PATHWAYS TO DIABETIC LIMB AMPUTATION - BASIS FOR PREVENTION
PATHWAYS TO DIABETIC LIMB AMPUTATION - BASIS FOR PREVENTION
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DOI：
10.2337/diacare.13.5.513
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发表时间：
1990-05-01
期刊：
影响因子：
16.2
通讯作者：
BURGESS, EM
中科院分区：
文献类型：
--
作者：
PECORARO, RE;REIBER, GE;BURGESS, EM
我们定义了从1984年到1987年，在西雅图退伍军人事务医疗中心，在30个月的时间间隔内，对80例糖尿病患者进行下肢截肢的因果关系。因果通路，无论是单一的还是由七个潜在原因的各种组合组成（即，缺血、感染、神经病变、伤口愈合不良、轻微创伤、皮肤溃疡、坏疽），在研究者综合各种客观和主观数据后凭经验确定。估计截肢的比例，可以归因于每一个组成部分的原因进行了计算。确定了23种导致糖尿病截肢的独特因果途径。八个常见的组成部分导致73%的截肢。大多数通路由多种原因组成，只有急性动脉闭塞导致的严重缺血才是导致截肢的单一原因。72%的截肢病例的原因依次为轻微创伤、皮肤溃疡和伤口愈合失败，通常还伴有感染和坏疽。我们在因果通路的定义中规定了精确的标准，以估计各种原因所致截肢的累积比例。46%的截肢归因于缺血，59%归因于感染，61%归因于神经病变，815归因于伤口愈合不良，84%归因于溃疡，55%归因于坏疽，81%归因于初始轻微创伤。在大多数情况下，一个可识别的潜在可预防的关键事件，涉及轻微创伤，造成皮肤损伤的发作，之前的80截肢69。定义易患糖尿病肢体截肢的因果通路提示可能有效预防糖尿病肢体丧失的实际干预措施。
We defined the causal pathways responsible for 80 consecutive initial lower-extremity amputations to an extremity in diabetic patients at the Seattle Veterans Affairs Medical Center over a 30-mo interval from 1984 to 1987. Causal pathways, either unitary or composed of various combinations of seven potential causes (i.e., ischemia, infection, neuropathy, faulty wound healing, minor trauma, cutaneous ulceration, gangrene), were determined empirically after a synthesis by the investigators of various objective and subjective data. Estimates of the proportion of amputations that could be ascribed to each component cause were calculated. Twenty-three unique causal pathways to diabetic limb amputation were identified. Eight frequent constellations of component causes resulted in 73% of the amputations. Most pathways were composed of multiple causes, with only critical ischemia from acute arterial occlusions responsible for amputations as a singular cause. The causal sequence of minor trauma, cutaneous ulceration, and wound-healing failure applied to 72% of the amputation, often with the additional association of infection and gangrene. We specified precise criteria in the definition of causal pathway to permit estimation of the cumulative proportion of amputations due to various causes. Forty-six percent of the amputations were attributed to ischemia, 59% to infection, 61% to neuropathy, 815 to faulty wound healing, 84% to ulceration, 55% to gangrene, and 81% to initial minor trauma. An identifiable potentially preventable pivotal event, in most cases an episode involving minor trauma that caused cutaneous injury, preceded 69 of 80 amputations. Defining causal pathways that predispose to diabetic limb amputation suggests practical interventions that may be effective in preventing diabetic limb loss.