足)。糖尿病组和非糖尿病组患者均给予全身治疗和创面换药治疗。根据患者意愿和治疗方式，将37例足部创面转化为深Ⅱ度的糖尿病患者分为削痂组14例和非削痂组23例。削痂组患者采取早期手术削痂，非削痂组患者给予创面换药。统计糖尿病组和非糖尿病组患者住院时间、住院治疗费用，入院后即刻足背动脉及胫后动脉搏动情况，治疗期间足部创面加深情况和创面愈合率，以及削痂组和非削痂组患者入院后即刻足背动脉及胫后动脉搏动情况，治疗期间足部创面加深情况、创面细菌及真菌检出率、创面愈合率。对数据行χ²检验、t检验、Fisher确切概率法检验、Mann－Whitney U检验。结果糖尿病组患者住院时间为(29±20)d，长于非糖尿病组的(19±13)d，t=2.730，P<0.01。糖尿病组患者住院治疗费用为(46 988±41 322)元，明显高于非糖尿病组的(29 106±24 813)元，t=2.396，P<0.05。糖尿病组患者足背动脉及胫后动脉搏动明显弱于非糖尿病组(Z=3.278、2.194，P<0.05或P<0.01)。糖尿病组患者足部创面加深为深Ⅱ度、Ⅳ度百分比为88.3%(53/60)、23.3%(14/60)，明显高于非糖尿病组的47.5%(28/59)、1.7%(1/59)，χ²=22.867、12.644，P<0.01。糖尿病组患者足部创面愈合率为78.3%(47/60)，明显低于非糖尿病组的100.0%(59/59)，χ²=14.351，P<0.01。削痂组患者共21只足，非削痂组患者共32只足。削痂组与非削痂组患者足部足背动脉及胫后动脉搏动情况比较，差异无统计学意义(Z=0、0.453，P>0.05)。非削痂组患者足部创面加深为Ⅳ度百分比为43.8%(14/32)，明显高于削痂组的0(χ²=12.486，P<0.01)。削痂组患者足部创面细菌及真菌检出率明显低于非削痂组(χ²=4.386，P<0.05)。非削痂组患者足部创面愈合率为59.4%(19/32)，明显低于削痂组的100.0%(21/21)，P<0.01。结论糖尿病患者足部浅Ⅱ度烧伤后，患者住院时间长、住院治疗费用高，创面容易加深、愈合率低，创面加深为深Ⅱ度后采取早期削痂的方式能够提高创面愈合率，防止创面进一步加深。
- 烧伤 /
- 糖尿病足 /
- 削痂
Abstract: Objective To analyze the characteristics and treatment of diabetic patients with superficial partial-thickness burn on feet. Methods Eighty-three patients with superficial partial-thickness burn on 119 feet were hospitalized in our unit from January 2011 to December 2017. The medical records of the patients with 46 men and 37 women, aged 60±11 were retrospectively analyzed. The patients were divided into diabetes group and non-diabetes group according to whether they had diabetes or not, with 41 patients (60 burn feet) in diabetes group and 42 patients (59 burn feet) in non-diabetes group. Patients in diabetes group and non-diabetes group were given systemic treatment and wound dressing change. Thirty-seven diabetic patients whose wounds deepened to deep partial-thickness were divided into eschar shaving group and non-eschar shaving group according to patients′ willingness and the treatment, with 14 patients in eschar shaving group and 23 patients in non-eschar shaving group. Patients in eschar shaving group were given eschar shaving operation at early stage, and patients in non-eschar shaving group were given wound dressing change. The length of hospital stay, hospitalization treatment expenses, pulse of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, and rates of wound healing on feet of patients in diabetes group and non-diabetes group were observed and calculated. Pulses of arteria dorsal pedis and posterior tibial artery immediately after admission, deepening of wounds on feet during hospital stay, positive rates of bacteria and fungus in wounds on feet, and rates of wound healing on feet of patients in eschar shaving group and non-eschar shaving group were observed and calculated. Data were processed with chi-square test, t test, Fisher′s exact propability method, and Mann-Whitney U test. Results The length of hospital stay of patients in diabetes group was (29±20) d, which was significantly longer than that of patients in non-diabetes group [(19±13) d, t=2.730, P<0.01]. The hospitalization treatment expense of patients in diabetes group was (46 988±41 322) yuan, which was significantly more than that of patients in non-diabetes group [(29 106±24 813) yuan, t=2.396, P<0.05]. The pulses of arteria dorsal pedis and posterior tibial artery of patients in diabetes group were significantly weaker than those of patients in non-diabetes group (Z=3.278, 2.194, P<0.05 or P<0.01). The percentages of wounds on feet of patients in diabetes group deepening to deep partial-thickness burn, full-thickness skin defect with bone and tendon exposure were respectively 88.3% (53/60) and 23.3% (14/60), which were significantly higher than those of patients in non-diabetes group [47.5% (28/59) and 1.7% (1/59), χ²=22.867, 12.644, P<0.01]. Rate of wound healing on feet of patients in diabetes group was 78.3% (47/60), which was significantly lower than 100.0% (59/59) of patients in non-diabetes group ( χ²=14.351, P<0.01). There were respectively 21 and 32 feet in patients of eschar shaving group and non-eschar shaving group. There were no significantly statistical differences in pulses of arteria dorsal pedis and posterior tibial artery of patients between eschar shaving group and non-eschar shaving group (Z=0, 0.453, P>0.05). The percentage of wounds on feet of patients in non-eschar shaving group deepening to full-thickness skin defect with bone and tendon exposure was 43.8% (14/32), which was significantly higher than 0 of patients in eschar shaving group ( χ²=12.486, P<0.01). Positive rates of bacteria and fungus in wounds on feet of patients in eschar shaving group was significantly lower than that of patients in non-eschar shaving group (χ²=4.386, P<0.05 ). Rate of wound healing on feet of patients in non-eschar shaving group was 59.4% (19/32), which was significantly lower than that of patients in eschar shaving group [100.0% (21/21), P<0.01]. Conclusions Diabetes patients with superficial partial-thickness burn wounds on feet has long length of hospital stay, high hospitalization treatment expenses. Wounds of the patients are easy to deepen, with low wound healing rate. Eschar shaving at early stage when the wounds deepened to deep partial-thickness burn is a good way to increase wound healing rate and prevent further deepening of wounds.
- Burns /
- Diabetic foot /
- Eschar shaving