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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 35 -38. doi: 10.3877/cma.j.issn.1674-0793.2020.01.010

所属专题： 文献；

论著

创面-缺血-足部感染分级预估糖尿病肢体动脉闭塞症腔内治疗术后截肢的临床研究
王建国1, 孟祥红2, 孙岩3, 王玉涛4,†()   
  1. 1. 256800　滨州市第二人民医院　滨州市沾化区人民医院介入科
    2. 256800　滨州市第二人民医院　滨州市沾化区人民医院健康体检科
    3. 250012　济南，山东大学附属山东省立医院血管外科
    4. 250012　济南市中医医院周围血管病科
  • 收稿日期:2019-04-30 出版日期:2020-02-01
  • 通信作者: 王玉涛
  • 基金资助:
    山东省医药卫生科技发展计划(2018WS273，2018WS478); 济南市第二届优秀卫生计生人才培养项目(济卫科外发〔2018〕8号); 济南市第三批"薪火传承231工程"培养项目(济中医药发〔2017〕11号); 济南市卫生健康系统青年岗位能手培养项目(济卫发〔2019〕1号)

Clinical research on predicting the outcome of amputation of diabetic arterial occlusion by WIFi classification after endovascular therapy

Jianguo Wang1, Xianghong Meng2, Yan Sun3, Yutao Wang4,†()   

  1. 1. Department of Interventional Therapy, Zhanhua District People’s Hospital of Binzhou City, Binzhou 256800, China
    2. Department of Health and Physical Examination, Zhanhua District People’s Hospital of Binzhou City, Binzhou 256800, China
    3. Department of Vascular Surgery, Shandong Provincial Hospital, Jinan 250012, China
    4. Department of Peripheral Vascular Surgery, Jinan Municiple Hospital of Traditional Chinese Medicine, Jinan 250012, China
  • Received:2019-04-30 Published:2020-02-01
  • Corresponding author: Yutao Wang
  • About author:
    Corresponding author: Wang Yutao, Email:
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王建国, 孟祥红, 孙岩, 王玉涛. 创面-缺血-足部感染分级预估糖尿病肢体动脉闭塞症腔内治疗术后截肢的临床研究[J]. 中华普通外科学文献(电子版), 2020, 14(01): 35-38.

Jianguo Wang, Xianghong Meng, Yan Sun, Yutao Wang. Clinical research on predicting the outcome of amputation of diabetic arterial occlusion by WIFi classification after endovascular therapy[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(01): 35-38.

目的

探讨创面-缺血-足部感染（WIFi）分级预估糖尿病肢体动脉闭塞症（DAO）患者腔内治疗术后发生截肢的临床意义。

方法

回顾性分析2015年7月至2018年7月山东省立医院、济南市中医医院和滨州市沾化区人民医院收治的DAO患者80例，根据是否截肢分为截肢组（44例）和未截肢组（36例），运用Logistic回归分析患者术后发生截肢的独立危险因素。

结果

两组患者在性别（χ2=1.678，P=0.195）、年龄（t=1.697，P=0.094）、糖化血红蛋白（t=-0.419，P=0.677）、体质指数（t=-0.236，P=0.814）、入院空腹血糖（t=-0.640，P=0.524）、糖尿病病程（t=-0.732，P=0.466）、高血压病史（χ2=1.347，P=0.466）等方面差异无统计学意义。截肢组W、I、Fi高级别的患者较未截肢组多，差异均有统计学意义（χ2=27.963、30.901、19.140，均P<0.001）。Logistic回归分析显示，W、I、Fi均为DAO患者腔内治疗术后发生截肢的独立危险因素（95% CI：0.022~0.309，0.020~0.319，0.073~0.900，P<0.001、<0.001、0.034）。

结论

下肢缺血程度、下肢创面或坏疽以及感染等情况是影响DAO腔内治疗后截肢的独立危险因素，WIFi分级可有效预测DAO腔内治疗后截肢情况。

关键词: 糖尿病, 动脉闭塞性疾病, 截肢术, 危险因素, WIFi分级
Objective

To evaluate the clinical significance of wound-ischemia-foot infection (WIFi) classification in predicting the occurrence of amputation after endovascular therapy in patients with diabetic arterial occlusion (DAO).

Methods

Eighty patients with DAO in Shandong Provincial Hospital, Jinan Municiple Hospital of Traditional Chinese Medicine and Zhanhua District People’s Hospital from July 2015 to July 2018 were divided into two groups according to be amputated or not. Forty-four patients were included in the amputation group while 36 patients in the non-amputation group. The clinical data and WIFi grading after endovascular therapy were analyzed retrospectively. The independent risk factors of amputation in DAO patients were analyzed by Logistic regression.

Results

There were no significant differences in sex (χ2=1.678, P=0.195), age (t=1.697, P=0.094), glycosylated hemoglobin (t=-0.419, P=0.677), body mass index (t=-0.236, P=0.814), fasting blood glucose (t=-0.640, P=0.524), duration of diabetes mellitus (t=-0.732, P=0.466) and history of hypertension (χ2=1.347, P=0.466) between the two groups. The number of high-grade patients with woud (W), ischemia (I) and foot infection (Fi) in the amputation group was significantly higher than that in the non-amputation group (χ2=27.963, 30.901, 19.140, all P<0.001). Logistic regression showed that W, I and Fi were independent risk factors for amputation in patients with DAO after intracavitary treatment (95% CI: 0.022-0.309, 0.020-0.319, 0.073-0.900, P<0.001, <0.001, 0.034).

Conclusions

The degree of lower limb ischemia, wound or gangrene of lower limb and foot infection are independent risk factors for amputation after intracavitary treatment of DAO. WIFi grade can effectively predict amputation after endovascular therapy of DAO.

Key words: Diabetes mellitus, Arterial occlusive diseases, Amputation, Risk factors, WIFi classification
图1 WIFi分级指导下的腔内治疗病例1　A为术前造影，患者术前造影见腘动脉重度狭窄，膝下胫前动脉、胫腓干、胫后动脉、腓动脉显影不良（箭头所示）；B为术中治疗，应用球囊扩张腘动脉（箭头所示）；C为术后造影，见腘动脉、胫腓干、胫后动脉、腓动脉显影良好
图2 WIFi分级指导下的腔内治疗病例2　A为术前造影，股动脉闭塞（箭头所示），下肢远端血供由股深动脉及其侧支保证；B为术中治疗，导丝通过闭塞段后，予以球囊扩张+支架植入（箭头所示）；C为术后造影，股动脉显影良好
表1 两组糖尿病肢体动脉闭塞症患者基线资料比较
组别 例数 年龄(岁) 性别(男/女,例) BMI(kg/m2) HbA1c(%) 入院空腹血糖(mmol/L) 高血压病史(年) DAO病程(年)
未截肢组 36 58.89±11.75 9/27 26.69±3.53 9.49±2.11 10.11±1.71 11 17.17±9.43
截肢组 44 54.84±9.59 17/27 26.89±4.04 9.69±2.03 10.35±1.62 19 18.71±9.27
统计值 1.697 1.678a -0.236 -0.419 -0.640 1.347a -0.732
P值 0.094 0.195 0.814 0.677 0.524 0.246 0.466
表2 两组糖尿病肢体动脉闭塞症患者WIFi分级资料比较（例）
组别 例数 W分级 I分级 Fi分级
0 1 2 3 0 1 2 3 0 1 2 3
未截肢组 36 13 11 7 5 15 10 7 4 12 15 9 0
截肢组 44 0 6 17 21 0 12 6 26 2 14 19 9
χ2值 27.963 30.901 19.140
P值 <0.001 <0.001 <0.001
表3 DAO患者截肢危险因素分析
变量 回归系数 标准误 Wald值 P值 OR值 95% CI
W分级 -2.504 0.678 13.633 <0.001 0.082 0.022~0.309
I分级 -2.524 0.704 12.851 <0.001 0.080 0.020~0.319
Fi分级 -1.359 0.640 4.511 0.034 0.257 0.073~0.900
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