Diabetic foot, commonly known as the "old bad feet," is one of the serious complications of diabetes. For diabetic neuropathy, lower extremity macrovascular disease and infection, the modern scholars diabetes diabetic foot raised "rings therapy."
First ring: control of sugar
Strict control of blood glucose in patients with diabetic foot is very important. Even with type 2 diabetes, it is best to switch to insulin therapy. Such as poor glycemic control, intensive insulin therapy can be used instead. Subcutaneous insulin 4 times a day used the program (early, middle and short-acting insulin injected before dinner, bedtime injection in effect), if necessary, intravenous infusion of insulin or insulin infusion pump, while keeping a close monitoring of blood glucose, blood glucose control in the fasting 7 mmol / liter, postprandial 8 mmol / l or so.
Second Ring: blood
1. Intravenous vasodilators: Anisodamine (654-2) 20 ~ 40 mg in 250 ml normal saline intravenously once a day for 10 days or 2 weeks as a course, or oral tablets 20 654-2 30 mg 3 times a day, can lift the capillary spasm, microvascular activation of self-discipline campaigns to reduce leakage, reduce blood viscosity, but there are dry mouth, skin flushing, palpitation, abdominal distention, blurred vision and other side effects. Prostaglandin E (PGE1): add 20 micrograms Kay hour slow intravenous infusion of 100 ml of saline or by adding 20 ml of normal saline intravenous injection, 10 to 14 days for treatment, there are other similar drugs PGI2, protection of new and so on. Oral blood medicine there PROVIEW (cilostazol): 50 ~ 100 mg / day; pentoxifylline (Pantone): 400 ~ 800 mg / day; 100 ~ 300 mg of aspirin per day 1; 50 dipyridamole 100 mg, day 3 inferior.
2. Microcirculation of medicine: 250 ~ 500 ml of saline to add TMP 80 ~ 400 mg once a day, 40 drops per minute, the following slow intravenous infusion for 2 to 3 weeks for a course, change clothes after sodium ferulate film; Salvia pin 20 pin 30 ml or 8 Danshen adding 16 ml in 250 ml normal saline intravenously once a day for 2 weeks of a course of treatment; red flower pin can also be used by adding 20 to 40 ml 250 ml intravenous saline infusion; ahylysantinfarctase 0.25 ~ 0.5 units in 250 ml of normal saline intravenously 2 weeks, can reduce blood viscosity and reduce plasma fibrinogen, platelet adhesion and aggregation and blood circulation to play effect; needle 10 Mailuoning 20 ml intravenous saline added 2 weeks; Others include health network elements, such Xuesaitong.
3. UV irradiation of autologous blood.
4. HBO: In 0. 15Mpa mask inhalation of pure oxygen under pressure from 1 to 2 hours a day for 10 to 20 Tianyi treatment, can promote infection control and to accelerate wound healing.
The third ring: anti-inflammatory
Mild infection: common and effective antibiotics include: oral anti-inflammatory drugs such as amoxicillin / clavulanate, dicloxacillin, cephalexin, etc.; intravenous infusion of anti-inflammatory drugs such as cefazolin, ampicillin / sulbactam, chlorine Lin lincomycin, etc.; often need medication 2 to 4 weeks.
Serious infections: a serious infection may lead to amputation, patients with life-threatening. Foci of early surgical treatment, removal of bad rot tissue, cut with foot compartment drainage. Secretion of bacterial culture at the same time, it is best to use antibiotics based on culture results. However, pending the culture results, taking into account the foot rot of gram positive cocci negative bacilli and anaerobic bacteria and other infections easily exist, the choice of broad-spectrum antibiotics, supplemented by metronidazole against anaerobic bacteria. According to the recovery of ulcers and systemic conditions, the application time to up to 4 weeks.
Life-threatening infections: can be combined with ampicillin / sulbactam and aztreonam (imipenem); piperacillin / tazobactam and vancomycin; vancomycin, ceftazidime and metronidazole; imipenem and cilastatin; fluoroquinolones, vancomycin and metronidazole and so on.
Fourth Ring: dressing
The principle of dressing can be summarized as:
A consumer: anti-inflammatory disinfection. Topical application of tincture of iodine, alcohol sterilization, spray and antibiotics.
B Less: reduce stress, try to eliminate the local edema, draining the secretions, if necessary, surgical abscess drainage. Do not pack too tightly while dressing, affecting blood supply.
Three clear: Surgical debridement. As the necrotic tissue, diaphragm, such as excision of sequestrum, the local clean out pus and other secretions, revealing the fresh granulation tissue, can be used with biological activity of enzymes break down dressings to promote autolysis of necrotic tissue.
Four extended resection and suture: a period of time after treatment, the bad foot skin temperature decreased, edema, wound dry, can be used in dressings containing epidermal growth factor to dressing, but also the local spray 654-2, insulin, and removal of dry crust and irregular protrusion of bone, skin or skin flap closure and so on.
S rings: symptomatic and support
1. Fever, a fever can be ice, alcohol, physical cooling sponge bath; necessary, applications of antipyretics (hormones or indomethacin suppository, etc.).
2. Correcting ketosis, water, electrolyte imbalance, timely potassium, rehydration and maintain water and electrolyte balance.
3. Improve heart function, may be appropriate to expand application of drugs and diuretics such as coronary artery.
4. Infection prevention and control of other organs, especially the lungs and urinary tract infections.
5. Nutritional supplements: such as nutrition nerve Methylcobalamin (methylcobalamin), neurotropin, such as intramuscular injection of vitamin B group or oral, with anemia, hypoproteinemia, malnutrition can be added plasma, human serum albumin.
More "rings" to focus on blood and anti-inflammatory, but interlocking, are indispensable.
First ring: control of sugar
Strict control of blood glucose in patients with diabetic foot is very important. Even with type 2 diabetes, it is best to switch to insulin therapy. Such as poor glycemic control, intensive insulin therapy can be used instead. Subcutaneous insulin 4 times a day used the program (early, middle and short-acting insulin injected before dinner, bedtime injection in effect), if necessary, intravenous infusion of insulin or insulin infusion pump, while keeping a close monitoring of blood glucose, blood glucose control in the fasting 7 mmol / liter, postprandial 8 mmol / l or so.
Second Ring: blood
1. Intravenous vasodilators: Anisodamine (654-2) 20 ~ 40 mg in 250 ml normal saline intravenously once a day for 10 days or 2 weeks as a course, or oral tablets 20 654-2 30 mg 3 times a day, can lift the capillary spasm, microvascular activation of self-discipline campaigns to reduce leakage, reduce blood viscosity, but there are dry mouth, skin flushing, palpitation, abdominal distention, blurred vision and other side effects. Prostaglandin E (PGE1): add 20 micrograms Kay hour slow intravenous infusion of 100 ml of saline or by adding 20 ml of normal saline intravenous injection, 10 to 14 days for treatment, there are other similar drugs PGI2, protection of new and so on. Oral blood medicine there PROVIEW (cilostazol): 50 ~ 100 mg / day; pentoxifylline (Pantone): 400 ~ 800 mg / day; 100 ~ 300 mg of aspirin per day 1; 50 dipyridamole 100 mg, day 3 inferior.
2. Microcirculation of medicine: 250 ~ 500 ml of saline to add TMP 80 ~ 400 mg once a day, 40 drops per minute, the following slow intravenous infusion for 2 to 3 weeks for a course, change clothes after sodium ferulate film; Salvia pin 20 pin 30 ml or 8 Danshen adding 16 ml in 250 ml normal saline intravenously once a day for 2 weeks of a course of treatment; red flower pin can also be used by adding 20 to 40 ml 250 ml intravenous saline infusion; ahylysantinfarctase 0.25 ~ 0.5 units in 250 ml of normal saline intravenously 2 weeks, can reduce blood viscosity and reduce plasma fibrinogen, platelet adhesion and aggregation and blood circulation to play effect; needle 10 Mailuoning 20 ml intravenous saline added 2 weeks; Others include health network elements, such Xuesaitong.
3. UV irradiation of autologous blood.
4. HBO: In 0. 15Mpa mask inhalation of pure oxygen under pressure from 1 to 2 hours a day for 10 to 20 Tianyi treatment, can promote infection control and to accelerate wound healing.
The third ring: anti-inflammatory
Mild infection: common and effective antibiotics include: oral anti-inflammatory drugs such as amoxicillin / clavulanate, dicloxacillin, cephalexin, etc.; intravenous infusion of anti-inflammatory drugs such as cefazolin, ampicillin / sulbactam, chlorine Lin lincomycin, etc.; often need medication 2 to 4 weeks.
Serious infections: a serious infection may lead to amputation, patients with life-threatening. Foci of early surgical treatment, removal of bad rot tissue, cut with foot compartment drainage. Secretion of bacterial culture at the same time, it is best to use antibiotics based on culture results. However, pending the culture results, taking into account the foot rot of gram positive cocci negative bacilli and anaerobic bacteria and other infections easily exist, the choice of broad-spectrum antibiotics, supplemented by metronidazole against anaerobic bacteria. According to the recovery of ulcers and systemic conditions, the application time to up to 4 weeks.
Life-threatening infections: can be combined with ampicillin / sulbactam and aztreonam (imipenem); piperacillin / tazobactam and vancomycin; vancomycin, ceftazidime and metronidazole; imipenem and cilastatin; fluoroquinolones, vancomycin and metronidazole and so on.
Fourth Ring: dressing
The principle of dressing can be summarized as:
A consumer: anti-inflammatory disinfection. Topical application of tincture of iodine, alcohol sterilization, spray and antibiotics.
B Less: reduce stress, try to eliminate the local edema, draining the secretions, if necessary, surgical abscess drainage. Do not pack too tightly while dressing, affecting blood supply.
Three clear: Surgical debridement. As the necrotic tissue, diaphragm, such as excision of sequestrum, the local clean out pus and other secretions, revealing the fresh granulation tissue, can be used with biological activity of enzymes break down dressings to promote autolysis of necrotic tissue.
Four extended resection and suture: a period of time after treatment, the bad foot skin temperature decreased, edema, wound dry, can be used in dressings containing epidermal growth factor to dressing, but also the local spray 654-2, insulin, and removal of dry crust and irregular protrusion of bone, skin or skin flap closure and so on.
S rings: symptomatic and support
1. Fever, a fever can be ice, alcohol, physical cooling sponge bath; necessary, applications of antipyretics (hormones or indomethacin suppository, etc.).
2. Correcting ketosis, water, electrolyte imbalance, timely potassium, rehydration and maintain water and electrolyte balance.
3. Improve heart function, may be appropriate to expand application of drugs and diuretics such as coronary artery.
4. Infection prevention and control of other organs, especially the lungs and urinary tract infections.
5. Nutritional supplements: such as nutrition nerve Methylcobalamin (methylcobalamin), neurotropin, such as intramuscular injection of vitamin B group or oral, with anemia, hypoproteinemia, malnutrition can be added plasma, human serum albumin.
More "rings" to focus on blood and anti-inflammatory, but interlocking, are indispensable.
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