The treatment of diabetic foot
Posted on January 8, 2010
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The treatment of diabetic foot a good blood sugar control is the foundation, while peripheral vascular disease should be done for specialist treatment, mainly Chinese and Western medicine route one with 6 treatment, oral medicine Huoxuetongmai, improve microcirculation and intravenous infusion nutrition nerves, dilation of blood vessels to correct metabolic disorders, with the intravascular perfusion, foot bath fumigation and other treatment. Prevention and treatment of diabetic foot goal is to focus on prevention, early diagnosis, early treatment, not only can significantly improve the quality of life of patients with diabetes, but also greatly reduce the medical expenses associated with important social and economic benefits.
A general treatment
(1) Support symptomatic treatment, including restrictions on activity, weight loss, Taigaohuanzhi to facilitate the return of lower extremity blood, reducing edema.
(2) strict control of blood glucose, insulin is better to apply the limbs, and actively correct the ketoacidosis, hypoalbuminemia, heart, brain and kidney complications and the healing of the impact of various negative factors gangrene.
(3) debridement: removal of necrotic tissue, placing drainage, regular disinfection of dressing and so on.
(4) strengthening of patient education, foot care and reasonable and to prevent damage from outside.
2 Anti-infective
Diabetic foot infection pathogens in order to Staphylococcus aureus common, followed by Streptococcus, Enterococcus, Enterobacter, and anaerobes such as. Taken as soon as possible after admission focal secretion of bacterial culture, first with the commonly used antibiotics until culture results after the use of effective antibiotics, in addition to need to increase with anti-anaerobe drugs.
3 the treatment of ischemic foot ulcers
(1) for vascular surgery is not very serious or there is no indication who can use a conservative medical treatment, the use of vasodilator drugs such as prostaglandin E ,654-2, and blood circulation of Chinese medicine, such as breviscapine, reference pulse and so on.
(2) For severe cases of vascular lesions in the conservative treatment, based on the vessel revascularization should be performed. The methods are: vascular bypass surgery, endarterectomy, pedicled omental graft, percutaneous endovascular angioplasty and so on.
(3) for gangrene when at rest in patients with pain and a wide range of vascular lesions can not be with vascular reconstruction, should be bold and amputation, amputation before the best line of angiography to determine the amputation plane.
(4) hyperbaric oxygen therapy (HBD): high-pressure oxygen can improve the organization of new blood vessels metaplasia, increased collagen synthesis, enhance neutrophil bactericidal effect, but can also promote the synthesis of platelet-derived factor, the factor can promote wound healing. If the pulmonary infection is not suitably hyperbaric oxygen therapy.
(5) UV irradiation and oxygenation of blood transfusion therapy (UBID): has anti-bacterial inflammation, improve immunity in increasing tissue oxygen supply, lower blood viscosity and blood lipids, improve blood circulation and so on.
4 the treatment of neuropathic foot ulcers
(1) change of foot 90% of the neurological abnormalities of stress ulcers can be reasonably conservative treatment and healing. The key is to reduce the incidence of the original deal with the pressure created by the pressure distribution through the foot gauge understanding, and then use a special orthopedic shoes or foot orthoses in patients with pressure to change.
(2) to improve neurological function can be used B vitamins, such as nerve growth factor can promote nerve cell nucleic acid and protein synthesis, promote axonal regeneration of myelin-forming.
(3) The dressing covering the wound dressing to prevent further damage and reduce the risk of infection, maintaining wound healing, an ideal environment. Diluent choice of antibiotics, vitamin mixture, bFGF temperature deposited.
5 Amputation
An active conservative treatment still occurs gangrene, amputation should be timely, amputation site to be an accurate estimate, the local loop should be to make a choice, to ensure a good cycle of a high degree.
In short, the treatment of diabetic foot than in the past has seen much progress, especially in high-pressure oxygen therapy and ultraviolet blood irradiation and oxygenation transfusion therapy has some efficacy, but there is still no single method can be completely cured, which requires us to establish and improve the prevention and control system.
But now there are autologous stem cell transplantation – vascular regeneration therapy, vascular lesions can be a rich collateral circulation around the building, from the fundamental issue of improving the ischemic extremities.
Autologous stem cell transplantation advantages:
1, there is no immune rejection
2 do not involve the ethical problems of embryonic stem cells
3, surgical risk-free, long-term effects evident for middle-aged patients with chronic limb ischemia
4, with a repeatable, can be repeated several times in order to achieve the best results using the
Stem cell transplantation for treatment of arterial ischemic mechanism:
1, bone marrow contains mesenchymal stem cells in ischemic conditions can be transformed into endothelial progenitor cells
2, bone marrow also contains endothelial progenitor cells and bone marrow precursor cells in the common progenitor cells in ischemic conditions can be transformed into endothelial precursor cells
3, mesenchymal stem cells in ischemic conditions may be a large number of cells secrete VEGF and other factors, including the promotion of angiogenesis
4, mesenchymal stem cells inhibit anti-apoptotic role in progression
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