足浴对早期糖尿病足的控制

1、足浴对早期糖尿病足的控制将糖尿病足定义为与下肢远端异常和不同程度的周围血管病变相关的足部(踝关节或踝关节以下)感染、溃疡和(或)深层组织破坏。其临床表现为足部的溃疡与坏疽,临床上控制好血糖是预防糖尿病足的关键,在此基础上进行积极地护理干预,有利于促进病变好转,降低患者致残率。近年来,我科运用中医辨证论治的理论自制中药熏洗剂进行辨证施护,对控制早期糖尿病足患者的局部病情临床效果比较理想,现报告如下。The diabetic foot is defined and distal end of lower limb abnormalities and various degree of periph

2、eral vascular disease associated with foot (ankle or foot below the ankle) infection, ulcer and (or) deep tissue damage. The clinical manifestations of ulcer and gangrene of the foot, the clinical control of blood glucose level is the key to prevent diabetic foot, on the basis of active nursing inte

3、rvention, is conducive to the promotion of the lesions improved, reduce the disability. In recent years, adopting the method of traditional Chinese medicine syndrome differentiation theory of self-made Chinese medicine lotion syndrome nursing, ideal for controlling the clinical effect of early local

4、 condition of patients with diabetic foot, report as follows now.1临床资料与方法1 clinical data and methods一般资料:选自我院2007年5月2011年5月间收治的住院病人56例,符合糖尿病足诊断疗效标准1,采用Wagner分级法2,56例病人均为糖尿病足0级和1级,病人有糖尿病病史,主要症状有四肢远端感觉、运动障碍,表现为肢体麻木、挛急疼痛,肌肉无力等;主要体征有震动觉、压力觉、痛觉、温度觉的减退以及跟腱反射的减弱或消失等;辅助物理学检查、神经电生理检查有异常改变,QST和NCS中至少两项异常。将56例

5、病人随机分成观察组和对照组,两组资料比较,差异无显着性,具有可比性。General information: 56 cases of inpatients in our hospital from 2007 May 2011 years were treated between May, accord with "standard" clinical diagnosis of diabetic foot 1, using the Wagner classification 2, 56 patients were diabetic foot 0 level and 1 lev

6、el, the patient with a history of diabetes, are the main symptoms of limbs far end feeling, movement disorders, manifested as limb numbness, spasm and pain, muscle weakness and so on; main signs are vibration perception, sensation, pain, temperature sensation of pressure loss and Achilles tendon ref

7、lex abate or disappear; auxiliary physics examination, electrophysiological abnormalities, QST and NCS in at least two abnormal. Methods 56 cases were randomly divided into observation group and control group, compared two groups of data, no significant difference, comparable.2方法The 2 method1常规治疗:两组

8、均根据医嘱使用胰岛素和口服降糖药,有效控制血糖和血压,开展健康教育,指导合理饮食,选择合适的鞋袜,预防意外损伤,适度进行散步、太极拳等运动。1 conventional treatment: two groups according to the doctor's use of insulin and oral hypoglycemic drugs, effective control of blood glucose and blood pressure, health education, reasonable diet, appropriate footwear, prevent

9、ion of accidental injury, moderate walking, Tai Chi exercise.2在常规治疗的基础上观察组运用中药熏洗剂泡足,对照组用温水泡足。两组均以14天为一疗程,共2个疗程。2 on the basis of routine treatment, the observation group used traditional Chinese medicine foot bath lotion, the control group with warm water bubble foot. The two groups were 14 days for

10、 a course of treatment, a total of 2 courses.3中药熏洗剂泡足:根据患者的临床表现,在临床中医的指导下进行辨证分型,制定个体化的中药熏洗剂泡足方案,按疗程使用。3 traditional Chinese medicine foot bath lotion: according to the clinical manifestations of patients, syndrome differentiations in clinical medicine under the guidance of traditional Chinese medici

11、ne, develop individualized lotion foot soaking solution, according to the course of use.1阴虚血瘀证:肢体麻木,腿足挛急,酸胀疼痛或小腿抽筋,夜间为甚,或灼热疼痛,五心烦热,失眠多梦,皮肤干燥,头晕耳鸣,口干不欲饮,便秘,舌质暗红,苔花少津,脉细数。中药方剂组成:当归25g,地黄20g,川芎20g,赤芍30g,川牛膝25g,透骨草25g,加清水4000ml,浸泡30分钟,水沸后煮10分钟,得煎液2000ml左右,倒入清洁的足浴盆内,将患肢安置于特制的承重架上,用大浴巾罩在浴盆上方,药液随热气蒸于患肢,待药液

12、的温度降至3840时,揭去浴巾,患肢浸泡于药液中,维持药液的温度不低于38,浸泡20分钟结束,每日一剂,每天两次。1 yin asthenia and blood stasis: numbness of the limbs, legs spasm, pain or leg cramps, the night why, or burning pain, five upset hot, insomnia, dry skin, dizziness and tinnitus, thirst without desire to drink, constipation, dark red tongue,

13、moss spend less Tianjin, thready pulse. Traditional Chinese medicine composition: Angelica 25g, Rehmannia glutinosa 20g, Chuanxiong 20g, red peony root 30g, Cyathula officinalis 25g, Speranskia grass 25g 4000ml, add water, soak for 30 minutes, after boiling water boil for 10 minutes, to extract 2000

14、ml, into the foot bath tub clean inside, limb is arranged in the bearing frame with special, big bath towel cover above the liquid in the tub, with hot steam to the limb, the liquid temperature dropped to 3840 , removing the bath towel, limb immersion in liquid, maintain the liquid temperature not l

15、ower than 38 , the end of the 20 minutes soaking, a day, two times a day.2寒凝血瘀证:肢体麻木不仁,肢末冷痛,得温痛减,遇寒痛增,入夜更甚,畏寒怕冷,尿清便溏,或尿少浮肿,舌质暗或有瘀点,苔白滑,脉沉细涩。中药方剂组成:桂枝20g,细辛10g,川乌20g,草乌20g,制乳香25g,药液煎制和熏蒸泡足的操作方法同前。2 syndrome of cold coagulation and blood stasis: limb be petrified, limb cold pain, pain reduction temper

16、ature, cold pain, night more very, aversion to cold, clear urine, loose stools, or oliguria, edema, dark tongue or petechiae, moss white slip, thready pulse astringent. Traditional Chinese medicine composition: cassia twig 20g, Radix Aconiti kusnezoffii Asarum 10g, 20g, 20g, prepared frankincense 25

17、g, with the method of operation liquid frying and fumigating foot bath.3痰瘀阻络证:肢麻不止,常有定处,足如采棉,肢体困倦,头重如裹,昏蒙不清,体多肥胖,腹胀不适,大便黏滞,三维排水网舌质暗紫,舌体胖大有齿痕,苔白厚腻,脉沉滑或沉涩。中药方剂组成:姜半夏20g,乳香20g,没药20g,苍术25g,生麻黄20g,白芥子10g,药液煎制和熏蒸泡足的操作方法同前。3 of phlegm and blood stasis syndrome: limb numbness, often at the foot, such as cot

18、ton, weary limbs, head wrapped in mist like, not clear, body fat, abdominal discomfort, stool viscosity, the tongue is dark purple, big fat tongue with teeth marks, thick white greasy fur, pulse Shen slide or sunken. Traditional Chinese medicine composition: Jiang Banxia 20g, 20g frankincense, myrrh

19、 20g, Atractylodes 25g, raw ephedra 20g, white mustard seed 10g, with the method of operation liquid frying and fumigating foot bath.4效果评价:治愈:症状消失,体征无异常;显效:症状明显好转,体征明显改善;有效:症状及体征改善;无效:症状及体征改善不明显4 Evaluation: Cure: symptoms, signs of abnormal; effect: the significant improvement in symptoms, signs we

20、re improved; effective: the symptoms and signs of improvement; ineffective: the symptoms and signs of improvement was not obvious3.1糖尿病足是糖尿病的并发症之一,也是糖尿病病人截肢致残的主要原因4,祖国医学认为,糖尿病足属于“消渴脱疽”范畴,是阴虚亏本,气血亏耗,阴阳俱虚,致气滞血瘀,血行不畅,气血不能通达四肢末梢,肌肉筋脉失于濡养以致出现肢麻、肢冷、肢痛、肿胀甚至溃烂的病症。四物汤中的白芍易赤芍,具有滋阴养阴活血功效,川牛膝补益肝肾并引血下行,透骨草祛风通络;桂

21、枝、细辛温经通络,川草乌为大辛大热之品,功善温经祛寒,钢塑土工格栅制乳香破血通络;苍术、半夏化湿祛痰,乳香没药活血通络,生麻黄辛温,走串之性极强,善通经络,白芥子善祛皮里膜外之痰。中药熏洗剂正是运用了中医辨证论治的理论,起到了通调腠理、舒畅血脉的作用。研究表明,观察组运用中药熏洗剂泡足的临床效果优于对照组,中药熏洗剂能有效延缓早期糖尿病足的病情发展,减少糖尿病足溃疡的发生,对不同证型进行辨证施护,对糖尿病足的治疗有明显的辅助作用。3.1 diabetic foot is one of the complications of diabetes, and is the main reason o

22、f diabetic amputation disability 4, motherland medicine thinks, diabetic foot is "diabetes gangrene" category is at a loss, yin deficiency, blood loss, yin and yang deficiency, caused by qi stagnation and blood stasis, poor blood, Qi and blood can not access the endings of extremities, mus

23、cle tendons and loss in Ruyang that emergence of limb numbness, cold limbs, limb pain, swelling and even fester disease. Siwu Decoction of Radix Paeoniae Alba is easy to root, with Ziyin nourishing yin and promoting blood circulation effect of Achyranthes bidentata, tonifying the liver and kidney an

24、d blood lead down, lopseed Qufeng Tongluo; Guizhi, asarum Wenjing Tongluo, Sichuan aconite for sanitary hot products, power good warm through the cold-dispelling, prepared frankincense broken blood collaterals; Atractylodes, Rhizoma Pinelliae Huashi expectorant, frankincense myrrh Huoxue Tongluo, st

25、udents go on Ephedra warm, strong, good through main and collateral channels, white mustard good skin membrane removing phlegm. Traditional Chinese medicine lotion is the use of TCM theory, play a regulating role of blood, sweat pores. Research shows that, the observation group is better than the cl

26、inical effect of the use of traditional Chinese medicine fumigation lotion bubble foot control group, Chinese medicine fumigation lotion can effectively delay the development of diabetic foot disease, reduce the occurrence of diabetic foot ulcer, dialectical nursing of different syndromes, have obvi

27、ous effect on the treatment of diabetic foot.3.2中药熏洗剂具有制作简单、操作方便、病人痛苦小、花费少的优点,更适合于糖尿病病人的家庭使用。丙烯酸聚氨酯在进行熏洗的过程中,护理人员能直接观察到患者的肢端血供情况,及时发现病情变化并不失时机地进行健康指导。3 2 medicine lotion has the advantages of simple fabrication, convenient operation, little pain, patients spend less, more suitable for diabetes patients families. In the washing process, nursing personnel can directly observe the patient's limb blood supply, timely detection of the disease changes and seize the opportune mo