目的:本研究解决了因糖尿病足而进行下肢截肢的糖尿病患者所面临的挑战,特别关注对伤口愈合和早期死亡率的影响。截肢残端处的伤口可能需要多次手术干预。目的是确定与这些结果相关的预后因素,揭示了截肢后阶段周围的复杂性。
方法:对2021年至2022年因糖尿病足而接受下肢截肢的39名糖尿病患者进行了前瞻性研究。全面的术前数据,包括血细胞计数等参数,红细胞沉降率,C反应蛋白,降钙素原,血红蛋白A1c,白蛋白,蛋白质,转铁蛋白,铁蛋白水平,年龄,性别,身体质量指数,吸烟习惯,透析,血运重建,手术持续时间,术中使用止血带的情况进行了细致的记录。此外,术前使用迷你精神状态检查(MMSE)和贝克抑郁量表(BDI)评估认知表现和抑郁状态,分别。手术后3个月的随访期允许将在截肢残端发生感染的患者与未发生感染的患者进行比较,以及幸存的患者和死于死亡的患者之间的区别。
结果:研究表明,在手术过程中使用止血带显着增加了感染的风险(p=0.027),较高的BDI评分与感染(AUC=0.814)和死亡率(AUC=0.769)的风险增加相关,截止分数为24.0和23.5,以高灵敏度和特异性预测这些结果,分别。此外,较低的MMSE评分与术后短期死亡率增加相关.两组在全血细胞计数等参数上没有统计学上的显着差异,ESR,CRP,降钙素原,HbA1c,白蛋白,总蛋白质,转铁蛋白,铁蛋白水平,年龄,性别,BMI,吸烟,透析,血运重建,和手术持续时间。
结论:这项调查强调了在截肢期间考虑使用止血带的重要性,术前抑郁状态,糖尿病足截肢患者的认知功能。手术过程中使用止血带是感染的重要危险因素,BDI评分升高是截肢患者感染和死亡率的强预测因子.研究结果强调了术前进行多学科神经精神病学评估以增强患者护理和预后的重要性。
方法:2级(前瞻性队列研究)。
This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of
tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a
tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering
tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a
tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes.