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下肢溃疡的评估与管理
Evaluation and Management of Lower-Extremity Ulcers


Adam J. Singer ... 心脑血管疾病 糖尿病 其他 • 2017.10.19
相关阅读
• 糖尿病足溃疡及其再发 • 高压氧对于治疗慢性糖尿病足溃疡无效

下肢溃疡很常见,在美国成年人中的患病率估计为1%~2%1,它对公众健康有着重大影响。下肢溃疡可根据其成因、发病机制以及治疗方法分为两大类——腿部溃疡和足部溃疡。即便用目前最好的治疗方案,25%~50%的腿部溃疡和超过30%的足部溃疡在治疗6个月后仍不能痊愈。大约70%的腿部溃疡由静脉疾病引起,大约20%由动脉供血不足或动静脉混合疾病引起1,2。大约85%的足部溃疡是由外周神经病变引起,通常还并发动脉疾病。

静脉性腿部溃疡的危险因素包括:高龄、女性、静脉腿部溃疡家族史、白种人、深静脉血栓形成或静脉炎病史、腿部受伤史、慢性腿部水肿、久坐的生活方式和长时间站立。动脉溃疡的危险因素包括:糖尿病、高血压、高脂血症、肥胖和吸烟3-6。足部溃疡的危险因素包括:感觉缺失、关节活动受限、解剖学异常、糖尿病、血管疾病和反复高压。

在美国,每年与静脉腿部溃疡和糖尿病足溃疡相关的成本分别为149亿美元7和90~130亿美元8。静脉腿部溃疡患者所需要的医疗资源要超过人口统计学特征相匹配的对照人群7。这些患者由于溃疡相关的并发症或是随访,误工天数也较多,由此导致的费用比匹配的对照人群高近1/3。糖尿病足溃疡患者与匹配的对照人群相比,住院通常更为频繁,需要更多家庭护理,急诊次数和门诊次数都较多8

本文主要描述我们对于下肢溃疡的管理方法。只要可能,我们都基于随机试验的结果做出我们的建议。因为有些建议是基于小型观察性研究或专家意见,因此我们也承认其中存在一定争议,但是推荐的方法在我们的临床实践中均有用。





作者信息

Adam J. Singer, M.D., Apostolos Tassiopoulos, M.D., and Robert S. Kirsner, M.D., Ph.D.
From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.). Address reprint requests to Dr. Singer at the Department of Emergency Medicine, Stony Brook University, HSC L4-080, 8350 SUNY, Stony Brook, NY 11794-8350, or at adam.singer@stonybrook.edu.

 

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