糖尿病足的科学现状:初级保健中的主观筛查与客观糖尿病神经病变检查

Jiménez Rafael Medrano, Rius Mª del Mar Gili
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摘要

在糖尿病足(DF)的调理因素中,神经病变被认为是主要因素,动脉病变被认为是加重因素,足部畸形被认为是触发因素。DF及其并发症的预防性干预措施按护理水平分布。在更高一级,医院护理的重点是减少DF截肢。在较低的层次,初级保健(PC)和足病,重点是预防DF。PC被认为是确定DF调节因素的理想场所。在这方面,预防遵循国际糖尿病足工作组(IWGDF)的建议,通过筛查敏感或不敏感足的神经病变。美国糖尿病协会(ADA)建议通过临床检查感觉、运动和自主神经病变的症状和体征,对神经病变进行以人为中心的评估。这一争议促使我们研究哪种方法(筛选或临床检查)在TERMOPIEDI研究中招募的一组人中可以更准确地识别DF的条件因素。根据糖尿病神经病变的定义、Young MJ诊断标准和多伦多委员会诊断类别对神经病变进行评估。这些结果使我们知道该程序在护理能力范围内的PC中的适用性,与筛查方法相比,检测出更多的神经病变患者。神经病变患者足底温度较高,表明神经病变干扰足部体温调节。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
State of the science in diabetic foot: subjective screening vs. objective diabetic neuropathy examination in primary care
Among the conditioning factors of Diabetic Foot (DF), neuropathy is considered the main factor, arteriopathy the aggravating factor, and foot deformities the triggering factor. The preventive interventions for DF and its complications are distributed by levels of care. At the higher level, hospital care focuses on reducing DF amputations. At the lower level, Primary Care (PC) and Podiatry, focused on preventing DF. PC is considered the ideal place to identify the conditioning factors of DF. In this area, prevention follows the recommendations of the International Working Group on Diabetic Foot (IWGDF) by screening neuropathy focused on the sensitive or insensitive foot. The American Diabetes Association (ADA) a recommends person-centered assessment of neuropathy by clinical examination of symptoms and signs testing sensory, motor, and autonomic neuropathy. This controversy lead us to investigate which methodology (screening or clinical examination) could be more accurate in identifying the conditioning factors of DF in a group of people recruited in the TERMOPIEDI study. Neuropathy was assessed following the definition of diabetic neuropathy, the Young MJ diagnostic criteria, and the Toronto Council diagnostic category. These results allowed us to know the applicability of this procedure in PC within nursing competencies, detecting a greater number of patients with neuropathy compared to the screening method. People with neuropathy presented higher plantar temperature, concluding that neuropathy interferes with foot thermoregulation.
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