糖尿病足慢性潰瘍之成功治療經驗－病例報告

Successful Experience in Treating Unhealed Chronic Diabetic Foot Ulcer: A Case Report

陳富鈞(Fu-Gin Chen) ； 許惠恒(Wayne Huey-Herng Sheu)

《北市醫學雜誌》 11卷4期 (2014/12) Pp. 95-102

https://doi.org/10.6200/TCMJ.2014.11.4.10

摘要

一位68歲男性患者因糖尿病足住院，他在外科門診經過一個多月治療後，傷口持續腫脹疼痛甚至潰爛之情況、且持續進展無法愈合。病患除了糖尿病外本身有肺結核、慢性阻塞性肺病及高血壓、心臟病史，長期在胸腔內科門診追蹤治療。這次因傷口加劇建議住院治療，醫療團隊評估病患臨床表現及各項理學監測結果後建議截肢（Amputation）治療，但病患基於心肺功能不佳以及對截肢的恐懼，拒絕外科治療，經過仔細溝通，病患及家屬均同意之下先住院，先以內科治療，如傷口持續惡化，病患願意隨時接受截肢。考量病患情緒的變化以及心肺功能欠佳，治療團隊給予適當的心理支持並展開積極治療。參閱相關文獻的經驗後，治療團隊為病患設計了一個傷口治療計畫。以抗生素以及五道步驟換藥方式（1.H_2O_2. 2. Acrinol solution. 3. Povidone-iodine. 4. Neomycin ointment 5.U-burn.），並每天評估病患傷口之狀況，經過大約一個月治療之後，傷口的腫脹逐漸消失、分泌物減少且傷口有逐漸癒合的現象，其間教導家屬正確的換藥方式，出院後繼續此種換藥方法，門診追蹤治療。經過三個多月持續治療傷口完全癒合，藉由本案例之成功治療經驗，提供醫界同仁參考。

關鍵字

糖尿病 ； 糖尿病足

並列摘要

A 68-year-old male was admitted for diabetic foot. His wound persisted with swelling, pain, necrosis, and progressed into a non-healing status after receiving treatment in our surgical outpatient department for over a month. In additional to diabetes mellitus, he also had pulmonary tuberculosis, chronic pulmonary obstructive lung disease, hypertension, and heart disease, with long-term management in our chest outpatient department. Due to the worsening wound, he was hospitalized for another 3 weeks. Based on his clinical presentations and physical examinations, surgical amputation was recommended by our medical team. However, he refused the surgical treatment because of his cardiopulmonary dysfunction and the fear of amputation. With the agreement of the patient and his family, he was admitted to start with drug treatment; if the wound continued to worsen, he would accept amputation option. Considering his emotional feeling and cardiopulmonary dysfunction, we comforted him and tried our best to treat him. A plan that used antibiotics and 5 steps of wound dressing was designed for his wound care: (1) hydrogen peroxide solution; (2) ethacriding lactate solution; (3) povidone iodine solution; (4) neomycin ointment and (5) silver sulfadiazine cream. We evaluated his wound conditions and signs of hemodynamics everyday. After a month of management, the swelling of the wound disappeared gradually; the discharge reduced, and the wound appeared to be in the way of coalescence. We taught and trained his family to use correct wound dressing methods, and the wound care was continued after discharge, with followups in our outpatient department. After 3 months of management, his wound healed completely. We provided our experience as a reference for treating diabetes patients with non-healing diabetic foot.

並列關鍵字

diabetes mellitus ； DM Foot