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[摘要] 目的 通过对糖尿病足湿性愈合换药的4个典型病例的总结、分析，探讨湿性换药处理的应用条件及具体方式。 方法 分析总结本院于2011年1~9月收治的4例糖尿病足典型病例的临床资料。 结果第1例经积极内科综合治疗，全身情况改善的同时给予分步去痂、加强换药得到治愈；第2例经局部彻底清创、抗感染治疗，创面床准备行持续负压吸引（VSD）、局部皮瓣移植术后痊愈；第3例局部扩创引流使用银离子抗菌敷料换药后保趾痊愈。第4例局部清创处理后，因足底深部感染，感染症状没有改善反而加重，行扩创术无效而截肢。结论 在综合内科治疗中采取积极外科干预很重要，是减少截肢率、提高治愈率的必要保证，故治疗应采取全身和局部治疗相结合，全身治疗贯穿始终，局部治疗应强调个体化———根据溃疡的分级和炎症的不同阶段或表现作相应处理。

[关键词] 糖尿病足；湿性愈合；换药

[中图分类号] R472[文献标识码] B[文章编号] 1673-9701（2014）16-0149-04

Report and experience of four cases diabetic foot with moist healing dressing method

CHEN Yuqun1 ZHOU Yinong2 LIU Jiahe1 ZHANG Hongmei1 XIE Jun3 HU Yaguo4

1.Department of Endocrinology，the Central Hospital of quzhou，Quzhou324000，China；2.Department of Surgery，the Central Hospital of Quzhou，Quzhou 324000，China； 3.Department of Orthopedics，the Central Hospital of quzhou，Quzhou324000，China； 4.Department of Clinical Laboratory，the Central Hospital of Quzhou，Quzhou324000，China

[Abstract] Objective To discuss the applied conditions and detailed way of moist dressing through analyzing and summarizing treatment of 4 typical cases diabetic foot. Methods Analyzedand summarizedthe clinical data of 4 typical diabetic foot inpatients admitted to our hospital from January 2011 to September 2011. Results In the 1st case， the patients condition improved with our positive internal comprehensive treatment. At the same time， the patient fully recovered with step-by-step scab removing and strengthened dressing. In the 2nd case，the patient got cured after local complete debridement.anti-infection treatment，wound bed preparation for continuous negative pressure aspiration（VSD） and local skin flap grafting surgery. The 3rd case applied local opening drainage and Silver ion antimicrobial dressings to preserve feet，then the patient recovered. In the 4th case， after local debridement. the symptoms of infection worsened rather than improved due to the presence of deep feet infections， thus debridement was ineffective and amputation was applied. Conclusion Active surgical intervention played an important role in the comprehensive medical treatment， and was a necessary guarantee for decreasing amputation rate and improving healing rate. Therefore， Systemic and local treatment should be combined，and systemic therapy must be provided through the whole process，local therapy should focus on individualization-specific treatment must be based on grades of ulcer and stages of inflammation.

[Key words] Diabetic foot; Moist healing; Change dressing 糖尿病足是糖尿病合并血管、神经病变遭遇创伤、感染等因素所发生的一种严重并发症，以肢体末端疼痛、感染、溃疡、坏疽为主要表现，病程长，不易愈合。加强糖尿病足溃疡高危患者的教育和管理、开展糖尿病足溃疡防治的多学科合作和贯彻预防为主的理念可以使糖尿病截肢率下降49%～85%[1]。本文总结了2011年1～9月收治的4例糖尿病足典型病例的临床资料及换药体会，现报道如下。

1 临床资料

4例病案入院后共同的治疗措施：胰岛素控制血糖、抗感染、改善循环、营养神经、全身营养支持、对症综合治疗措施。……