Diabetes Care：抗生素是糖尿病足骨髓炎的治疗**
2013-11-07 luohucy 丁香园
西班牙一项研究发现，对于糖尿病足骨髓炎和前足部溃疡患者，抗生素治疗是合理的首选。研究结果在线发表于10月15日《糖尿病护理》杂志。这是首个比较使用抗生素与手术治疗糖尿病足骨髓炎的研究，结果显示，2种治疗方法的愈合率、愈合时间和短期并发症相似。研究人员认为，该研究为糖尿病足医生提供了非常有用的信息，当患者有软组织感染伴有骨髓炎，如果有良好的血管供应，溃疡不会深到见骨，此时最好的治疗选择是使用抗生素9
西班牙一项研究发现，对于糖尿病足骨髓炎和前足部溃疡患者，抗生素治疗是合理的首选。研究结果在线发表于10月15日《糖尿病护理》杂志。
这是首个比较使用抗生素与手术治疗糖尿病足骨髓炎的研究，结果显示，2种治疗方法的愈合率、愈合时间和短期并发症相似。
研究人员认为，该研究为糖尿病足医生提供了非常有用的信息，当患者有软组织感染伴有骨髓炎，如果有良好的血管供应，溃疡不会深到见骨，此时最好的治疗选择是使用抗生素90天。在此之后，如果病情没有改善，可以考虑手术治疗作为第二选择。
糖尿病足骨髓炎最佳治疗之争
糖尿病足骨髓炎的治疗是一个有争议的问题，治疗的选择往往是根据感染的解剖部位、局部血管供应、软组织和骨破坏的程度、是否存在坏死、全身感染的体征以及患者和临床医生的喜好。
手术一直是最主要的治疗方法，但使用抗生素可以避免手术成本和潜在的手术并发症。这两种治疗方法各有优缺点，且手术和抗生素治疗的确切作用尚未被充分阐明，因此最佳的治疗方法目前仍存在争议。
这项研究在2010年和2012年之间进行，52名糖尿病足部骨髓炎患者随机接受90天抗生素治疗(n = 25)或手术后短疗程抗生素治疗10天(n = 27)。可选用的抗生素包括阿莫西林/克拉维酸、甲氧苄啶、环丙沙星、甲氧苄啶/磺胺甲恶唑、克林霉素、左氧氟沙星和四环素，根据患者进入研究之前的治疗情况决定抗生素种类和剂量。
研究对所有糖尿病足骨髓炎患者都是开放的，但因为临床上非足前部溃疡(如足跟溃疡)的患者往往有缺血并发症，需要进行血运重建等其他治疗，未纳入研究。
结果显示：治愈或并发症没有差异
12周后，抗生素组18例(75%)患者初步愈合，手术组为19例(86.3%)，两组没有显著性差异(P=0.33)。
抗生素组和手术组的平均愈合时间分别为6周和7周。抗生素组4例(16.6%)患者恶化，并接受了手术。手术组3例患者需再次手术。两组的截肢率没有显著差异(P=0.336)。
研究人员在结论中写道，本研究首次比较了单用抗生素与手术后给予短期抗生素治疗用于糖尿病足骨髓炎的疗效，研究发现2种类型治疗的愈合率和愈合时间无差异。两组并发症发生率相似，并发症所致的截肢率无差异。
本研究的优点在于，所有手术均由在糖尿病足问题专业治疗中心工作的同一位医生进行。研究人员也承认研究存在一些局限性，包括样本量小，随访时间仅12周，无法分析中期和长期复发率。
专家评论
英国曼彻斯特大学的Andrew Boulton博士受邀对本研究发表评论，他说：“这是一项很有趣的研究，研究发现很多骨髓炎病例其实无需手术。基于之前的一些系列病例研究，该研究认为单用抗生素治疗也有效。”
“事实上，我有很多这方面的经验，我们常碰到有很多病灶局限在一个足趾的骨髓炎患者，可以长期使用抗生素进行治疗(最多3个月的药物治疗，如克林霉素)。我也见过单用抗生素治疗的患者放射学愈合和病变消退的情况，这一新研究是一个重要的补充。”
原文出处：
Lázaro-Martínez JL;Aragón-Sánchez;GarcíaMorales.Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis.A randomized comparative trial.Diabetes Care Publish Ahead of Print, published online October 15, 2013【原文下载】
小提示：本篇资讯需要登录阅读，点击跳转登录
版权声明：
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料，版权均属于梅斯医学所有。非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章，或“梅斯号”自媒体发布的文章，仅系出于传递更多信息之目的，本站仅负责审核内容合规，其内容不代表本站立场，本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。
在此留言
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料，版权均属于梅斯医学所有。非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章，或“梅斯号”自媒体发布的文章，仅系出于传递更多信息之目的，本站仅负责审核内容合规，其内容不代表本站立场，本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。
在此留言
很好的知识.学习了
88
#Diabetes#
54
#糖尿病足骨髓炎#
51
#BET#
49
#DIA#
60
Terrorist? Apparently notThe site informs me that Khalid Sheikh Mohammed has . "I decapitated with my blessed right hand the head of the American Jew Daniel Pearl," he says.The Kuwait-born Al-Qa'eda murderer has also confessed to being the mastermind behind the slaughter of 9/11 – something that intelligence experts worked out long ago. He also planned the 2002 Bali bombing (in which an acquaintance of mine died) and the foiled shoebomber attack. In fact, his fingerprints are on 31 homicidal plots.Here's the mystery. I can't find this unspeakably evil man described as a terrorist anywhere on BBC News Online. "Militant," yes. "Operative", yes. But not "terrorist".It must be my mistake. Can anyone help?Just Eat is a simple idea: it takes the menus of every takeaway it can convince, puts them online and lets you click to order what you want. Put in your postcode and go from there. Initially a website, Just-Eat's final debut as an Android app is long overdue, and finally cuts out not only the infuriating conversation over a dodgy phone line to a noisy restaurant, but means you can easily pay for a takeaway by card and have it delivered to your door. Never mind that this pushes us all closer to a world without human interaction, save for that with the delivery driver.I've returned to London after sharing the train journey with Paul Goodman, and we spent a chunk of the journey trying to work out why we didn't like the speech (though Paul won't mind me saying he liked it a heap less than I did). ?An hour long and a bit too chewy might be one way to summarise it. It will not join the roll-call of David Cameron's great outings. The reception was warm but not delirious. The jokes were weak. Those for whom light at the end of the tunnel was code for talk of tax cuts will be disappointed. The nod to the 96-year-old activist Harry Beckhough worked as did his rapid-fire lists of Coalition achievements so far, and Labour's failures. It also worked as a reminder that this is a fundamentally radical government – "revolutionary" in Mr Cameron's word. The detail of what he is attempting is impressive.
Cheap Nike Air Max http://nikeairmax95.pdcc.co.uk/
131
Are you a nervous flyer prompting special warnings for drivers to be prepared for closures and extreme winter conditions before setting out.In another avalanche on Dec. But consolidation won't cut the total amount owed and it may stretch out the payback period.There's also the option of refinancing one's current higher-rate mortgage At today's low rates— a fixed-rate 10-year mortgage can now be had for slightly less than four per cent—the savings can be huge A decade of stable low payments can be a real stress-reducer for someone on a fixed income?Reverse mortgages may be appropriate for some low-income retirees who want to stay in their homes for a few more years But by deferring repayment of the money borrowed—sometimes for decades—the remaining equity in the home can be entirely eaten awayWe asked several financial experts for some other strategies to deal with debt inretirementLaurie Campbell CEO of, and soaring house values in many cities have allowed people to use their? And those credit cards that require minimum monthly payments of just one per cent of the balance have proven to be irresistibleThe figures show that as a nation we've already borrowed our way to record levels of debt Many of us are comfortable with thatBut once retired with incomes fixed and withinterest rates poised to rise the wiggle roombegins to narrow? but Hoyer has the Browns on the verge of making it happen again. The Browns kept the Bengals out of the end zone while holding them to 266 yards and a 29 per cent conversion rate on third down. who was immortalized in her daughter's novel Little Women as the beloved "Marmee. I would not recommend giving Gottlieb's Great Expectations as a holiday gift to any impressionable loved one.022.
Bolsos Michael Kors http://michaelkorsbolos.quad-welt.eu/
122
Greig Spence (Raith Rovers) header from the centre of the box is saved in the centre of the goal. Aleksandar Kolarov (Manchester City) header from the centre of the box is saved in the centre of the goal. Conceded by Jussi J?skelinen 41:14 Attempt saved Yaya Touré (Manchester City) left footed shot from the centre of the box is saved in the top left corner Assisted by David Silva 40:27 Attempt blocked Ricardo Vaz Te (West Ham United) header from very close range is blocked Assisted by Stewart Downing with a cross 37:30 Delay over They are ready to continue 36:43 Delay in match Ricardo Vaz Te (West Ham United) because of an injury 34:11 Foul by Gal Clichy (Manchester City) 34:11 Ravel Morrison (West Ham United) wins a free kick in the defensive half 32:55 Booking Booking Kevin Nolan (West Ham United) is shown the yellow card for a bad foul 32:50 David Silva (Manchester City) wins a free kick in the defensive half 32:50 Foul by Kevin Nolan (West Ham United) 31:49 Attempt missed lvaro Negredo (Manchester City) left footed shot from the left side of the box misses to the right 30:34 Corner Manchester City Conceded by Guy Demel 29:05 Yaya Touré (Manchester City) wins a free kick in the attacking half 29:05 Foul by Kevin Nolan (West Ham United) 25:51 Attempt missed Ravel Morrison (West Ham United) right footed shot from outside the box misses to the left Assisted by Mark Noble following a set piece situation 25:21 Booking Booking David Silva (Manchester City) is shown the yellow card for a bad foul 24:46 Foul by David Silva (Manchester City) 24:46 Razvan Rat (West Ham United) wins a free kick on the left wing 24:33 Attempt missed Mohamed Diamé (West Ham United) header from the centre of the box misses to the right Assisted by Ricardo Vaz Te with a cross 21:41 Attempt saved Sergio Agüero (Manchester City) left footed shot from the left side of the box is saved in the bottom left corner Assisted by Fernandinho 19:17 Attempt blocked Micah Richards (Manchester City) header from the centre of the box is blocked Assisted by David Silva with a cross 18:49 Corner Manchester City Conceded by James Tomkins 18:10 Attempt saved Sergio Agüero (Manchester City) right footed shot from the centre of the box is saved in the centre of the goal 16:47 Attempt missed Ravel Morrison (West Ham United) right footed shot from outside the box misses to the left 15:11 Goal scored Goal Goal West Ham United 0 Manchester City 1 Sergio Agüero (Manchester City) right footed shot from the centre of the box to the bottom left corner Assisted by Fernandinho with a through ball 13:50 Attempt missed Mohamed Diamé (West Ham United) right footed shot from outside the box misses to the right Assisted by Razvan Rat 12:34 Foul by David Silva (Manchester City) 12:34 Ricardo Vaz Te (West Ham United) wins a free kick in the defensive half 11:51 Corner Manchester City Conceded by Guy Demel 7:05 Corner West Ham United Conceded by Matija Nastasic 0:00 First Half begins 0:00 Lineups are announced and players are warming up Mark Bradley (Rotherham United) left footed shot from outside the box is saved in the top centre of the goal. Conceded by Evan Horwood. Conceded by Daniel Fox. James Hayter (Yeovil Town) header from the centre of the box is saved in the centre of the goal. Portugal 1. but misses to the left. Peterborough United 1.
toms outlet http://www.trifidmedical.com/toms/modra.asp?article_id=0
163
#骨髓炎#
81