什么是糖尿病足？

許多病程較長(zhǎng)的糖尿病患者經(jīng)常被醫(yī)生告知“平時(shí)要注意小腿和足部的顏色和傷口”。

Many patients with diabetes with a long course of disease will be asked by the doctor to pay attention to the color and wound on the leg and foot.

不懂的人往往生活在未知之中。這實(shí)際上是因?yàn)獒t(yī)生擔(dān)心他們會(huì)患糖尿病足。

People who don't understand often don't understand why, this is actually doctors afraid they have diabetic foot.

糖尿病足分類

中醫(yī)認(rèn)為，糖尿病足終末期分干濕兩型，可通過(guò)傷口是否有膿性分泌物、異味、顏色變化等區(qū)分，但病情往往已經(jīng)較為嚴(yán)重。

Traditional Chinese medicine thinks, diabetic sufficient terminal stage cent is dry wet two kinds, can pass the distinction such as whether the wound has purulent sex secretions, peculiar smell, color change, but the condition is often already more serious.

北京清華長(zhǎng)庚醫(yī)院血管外科副主任醫(yī)師張童介紹，臨床上，醫(yī)生常按受累系統(tǒng)，將糖尿病足分為缺血型、神經(jīng)型和混合型。

Beijing tsinghua changgung hospital vascular surgery deputy chief physician zhang tong, clinical, doctors often according to the involved system, the diabetic foot will be divided into ischemic type, neurological type and mixed type.

糖尿病足的主要表現(xiàn)

缺血型表現(xiàn)為下肢發(fā)涼、行走受影響、靜息痛等癥狀，較為兇險(xiǎn)，容易導(dǎo)致截肢;

The symptoms of ischemic blood type are lower limb cooling, walking affected, resting pain, etc., which are more dangerous and easily lead to amputation.

神經(jīng)型常表現(xiàn)為下肢感覺異常，比如麻木、疼痛，也有不少患者屬于混合型。

Neurological type is often manifested as lower limb sensory abnormalities, such as numbness, pain, there are also many patients belong to the mixed type.

當(dāng)患者足部破潰時(shí)，為避免細(xì)菌感染，專業(yè)醫(yī)生首先要對(duì)傷口進(jìn)行換藥消毒甚至清創(chuàng);

When the patient's foot is broken, in order to avoid bacterial infection, professional doctors should first of all to the wound for dressing disinfection or debridement;

如果已出現(xiàn)感染，在消毒清創(chuàng)后，還要針對(duì)感染面積、深度、細(xì)菌種類，結(jié)合抗菌藥物治療。

If there is infection, after disinfection debridement, but also for the infection area, depth, bacterial species, combined with antimicrobial treatment.

血管狹窄閉塞是糖尿病足至關(guān)重要的病因，統(tǒng)計(jì)學(xué)調(diào)查分析發(fā)現(xiàn)，中國(guó)糖友合并缺血型糖尿病足的比例為75%~80%。

Vascular stenosis is the most important cause of diabetic foot. According to statistical analysis, the proportion of diabetic foot with ischemic type in Chinese patients is 75 to 80 percent.

糖尿病病程越長(zhǎng)，全身微血管損傷越嚴(yán)重，微循環(huán)受阻程度越高;

The longer the course of diabetes, the more serious the systemic microvascular injury, the higher the degree of microcirculation obstruction;

而下肢血管十分修長(zhǎng)、管徑小，且足部離心臟最遠(yuǎn)，這一區(qū)域更易因微循環(huán)受阻導(dǎo)致缺血。

However, the blood vessels in the lower extremity are very slender, the diameter of the tube is small, and the foot is furthest from the heart, which is more likely to be blocked by microcirculation and lead to ischemia.

這種情況下，不解決血管病變，單純清創(chuàng)不但不能有效延緩糖足進(jìn)展，還會(huì)適得其反。

In this case, not to solve the vascular lesions, debridement alone not only can not effectively delay the progress of sugar foot, but also will be counterproductive.

正確的做法是，針對(duì)下肢缺血癥狀，早期應(yīng)用抗血小板、擴(kuò)血管藥物治療，比如阿司匹林、氯吡格雷、沙格雷酯、貝前列腺素等。

The correct approach is to early use of antiplatelet, vasodilator drugs, such as aspirin, clopidogrel, sagrel ester, prostagstagen, and so on, for the symptoms of lower limb ischemia.

若患者血管出現(xiàn)狹窄或堵塞，絕大部分情況下會(huì)選用微創(chuàng)手術(shù)進(jìn)行治療。

In most cases, minimally invasive surgery is used to treat patients with narrowed or blocked blood vessels.

比如經(jīng)皮穿刺，進(jìn)行“下肢動(dòng)脈腔內(nèi)介入”治療。

Such as percutaneous puncture, "lower limb arterial lumen intervention" treatment.

手術(shù)中，醫(yī)生會(huì)在堵塞部位放入球囊，接著給球囊“打氣”，將狹窄的血管“撐開”，取出球囊后，血流便恢復(fù)暢通，或者在病變處置入支架。

During the procedure, a balloon is inserted into the blocked area and then "pumped up" to "open" the narrow blood vessel. Once the balloon is removed, the blood flow is restored, or a stent is placed at the affected area.

更為合理先進(jìn)的做法是通過(guò)斑塊旋切或斑塊消融導(dǎo)管清除病變區(qū)域的斑塊或血栓，這樣更加徹底且不用植入異物，重建血運(yùn)后通暢率更高，后期維護(hù)方便。

A more reasonable and advanced approach is to remove plaques or thrombus in the lesion area by plaque rotation or plaque ablation catheter, which is more thorough and does not need to implant foreign bodies, and has a higher patency rate after reconstruction of blood supply, and is convenient for later maintenance.