Corelaţii clinico-terapeutice în cadrul „piciorului diabetic”

Corelaţii clinico-terapeutice în cadrul „piciorului diabetic”

D CRŢU, D MĂRGĂRITESCU, V ŞURLIN, E GEORGESCU, MILENA GEORGESCU, M ŞT GHELASE, I GEORGESCU

Clinica I Chirurgie, Facultatea de Medicină, UMF din Craiova Craiova


REZUMAT

Piciorul diabetic este insuficient cunoscut, ceea ce face ca diagnosticul să fie stabilit deseori trziu, iar tratamentul chirurgical să fie de multe ori inadecvat stadiului bolii, conducnd la prelungirea suferinţei pacientului, dar şi cu amplificarea costurilor de spitalizare şi cu un impact deosebit economic şi social al acestei complicaţii.


Scopul lucrării. Elaborarea de algoritmi clinico-terapeutici de utilitate n practica medicală curentă.


Material şi metodă. Lotul studiat este alcătuit din 190 pacienţi cu picior diabetic (148 bărbaţi si 42 femei) dintre care 165 au fost operaţi. Am calculat retroactiv pentru pacienţii operaţi n clinică, un scor de gravitate conform metodei elaborate n anul 2002 de T. Patraşcu şi colab.


Rezultate şi discuţii. Pacienţii cu picior diabetic au necesitat n medie 23,13 zile de spitalizare, 52 de pacienţi necesitnd intervenţii chirurgiale seriate. Prin aplicarea Indicelui de Prognostic Terapeutic (IPT), numărul intervenţiilor seriate poate fi diminuat, iar numărul zilelor de spitalizare ar scădea cu mai mult de 25%. Cu toate acestea, prin aplicarea acestei metode ar fi fost subevaluate 11 cazuri, n toate fiind realizată amputaţia majoră după intervenţii chirurgicale seriate, nsumnd aproximativ 500 zile de spitalizare. Studiul demonstrează că anumite modificări aduse n calculul IPT, i poate mbunătăţi gradul de predicţie cu aproape 10%


Concluzii. Considerăm că utilizarea de sistem a IPT n practica medicală ar aduce beneficii att pacientului, prin evitarea unor intervenţii seriate, ct şi serviciilor chirurgicale prin scăderea costurilor de spitalizare şi tratament.


CUVINTE CHEIE picior diabetic, diabet zaharat



Clinical and therapeutical correlations in the diabetic foot


ABSTRACT

The diabetic foot is not known enough, this making that the diagnosis is often set later, and the surgical treatment is many times inadequate to the disease stage, leading to extension of the patient distress, but also increasing the costs with hospitalization and with special economic and social impact of this complication.


Aim. Elaborate the clinica land therapeutical conlusions and algorithms, usefuls in the current medical practice.


Material and method. The group studied is made up of 190 patients with diabetic foot (148 men and 42 women) 165 patients has operated.


Results and discussion. The diabetic foot patients necessitated in average, 23.13 days of hospitalization, 52 patients necessitating seriate surgical interventions. Applying the Index of Therapeutic Prognostic (IPT) a number of seriate interventions would have been avoided, the number of hospitalization days decreasing by 25%. Nevertheless, applying this method a number of 11 cases had been under-evaluated, all of them completed with major amputation after seriate intervention, summing about 500 days of hospitalization. Our study shows that some modification brought in the IPT calculation may improve the its prediction degree by 10%. We consider that the use of an IPT system in the medical practice would bring important benefits both for patients by avoidance of seriate interventions and surgical services by decreasing the hospitalization and treatment costs.


Conclusions. We consider that the use of an IPT system in the medical practice would bring important benefits both for patients by avoidance of seriate interventions and surgical services by decreasing the hospitalization and treatment costs.


KEY WORDS diabetic foot, diabetes mellitus

Actualizat la 08.09.2021, 18:25