Diabetic patients with diabetic foot is the result of local nerve abnormalities and distal lower limb peripheral vascular disease occurred foot infections,
ulcers, and (or) deep tissue destruction. When the diabetic patients affected by cutaneous nerve injury, patients often do not feel squeezed or temperature
changes, making the skin's defense capabilities of various injuries reduced, it may cause repeated injuries to the skin. The treatment of diabetic foot can
be largely divided into the following aspects: surgical treatment: partial care; antidiabetic treatment: anti-infective treatment; vasodilative a
microcirculation regulation.
Local surgical treatment of the appropriate surgical treatment of the wound is very important, for deep infection has already occurred and the location for
the formation of abscess incision and drainage is very necessary, if the existence ulcer surgical treatment should be necessary. Effective way to include the
use of 3% hydrogen peroxide cleaning deep wound, can also be used iodophor gauze drainage. Ulcer should be based on ulcer size and depth, with 3% of the
pairs of ammonia or saline, after washing the wound with povidone-iodine gauze external application. Dry gangrene are available 75% alcohol or povidone-
iodine topical gauze, if necessary, resectability of necrotic toes. Specific circumstances should be based on the patient medication one time a day, at least
every other day dressing a times, a serious condition dressing two times a day. When gangrene occurs when the toe (usually dry gangrene), and sometimes can
lead to necrotizing fasciitis, causing the affected foot localized redness, swelling, fever, pain, skin a dark purple stain, etc. In severe cases, required
to cut the toe or limb amputation and mortality rate is more high. Therefore, according to the clinical circumstances of the removal of necrotic toes. Note
that: when the surgical dressing be sure to remove dead tissue and keep the wound clean, should keep the wound dry, well-defined, limited, pay attention to
maintaining environmental hygiene and to prevent the bedding contaminated wound, for subsequent surgery may be undertaken to prepare .
Local nursing care is a key step in treatment of diabetic foot is one of 10 million can not be ignored. Clinical nursing care generally includes: from the
overall understanding of the patient's basic physiological needs: appropriate health education; to patients and their families, introducing the basics of
diabetes and its complications prevention and treatment methods and experience; from the ideological stability in the patient mood; the same time, patience
and guidance patients self-regulation in order to alleviate or eliminate the psychological barrier of patients and their families to make it in the best
mental state and actively cooperate with the treatment. As soon as possible inform the patient of the following content: foot skin need to be carefully
protected against grasping, scratching, try to avoid abrasions, burns and so on, should not cut toenails too short, wear shoes and socks should loose,
comfortable, no ulcer or injury to per night with warm water (37 ~ 38 ℃) feet, and gently massage my limbs, in order to promote foot circulation cold feet
warm when you pay attention. This shows that surgical treatment of local care is mainly the need to always observe the affected foot local skin color,
temperature, feeling, and whether conditions such as edema and ulceration, abnormal should be dealt with promptly.
Hypoglycemic therapy is an important part of treatment of diabetic foot. Should first be an active treatment of diabetes, controlling blood sugar in the
ideal range, adjust, metabolic disorders, electrolyte imbalance, if necessary, complement proteins, in order to promote wound healing and skin growth.
Infected with more severe cases, oral hypoglycemic agents may be suspended and replaced by intensive insulin therapy, such as subcutaneous injection of
insulin or continuous subcutaneous insulin infusion pump to control blood sugar in an appropriate range. Bed rest during hospitalization as far as possible,
reasonable diet, avoiding foot trauma, burn, so that foot comfort, reduce the incidence of foot ulcers.
Anti-infective therapy as soon as possible the appropriate choice of specimen smears, bacterial culture and drug sensitivity test, etc., such as sputum,
blood, urine, purulent secretions, ulcers and other specimens, specimens of specimens from the best in the use of anti-infective drugs Prior to, and in
particular should be taken to avoid contamination in order to avoid misleading. To obtain reliable results of bacteriology. According to susceptibility test
results choose the appropriate antimicrobial agents according to the actual situation in individual patient administration. However, the clinical reality is
often too late to wait for etiological test results, the majority of cases are treated while checking side. When the mild diabetic foot infection, it can
oral antibiotics 1 ~ 2 weeks, the need to observe the changes in the condition, once the condition worse or continue to develop, it should be changed to
parenteral administration. For patients with more serious disease should be better joint use of antimicrobial agents and to the full dose, full course of
treatment. Is best administered intravenously, improved change after oral. There is a saying within the profession, "diabetes better to use two Su", the
former refers to a good insulin control of blood sugar levels, which is good to use antibiotics to control infection progress. Anti-infective treatment is
medical treatment of diabetic foot is one of the main measures, the main route of administration by intravenous infusion. Even the need for surgical
treatment of diabetic foot, it must first control the infection, and then on this basis, the purposes of surgical intervention, thus a timely and effective
control of symptoms of diabetic foot infection should give high priority clinical issues. The use of antimicrobial agents sterilization of β-lactam-based,
appropriate combination of anti-anaerobic drugs (specifically anti-or facultative anaerobes). Patients according to renal function and other related
parameters set out the administration of appropriate individualized programs to improve drug efficacy and reduce adverse reactions. More varieties of
clinical use at present are: cefoperazone / sulbactam, piperacillin / tazobactam, levofloxacin, cloxacillin, clindamycin, fosfomycin, metronidazole,
tinidazole and so on. Serious illness can be used imipenem / West Division statins, vancomycin and so on. Concurrent osteomyelitis, should continue to give
antibiotics more than 6 weeks.
Vasodilator - regulating microcirculation in the treatment of complications of diabetes, the vasodilator drugs, a micro-cycle regulation is an important
application of one of the measures aimed to achieve through the use of this class of drugs to improve peripheral vascular function of a micro-circulation to
enhance the body's tissues blood supply, reducing hypoxia is conducive to tissue repair and so on. Another important significance to improve the clinical
treatment of diabetic foot infection of local tissue blood circulation, improve anti-infective lesions in infected blood concentration, thereby increasing
the antibacterial effects of drugs.
