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横浜総合病院 創傷ケアセンター メディカルディレクター 東田 隆治. 糖尿病足病変・壊疽 ~足の切断を免れるために~. 糖尿病性足病変について 本日の内容. 糖尿病と足病変の実態 糖尿病性潰瘍・壊死の治療 創傷ケアセンターの役割 糖尿病足病変の予防. 中原区医師会糖尿病病診連携の会 Sep. 8, 2009. 米国の糖尿病事情. 米国糖尿病患者 推定 2100 万人(全人口の約 7 %) 準糖尿病患者 4100 万人 糖尿病は下肢切断の第一原因 毎年 82,000 件の下肢切断 糖尿病患者の 15 %に足創傷 足創傷の 24 %が下肢切断 - PowerPoint PPT Presentation
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Sep. 8, 2009
210074100
82,0001524
5 32DM Epidemic in the USA
1370162022102007
50.6% = 4501.6% = 7.20.6% = 2.7570
Moulik PK, et al: Diabetes Care 26:491-494,2003
J Vasc Surg 45 (Suppl S) : S5-S67, 2007
(ankle-brachial index; ABI)0.9 ~ 1.3ABI or Norman PE, etal: Diabetes Care 29:575-580,2006ABI or Resnick HE, etal: Circulation 109:733-739,2004
PAD(2001~2003ABI 0.9 263/39067.6 vs 2.7%Maeda Y: Peripheral arterial disease and diabetes. Angiology Frontier 7: 17-23, 2008
PADMaeda Y: Peripheral arterial disease and diabetes. Angiology Frontier 7: 17-23, 2008
ADAPADPAD
ABIPAD
51ABI50 ADA: Peripheral arterial disease in people with diabetes. Diabetes Care 26:333-341,2003
HbA1cPAD26Selvin E, et al: Ann Intern Med 141: 421-431,2004Norgren L, et al: J Vasc Surg 45(I Suppl): S5-S67,2007Norgren L, et al: J Vasc Surg 45(I Suppl): S5-S67,2007
Critical limb ischemia: CLI)
11Wolfe JHN: Br J Surg 11: 153-157, 1986
Norgren L et al. Eur J Vasc Endovasc Surg 33(1 Suppl).S1, 2007
PADBhatt DL et al. JAMA 295: 180-189, 2006
CAD, CVD, PAD polyvascular disease REACH Registry Investigators: JAMA 295(2); 180-189, 2006
862008227220ABI
ABI: Rt. (-), Lt. 0.50
D-CT
100% 100% 100% 100% 100%
SPP
SPPmmHg%perfusion =
(skin perfusion pressure; SPP)Right Foot Dorsal18 mmHgRight Foot Plantar18 mmHg
Right Foot Dorsal27 mmHg
Right Foot Dorsal60 mmHgSPPOne straight line
62 200520071118, : 90%, 90% 20071217. 200712200821
SPP 53 mmHg 94 mmHg 58 mmHg 74 mmHgmmHg%perfusion =
75
2
Moist wound healing
(NPWT) Vacuum Assisted Closure (VAC) 23
NPWT (VAC)
1 week 2 week
5 week 7 week
9 week 11 week
15 week 9 month
675052 652007122620081, 3/ 2008716
NPWT
Vascular laboCVTABITBISPP)
ABI0.550.473.5m/s5.085%75%
X-P CT/CTA MRI/MRA Angiography/DSA
88200712201221200812564
2008618
710
NPWT
10/310/24
12/5
=77.7% (167/215)=76.9% (40/52)
8 (10%)4 (5%)2008/6/6~2009/7/31 78 83 (31
ABI
*CTAAAACFA10cm/sdistal occlusion patternCFApost stenotic pattern