资讯内容 Content

[ADA2014]神秘的Charcot足
——美国匹兹堡大学医学中心Dane K. Wukich教授访谈
国际糖尿病网版权所有,谢绝任何形式转载,侵犯版权者必予法律追究。

作者:D.K.Wukich 2014/6/17 13:33:00    加入收藏
内容概要:《国际糖尿病》:感谢您为大家带来精彩的演讲。众所周知,夏科氏足是糖尿病患者致残的主要原因,能否请您与我们分享一下该病治疗方面的最新进展?
  <International Diabetes>: We know that self care of the patients is very important in the care of this disease.  In which aspect you can share with us, that will bring the patient into the self care.  How can we educate the patient?
  Dr. Wukich : The most important thing is that every time you see that patient in your office, even if you are an endocrinologists or a family practitioner, you need to ask them about their feet.  Look at their feet, take their shoes off and examine them, and tell them the complications of diabetes include not only blindness, not only kidney disease, not only cardiac disease, but problems with their feet.  We have to continually education patients and really the most important people to do that is their primary care physicians.  Once they see me, it is usually late.  Endocrinologists may see patients every 6 months, they need to do this with family physicians. Primary care nurses are the key.
  《国际糖尿病》:患者的自我管理对该病的治疗是非常重要的。您能否分享一下有关如何促进患者进行自我管理的一些经验?我们应如何对患者进行教育?
  Wukich教授:最重要的是,每次在诊室见到患者时,医生(包括内分泌科医生及家庭医生)都要询问其足部的情况,让患者脱掉鞋子,检查其足部,并告知患者“糖尿病的并发症不仅包括失明、肾脏疾病、心脏疾病还包括糖尿病足”。我们需要不断地对患者进行教育,而患者教育工作最重要的承担者应该是初级保健医生。一般患者来到我这里就诊时,通常都已经处于疾病晚期了。内分泌科医生可能需要每6个月对患者进行一次随访,并与家庭医生合作进行。此外,在患者教育中,初级保健护士发挥着很关键的作用。
 
  <International Diabetes>:  Also from your speech, you mentioned you can not support early reconstruction operation.  Can you please share some thoughts on that?
  Dr. Wukich :  I am an orthopedic surgeon so when somebody comes in with a dislocated foot or a foot that is mal-aligned, my bias is inherently to reconstruct that and get it lined up.  I do not understand why we wait until their deformity develops and for an ulcer to develop to intervene.  Once an ulcer develops they have an amputation risk that goes up 12 times.  My feeling is if I can realign their foot and prevent a foot ulceration, I can prevent an infection, and I  can prevent an amputation.  That is not based on high level evidence but if somebody came in who did not have diabetes, that is how I would treat it and we all would agree that that is the standard of care.  Why we do it differently in patients with diabetes neuropathy, I am not sure.
  《国际糖尿病》:您在演讲中提到,您并不支持早期进行重建手术。能否请您分享一下您的见解?
  Wukich教授:我是一名骨科医生,因此当有人出现足部脱臼或需要矫正时,我对重建是存在偏见的。我不知道为什么我们非得等到患者发生畸形或是足溃疡时采对其进行干预。一旦发生足溃疡,患者的截肢风险可增加12倍。我认为,如果我能够积极对患者的足部进行管理,并预防足溃疡,就能预防感染及截肢的发生。虽然这样做并未基于很高水平的证据,但非糖尿病患者来我这里就诊时,我会这样对其进行治疗,大家都认为这是标准治疗。既然如此,我们为什么要对糖尿病神经病变患者有所不同呢。


上一页  [1]  [2]  

 延伸阅读
注册

网友评论仅供其表达个人看法,并不表明国际糖尿病同意其观点或证实其描述。 发表评论需登陆

相关标签

相关幻灯

相关视频

 
关于本站 | 设为首页 | 加入收藏 | 站长邮箱 | 友情链接 | 版权申明

国际糖尿病(www.idiabetes.com.cn)对刊载的所有文章、视频、幻灯、音频等资源拥有全部版权。未经本站许可,不得转载。

国际糖尿病 版权所有  2008-2018 idiabetes.com.cn  All Rights Reserved