The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of...The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres,which are mostly nociceptors and excitable by noxious stimuli only.However,some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported.Hence,it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy.Pain perception(nociception),by contrast,has rarely been studied.Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 m N(equivalent to 51.2 g) at the diabetic foot.However,deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 k Pa(equivalent to 14 kg;limit of measurement) only in every fifth case.These discrepancies of pain perception between forefoot and hindfoot,and between skin and muscle,demand further study.Measuring nociception at the feet in diabetes opens promising clinical perspectives.A critical nociception threshold may be quantified(probably corresponding to a critical number of intraepidermal nerve fibre endings),beyond which the individual risk of a diabetic foot rises appreciably.Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.展开更多
糖尿病足给全球糖尿病患者以及卫生保健系统带来沉重的负担。国际糖尿病足工作组(The International Working Group on the Diabetic Foot,IWGDF)自1999年起一直致力于制定基于循证的糖尿病足防治指南。2019年,在文献系统综述以及全球...糖尿病足给全球糖尿病患者以及卫生保健系统带来沉重的负担。国际糖尿病足工作组(The International Working Group on the Diabetic Foot,IWGDF)自1999年起一直致力于制定基于循证的糖尿病足防治指南。2019年,在文献系统综述以及全球多学科领域专家推荐意见的基础上,对IWGDF的所有指南进行了更新。本实践指南在IWGDF指南第六部分的基础上阐述了糖尿病足的预防、分类和治疗的基本原则。同时,阐述了如何基于这些原则从组织层面成功地预防与治疗糖尿病足,并提供了用于辅助糖尿病足筛查的附录(见附录1和附表1)。本实践指南针对的是全球参与糖尿病患者医疗照护的医务人员。全球大量的研究证实,实施这些防治原则与降低糖尿病相关的下肢截肢发生率有关。我们希望这些更新的实践指南能继续作为有效参考文件以帮助卫生保健人员减轻全球糖尿病足的负担。展开更多
国际糖尿病足工作组(IWGDF)1999年发布了关于预防和管理糖尿病足病的循证指南。该指南旨在预防糖尿病患者的足部溃疡,并在2015年,IWGDF对预防指南进行了更新。我们遵循GRADE(grading of recommendations assessment development and eva...国际糖尿病足工作组(IWGDF)1999年发布了关于预防和管理糖尿病足病的循证指南。该指南旨在预防糖尿病患者的足部溃疡,并在2015年,IWGDF对预防指南进行了更新。我们遵循GRADE(grading of recommendations assessment development and evaluation)的评分方法,采用以患者为观察对象、有干预措施、与对照组进行比较、观察结局(patient-intervention-comparison-outcome,PICO)的方法来设计临床问题和关键成果,对医学科学文献进行系统评价,并撰写推荐意见及其理由。这些推荐基于系统评价中发现的证据质量、专家意见,以及益处及危害的权重、患者偏好、可行性和适用性以及与干预相关成本的权衡。我们建议对处于极低溃疡风险的患者每年做一次筛查,了解其是否有周围神经病变和外周血管病变,对高风险人群检查的频率要更高,以筛查其他危险因素。为了预防足溃疡,要对有危险因素的患者进行健康教育,教育患者适当地对足部进行自我护理以及对溃疡前症状进行有效治疗。指导中高危患者穿着合适的治疗鞋,并对其足部皮肤温度进行监测。处方治疗鞋在行走过程中具有明显的减轻足底压力的效果,能够防止足底溃疡复发。急性足溃疡或即将发生的足溃疡保守治疗失败,应考虑手术干预。我们不建议使用神经松解减压术。对高危患者给予综合足部医疗护理,以防溃疡复发。贯彻这些推荐将有助于医疗专业人员对有足溃疡风险的糖尿病患者提供更好的护理,降低糖尿病足溃疡的发生率,使足部健康维持更长的时间即增加无足病的天数,显著减少糖尿病患者和医疗机构的负担。展开更多
文摘The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres,which are mostly nociceptors and excitable by noxious stimuli only.However,some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported.Hence,it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy.Pain perception(nociception),by contrast,has rarely been studied.Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 m N(equivalent to 51.2 g) at the diabetic foot.However,deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 k Pa(equivalent to 14 kg;limit of measurement) only in every fifth case.These discrepancies of pain perception between forefoot and hindfoot,and between skin and muscle,demand further study.Measuring nociception at the feet in diabetes opens promising clinical perspectives.A critical nociception threshold may be quantified(probably corresponding to a critical number of intraepidermal nerve fibre endings),beyond which the individual risk of a diabetic foot rises appreciably.Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.
文摘糖尿病足给全球糖尿病患者以及卫生保健系统带来沉重的负担。国际糖尿病足工作组(The International Working Group on the Diabetic Foot,IWGDF)自1999年起一直致力于制定基于循证的糖尿病足防治指南。2019年,在文献系统综述以及全球多学科领域专家推荐意见的基础上,对IWGDF的所有指南进行了更新。本实践指南在IWGDF指南第六部分的基础上阐述了糖尿病足的预防、分类和治疗的基本原则。同时,阐述了如何基于这些原则从组织层面成功地预防与治疗糖尿病足,并提供了用于辅助糖尿病足筛查的附录(见附录1和附表1)。本实践指南针对的是全球参与糖尿病患者医疗照护的医务人员。全球大量的研究证实,实施这些防治原则与降低糖尿病相关的下肢截肢发生率有关。我们希望这些更新的实践指南能继续作为有效参考文件以帮助卫生保健人员减轻全球糖尿病足的负担。
文摘国际糖尿病足工作组(IWGDF)1999年发布了关于预防和管理糖尿病足病的循证指南。该指南旨在预防糖尿病患者的足部溃疡,并在2015年,IWGDF对预防指南进行了更新。我们遵循GRADE(grading of recommendations assessment development and evaluation)的评分方法,采用以患者为观察对象、有干预措施、与对照组进行比较、观察结局(patient-intervention-comparison-outcome,PICO)的方法来设计临床问题和关键成果,对医学科学文献进行系统评价,并撰写推荐意见及其理由。这些推荐基于系统评价中发现的证据质量、专家意见,以及益处及危害的权重、患者偏好、可行性和适用性以及与干预相关成本的权衡。我们建议对处于极低溃疡风险的患者每年做一次筛查,了解其是否有周围神经病变和外周血管病变,对高风险人群检查的频率要更高,以筛查其他危险因素。为了预防足溃疡,要对有危险因素的患者进行健康教育,教育患者适当地对足部进行自我护理以及对溃疡前症状进行有效治疗。指导中高危患者穿着合适的治疗鞋,并对其足部皮肤温度进行监测。处方治疗鞋在行走过程中具有明显的减轻足底压力的效果,能够防止足底溃疡复发。急性足溃疡或即将发生的足溃疡保守治疗失败,应考虑手术干预。我们不建议使用神经松解减压术。对高危患者给予综合足部医疗护理,以防溃疡复发。贯彻这些推荐将有助于医疗专业人员对有足溃疡风险的糖尿病患者提供更好的护理,降低糖尿病足溃疡的发生率,使足部健康维持更长的时间即增加无足病的天数,显著减少糖尿病患者和医疗机构的负担。
