什么是糖尿病足？

Many patients with diabetes with a long course of disease will be asked by the doctor to pay attention to the color and wound on the leg and foot.

不懂的人往往生活在未知之中。这实际上是因为医生担心他们会患糖尿病足。

People who don't understand often don't understand why, this is actually doctors afraid they have diabetic foot.

糖尿病足分类

中医认为，糖尿病足终末期分干湿两型，可通过伤口是否有脓性分泌物、异味、颜色变化等区分，但病情往往已经较为严重。

Traditional Chinese medicine thinks, diabetic sufficient terminal stage cent is dry wet two kinds, can pass the distinction such as whether the wound has purulent sex secretions, peculiar smell, color change, but the condition is often already more serious.

北京清华长庚医院血管外科副主任医师张童介绍，临床上，医生常按受累系统，将糖尿病足分为缺血型、神经型和混合型。

Beijing tsinghua changgung hospital vascular surgery deputy chief physician zhang tong, clinical, doctors often according to the involved system, the diabetic foot will be divided into ischemic type, neurological type and mixed type.

糖尿病足的主要表现

缺血型表现为下肢发凉、行走受影响、静息痛等症状，较为凶险，容易导致截肢;

The symptoms of ischemic blood type are lower limb cooling, walking affected, resting pain, etc., which are more dangerous and easily lead to amputation.

神经型常表现为下肢感觉异常，比如麻木、疼痛，也有不少患者属于混合型。

Neurological type is often manifested as lower limb sensory abnormalities, such as numbness, pain, there are also many patients belong to the mixed type.

当患者足部破溃时，为避免细菌感染，专业医生首先要对伤口进行换药消毒甚至清创;

When the patient's foot is broken, in order to avoid bacterial infection, professional doctors should first of all to the wound for dressing disinfection or debridement;

如果已出现感染，在消毒清创后，还要针对感染面积、深度、细菌种类，结合抗菌药物治疗。

If there is infection, after disinfection debridement, but also for the infection area, depth, bacterial species, combined with antimicrobial treatment.

血管狭窄闭塞是糖尿病足至关重要的病因，统计学调查分析发现，中国糖友合并缺血型糖尿病足的比例为75%~80%。

Vascular stenosis is the most important cause of diabetic foot. According to statistical analysis, the proportion of diabetic foot with ischemic type in Chinese patients is 75 to 80 percent.

糖尿病病程越长，全身微血管损伤越严重，微循环受阻程度越高;

The longer the course of diabetes, the more serious the systemic microvascular injury, the higher the degree of microcirculation obstruction;

而下肢血管十分修长、管径小，且足部离心脏最远，这一区域更易因微循环受阻导致缺血。

However, the blood vessels in the lower extremity are very slender, the diameter of the tube is small, and the foot is furthest from the heart, which is more likely to be blocked by microcirculation and lead to ischemia.

这种情况下，不解决血管病变，单纯清创不但不能有效延缓糖足进展，还会适得其反。

In this case, not to solve the vascular lesions, debridement alone not only can not effectively delay the progress of sugar foot, but also will be counterproductive.

正确的做法是，针对下肢缺血症状，早期应用抗血小板、扩血管药物治疗，比如阿司匹林、氯吡格雷、沙格雷酯、贝前列腺素等。

The correct approach is to early use of antiplatelet, vasodilator drugs, such as aspirin, clopidogrel, sagrel ester, prostagstagen, and so on, for the symptoms of lower limb ischemia.

若患者血管出现狭窄或堵塞，绝大部分情况下会选用微创手术进行治疗。

In most cases, minimally invasive surgery is used to treat patients with narrowed or blocked blood vessels.

比如经皮穿刺，进行“下肢动脉腔内介入”治疗。

Such as percutaneous puncture, "lower limb arterial lumen intervention" treatment.

手术中，医生会在堵塞部位放入球囊，接着给球囊“打气”，将狭窄的血管“撑开”，取出球囊后，血流便恢复畅通，或者在病变处置入支架。

During the procedure, a balloon is inserted into the blocked area and then "pumped up" to "open" the narrow blood vessel. Once the balloon is removed, the blood flow is restored, or a stent is placed at the affected area.

更为合理先进的做法是通过斑块旋切或斑块消融导管清除病变区域的斑块或血栓，这样更加彻底且不用植入异物，重建血运后通畅率更高，后期维护方便。

A more reasonable and advanced approach is to remove plaques or thrombus in the lesion area by plaque rotation or plaque ablation catheter, which is more thorough and does not need to implant foreign bodies, and has a higher patency rate after reconstruction of blood supply, and is convenient for later maintenance.