糖尿病足之臨床評估與治療

Clinical Evaluation and Treatment of Diabetic Foot

10.6314/JIMT.2011.22(4).04

沈惠民(Huey-Min Sheen)；林東亮(Tung-Liang Lin)；鍾進燈(Chin-Teng Chung)；許惠恒(Wayne H-H Sheu)

糖尿病足 ； 糖尿病神經病變 ； 周邊動脈血管疾病 ； Diabetic foot ； Diabetic neuropathy ； Peripheral arterial disease

內科學誌

22卷4期（2011 / 08 / 01）

254 - 265

繁體中文

糖尿病足部潰瘍，肇因於長期血糖控制不佳，所引起之下肢病變。患者往往會伴隨著糖尿病神經病變(Diabetic Neuropathy)、周邊動脈血管疾病(Peripheral Arterial Disease)與足部變形。這些病變會造成足部感覺、運動、循環功能與結構上的異常。這些病變使得糖尿病患的足部，較一般人更容易產生傷口與感染的現象。若傷口持續惡化，進而演變成潰瘍與壞死，嚴重者甚至必須要截肢。有鑑於截肢，對於個人日常生活功能與家庭社會的影響甚鉅，本文針對糖尿病足部潰瘍的病理成因、糖尿病足部潰瘍評估、分類、相關併發症、治療、鞋具預防與衛教等，進行文獻回顧與建議。所得結論爲：糖尿病足部潰瘍的預防，著重於長期血糖控制、定期地足部檢查與衛教。糖尿病足部潰瘍的治療，需評估傷口現況與感染程度，選擇有效的治療方式。依照每位病患足部形狀與病況的進展，早期適時的鞋具介入，客製化的選配，可能可以降低糖尿病足部潰瘍之發生與後續截肢的風險。

Diabetic foot ulcer is the lower extremity lesion caused by long-term poor blood glucose control. Patients are often associated with diabetic neuropathy, peripheral artery disease and foot deformation. These lesions, usually accompanied by foot abnormalities of sensory, motor, blood supply and structure prone individuals with diabetes mellitus to wound their feet. If the wound deteriorates, subsequent development of ulcers, necrosis and event amputation will occur. Amputation has great impact on the personal daily activities, family and society. In this article, we had thoroughly reviewed the causes and pathophysiology of diabetic foot ulcers, diabetic foot ulcer assessment, classification, complications, treatment, footwear interventions, prevention and health education. The conclusions as follows: the long-term metabolic control, regular foot protection and examination, timely education all play important role in the prevention and management of diabetic foot ulcers. Treatment of diabetic foot ulcers depends on the assessment of wound and infection. The customized footwear with early intervention based on the foot condition and progression might reduce the costs of wound care, surgical debridement, and the risk of amputation.

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