作者：刘毅斌 Clinical Control Observation on Treatment of Gangrenous Foot
Caused by Diabetes Through In-take and Immersion
of Chinese Herbal Medicine1 临床资料 40例均为Ⅱ型糖尿病住院患者，诊断标准符合《糖尿病足检查方法及诊断标准》〔1〕，病变程度按照《糖尿病性肢端坏疽的分级》标准〔2〕，随机分为2组。
治疗组20例，男性8例，女性12例；年龄43～78岁，平均63.6岁；糖尿病病程3～17年，下肢感染5个月～3年，入院时平均空腹血糖13.08±5.72mmol/L.病变程度属Ⅰ级2例，Ⅱ级9例，Ⅲ级5例，Ⅳ级3例，Ⅴ级1例。湿性坏疽18例，混合性坏疽2例。中医分为热毒型3例，湿热型8例，阴虚型6例，脾虚型1例，气血两虚型2例。
对照组20例，男性6例，女性14例；年龄39～75岁，平均61.3岁；糖尿病病程5～20年，下肢感染3个月～5年，入院时平均空腹血糖14.37±7.51mmol/L.病变程度属Ⅰ级1例，Ⅱ级10例，Ⅲ级4例，Ⅳ级3例，Ⅴ级2例。湿性坏疽16例，混合性坏疽4例。中医分为热毒型4例，湿热型9例，阴虚型4例，脾虚型2例，气血两虚型1例。
两组性别、年龄、病情比较，经统计学处理无显著性差异(P＞0.05)。2 治疗及观察方法3 疗效观察
摘要 目的：探讨中药内服并浸泡对糖尿病足的治疗作用。方法：将40例糖尿病足患者随机分为2组，在基础治疗相同的情况下，治疗组20例采用中药内服并浸泡治疗，对照组20例采用山莨菪碱治疗。两组病人均连续用药2个月。结果：治疗组治愈11例，好转6例，无效3例，总有效率85.0%；对照组治愈6例，好转5例，无效9例，总有效率55.0%.两组总有效率比较，治疗组疗效明显优于对照组(P＜0.05)。在改善患者的血脂、全血比粘度方面，治疗组亦优于对照组(均P＜0.05)。结论：中药内服并浸泡对糖尿病足的治疗作用确切，并有改善患者的血脂、全血比粘度的功能。
关键词 糖尿病足；中药内治；中药浸泡
Liu Yibin Liuzhou Peoples Hospital
#8 Guangchang Rd.Liuzhou Guangxi 545001
Abstract: Objective: To disouss the author discussed the curative effect of in-take and immersion of Chinese herbal medicine on gangrenous foot due to diabetes. Methods: 40 cases with gangrenous foot were randomly divided into two groups. Under the same basic treatment, the treatment group with 20 cases was treated with both in-take and immersion of Chinese herbal medicine,while the control group with the rest 20 cases was treated with anisodamine. The methods had been applied to the two groups differently for two months. Results: In the treatment group, 11 cases were cured, 6 cases showed improved and 3 cases ineffective with the total effective rate of 85.0%. For the control group, 6 cases were cured, 5 cases showed improved and 9 cases ineffective, the total effective rate being 55.0%. The comparison proved the curative effect in the treatment group was better than the control group(P＜0.05).In addition, the treatment group gained better results in improving patients'blood-fat and specific viscosity rate of whole blood than the control group(average P＜0.05). Conclusion: In-take and immersion of Chinese herbal medicine were functional for the treatment of gangrenous foot and also for the improvement of blood-fat and specific viscosity rate of whole blood.
Key Words: Gangrenous Foot Caused by Diabetes; In-take and Immersion of Chinese
Herbal Medicine
糖尿病足是糖尿病的严重并发症，致残率高，患者常需截肢，甚至由于感染加重死亡，因而对患者危害极大。笔者从1994年3月～1998年10月用中药内服并浸泡治疗获得良好疗效，并设基础治疗相同的20例作对照。现将结果报道如下：
2.1 基础治疗 全部病例均用胰岛素皮下注射或口服降糖药控制血糖，并根据病变部位分泌物病原菌培养及药敏结果选用相应抗生素口服或静滴，及时清创处理疮面。
2.2 治疗组 内治法：热毒型用仙方活命饮或四妙勇安汤；湿热型用四妙散；阴虚型用知柏地黄汤；脾虚型用参苓白术散；气血两虚型用八珍汤随症加减，然后均于上述方中加生黄芪60～90g，玄参60g，鸡血藤30g，川牛膝12g.每日1剂，水煎服。外治法：初起疮面未破溃或溃疡较浅，周围组织红肿热痛明显者，以忍冬藤100g，苦参30g，黄柏20g，赤芍30g，牡丹皮20g，苏术20g，红花15g清热解毒，凉血活血消肿；中期溃疡形成，脓液排泄不畅者，以忍冬藤100g，九里明60g，苦参30g，百部20g，黄柏20g，土茯苓20g，苍术15g，皂角刺15g清热解毒、燥湿杀虫；后期脓液干净，疮面周围组织皮色黯黑者，则以忍冬藤60g，桂枝30g，细辛30g，丹参30g，当归20g，红花15g，川芎15g温经活血；溃疡久不愈合，加黄芪60g，五倍子15g，白及15g敛疮生肌。每日清洁疮面后，以中药煎剂浸泡患足，早晚各1次，然后覆盖无菌纱布保护疮面，脓液排净，分泌物培养细菌阴性者，于纱布上滴敷康复新滴剂。
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