disease and infection, the modern scholars put forward the diabetic patients with diabetic foot "rings therapy."
1st Ring: Control of sugar
Strict control of blood glucose in patients with diabetic foot is very important. Even if type 2 diabetes, insulin therapy had better use. Such as poor blood
glucose control can switch to intensive insulin therapy. Commonly used subcutaneous insulin 4 times a day program (early, middle and short-acting insulin
injected before dinner, bedtime injections in effect), if necessary, intravenous infusion of insulin or continuous insulin infusion pump, while closely
monitoring blood glucose, blood glucose control in fasting 7 mmol / l below postprandial 8 mmol / l or so.
The second link: Huoxue
1, pulse application of vasodilator drugs: anisodamine (654-2) 20 ~ 40 mg dissolved in 250 ml of normal saline intravenously once daily for 10 consecutive
days or two weeks for a course of treatment, or oral tablets 654-2 20 ~ 30 mg a day three times to lift the capillary spasm, the activation Vasomotion,
reduce leakage, reduce blood viscosity, but there are dry mouth, skin flushing, palpitation, abdominal distention, blurred vision and other side effects.
Prostaglandin E (PGE1): Kay clock by adding 20 micrograms in 100 ml of a slow intravenous infusion of saline or normal saline 20 ml intravenous injection, 10
~ 14 days for a course of treatment, there are other similar drugs PGI2, insurance and so on up to the new. Oral medicine have Peter Kam blood circulation
(cilostazol): 50 ~ 100 mg / day; pentoxifylline (Pantone): 400 ~ 800 mg / day; 100 ~ 300 mg of aspirin a day 1; 50 ~ 100 mg of dipyridamole, on the 1st three
second-class.
2, improvement of microcirculation of the traditional Chinese medicine: 250 ~ 500 ml of normal saline added the TMP 80 ~ 400 mg once a day, every 40 minutes
following a slow intravenous drip infusion for 2 to 3 weeks for a course of treatment, after the change service Chuanxiong Tablets; Salvia needle 20 ~ 30 ml
or Danshen pin 8 ~ 16 milliliters in 250 ml normal saline intravenously once a day, two weeks a course of treatment; can also be used safflower needle 20 ~
40 ml normal saline 250 ml intravenous drip; ahylysantinfarctase 0.25 ~ 0.5 units by adding 250 ml normal saline intravenously two weeks, can reduce blood
viscosity and reduce plasma fibrinogen, platelet adhesion and aggregation and play a blood circulation Huayu effect; Mailuoning needle 10 ~ 20 ml normal
saline intravenous infusion of 2 weeks; Others include health network element, Xuesaitong so.
3, autologous blood ultraviolet irradiation.
4, high-pressure oxygen: in 0. 15Mpa mask inhalation of pure oxygen under pressure from 1 to 2 hours a day, for 10 ~ 20 Tianyi course of treatment, can
promote infection control and to accelerate wound healing.
3rd Ring: anti-inflammatory
Mild infection: common and effective antibiotics include: oral anti-inflammatory drugs such as amoxicillin / clavulanate potassium, dicloxacillin,
cephalexin, etc.; intravenous infusion of anti-inflammatory drugs such as cefazolin, ampicillin / sulbactam, chlorine Lin Lincomycin, etc.; often take
medication 2 to 4 weeks.
Serious infections: Severe infection may lead to amputation, patients with life-threatening. Gan Ranzao early surgical treatment, removal of bad rot
organization, cut with the soles of the feet compartment drainage. Secretion of bacterial culture at the same time, it is best to use antibiotics according
to culture results. However, pending the culture results, taking into account bad foot office Gram-positive cocci, negative bacilli and anaerobic bacteria
and other infections easily co-exist, use broad-spectrum antibiotics, supplemented by metronidazole resistant anaerobe. According to the recovery of ulcers
and systemic conditions, application time should be up to 4 weeks.
Life-threatening infections: can be combined with ampicillin / sulbactam and aztreonam (Thailand can); piperacillin / tazobactam and vancomycin; vancomycin,
ceftazidime, and metronidazole; imipenem and cilastatin; fluoroquinolones, vancomycin and metronidazole and so on.
4th Ring: dressing
The principle of dressing can be summarized as follows:
1, elimination: anti-inflammatory disinfection. Topical application of tincture of iodine, alcohol disinfection, spraying antibiotics.
2 Less: reduce stress, try to wipe out local edema, drainage out of secretions, if necessary, surgical incision abscess drainage. Dressing the same time, do
not pack too tightly, affecting blood supply.
3, clear: Surgical debridement. As far as possible necrotic tissue, diaphragm, resection of sequestrum and so clean, clean up the local pus and other
secretions out, exposing the fresh granulation tissue, can be used with the biological activity of enzymes break down dressing to promote autolysis of
necrotic tissue.
4, extended resection and suturing: Treatment period of time, the bad foot skin temperature decreased, edema subsided, the wound dried, can be used in
dressings with epidermal growth factor to medication, but also can be partially sprayed 654-2, insulin, etc., and removal of stem callus and irregular bone
protrusion, such as suturing the skin flap or graft.
The Fifth Ring: symptomatic and support
1, fever, fever who used ice packs, alcohol, physical cooling sponge bath; necessary, applications antipyretic drugs (hormones or anti-inflammatory pain
suppository, etc.).
2, correcting ketosis, water, electrolyte disorders, timely potassium, rehydration, maintaining water and electrolyte balance.
3, improve cardiac function, may be appropriate to apply the expansion of drugs and diuretics such as coronary artery.
4, control infection in other organs, especially the lungs and urinary tract infections.
5, supplementary nutrition: such as nutrition nerve Methylcobalamin (Methycobal), neurotropin, vitamin B family such as intramuscular injection or oral, with
anemia, hypoproteinemia, malnutrition can complement plasma, human serum albumin and so on.
More "rings" to focus on promoting blood circulation and anti-inflammatory, but interlocking, are indispensable.
