The burden of diabetic foot ulcers
The burden of diabetic foot ulcers
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DOI：
10.1016/s0002-9610(98)00181-0
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发表时间：
1998-08-01
影响因子：
3
通讯作者：
Gibbons, GW
中科院分区：
文献类型：
--
作者：
Reiber, GE;Lipsky, BA;Gibbons, GW
从生活质量和经济角度来看，下肢溃疡是糖尿病患者及其治疗者的主要关注点。评估生活质量的研究表明，足部溃疡患者的身体、情感和社会功能都有所下降。对经济影响的分析表明：(1) 大部分费用发生在住院环境中，(2) 将初次截肢与包括血管重建在内的积极保肢方法进行比较时，缺乏经济利益，(3) 私人保险为住院护理提供的报销比医疗保险更高。病因学研究结果表明，高血糖通过山梨醇积累和蛋白质糖基化诱发糖尿病相关并发症，由此引起的神经损伤表现为周围神经病变，从而容易发生溃疡。糖尿病患者周围血管疾病的发生率也增加，伤口愈合受损，抵抗感染的能力下降。鉴于这些因素，有时很难确定患者管理的最佳方案。本次审查旨在帮助医疗保健提供者就治疗、资源使用和未来足部溃疡预防策略做出更好的决策。我是 J Suug。 1998；176（增补2A）：5S-10S。 (C) 1998 年，Excerpta Medica, Inc.
Lower extremity ulcers represent a major concern for patients with diabetes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown that patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majority of costs occur in the inpatient setting, (2) a lack of financial benefit when comparing primary amputation with an aggressive approach to limb salvaging including vascular reconstruction, and (3) private insurance provides greater reimbursement for inpatient care than does Medicare. Results of etiologic studies suggest that hyperglycemia induces diabetes-related complications through sorbitol accumulation and protein glycation, and the resultant nerve damage manifests as peripheral neuropathy, which predisposes to ulcer development. Patients with diabetes also have an increased incidence of peripheral vascular disease, impaired wound healing, and decreased ability to fight infection. In light of these factors, it is sometimes difficult to determine the optimal course for patient management. This review is aimed at helping healthcare providers make better decisions about treatment, resource use, and strategies for future foot ulcer prevention. Am J Suug. 1998;176(Suppl 2A):5S-10S. (C) 1998 by Excerpta Medica, Inc.