Objective To investigate the amputation-related pain and quality of life (QoL) between the amputees with transfemoral amputation (TFA) and transtibial amputation (TTA) 10 years after the Wenchuan earthquake, and compare the effects of two different amputation level on the long-term functional rehabilitation of amputees. Methods A total of 305 amputees from Center of Comprehensive Service of Disabled of Deyang for the disabled 10 years after the Wenchuan earthquake were selected for cross-sectional study from February to June 2018. Through face-to-face interview, the basic information of amputees was collected and the evaluation of Prosthetic Evaluation Questionnaire (PEQ) was completed. The amputees were divided into TFA group and TTA group according to the amputation level. Results A total of 53 amputees were included, including 27 in the TFA group and 26 in the TTA group. The PEQ scores showed that the prevalences of phantom limb sensation (96.3% vs. 65.4%; χ2=6.372, P=0.012) and phantom limb pain (92.6% vs. 69.2%; P=0.039) in the TFA group were significantly higher than those in the TTA group. There was no significant difference with regard to the intensity of amputation-related pain between the victims with TFA and TTA (P>0.05). However, the TFA group were more bothered by phantom limb sensation than the TTA group (52.9±24.1 vs. 35.9±26.7; t=2.108, P=0.042), there was no significant difference in other indexes (P>0.05). There was no significant difference in QoL between the TFA and TTA groups (P>0.05). Conclusions The phantom limb sensation, phantom limb pain, residual limb pain, non-amputated limb pain and back pain are still prevalent among the victims with TFA and TTA 10 years after the Wenchuan earthquake. The higher amputation level is associated with increased prevalence of phantom limb sensation and phantom limb pain, as well as more bothersomeness of phantom limb sensation. The amputation level appeares to have no impact on the long-term QoL.
目的:探讨5·12汶川地震中因外伤而截肢的患者产生各种心理反应的原因和护理对策,以采用有效的护理措施。方法:以我院收治的地震伤致截肢患者23例为研究对象,采用面对面与患者及家属交谈、观察患者的心理行为、转院后随访等形式,用应对方式量表对心理护理进行评分及分析,并针对性采取心理护理。结果:截肢患者在治疗前后出现自我概念改变、不确定感、社会适应力改变等正性和负性心理效应;经过心理护理,能消除心理障碍,均获得较好的治疗效果。结论:正确的心理分析和针对性心理护理有利于患者的心理调适,产生正性心理效应,积极应对疾病。
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.
Objective To review the progress in amputation technique of diabetic foot. Methods Recent l iterature concerning the amputation technique of diabetic foot was reviewed and analyzed. Results According to the different levels of the amputation, the diabetic foot’s amputation can be classified as major amputation and minor amputation, and differentkinds of methods can derive from these styles. Different factors should be considered when the style and method of amputation are chosen. Conclusion To the diabetic foot amputation, the general rule is to l imit the amputation level on the premise of the good cl inical effect. The health state, the region of the diabetic foot, the tissue perfusion, the susceptibil ity to infection in local tissue, and the abil ity of wound healing are important factors in selecting the styles and methods of diabetes-related amputations. Importance should be attached to the synthesis treatments of diabetes to prevent the higher level amputation.
Objective To investigate the clinical features and risk factors of diabetic foot. Methods A total of 100 patients with diabetic foot and 158 diabetic patients without diabetic foot were selected from April 2012 to May 2015 in Meishan Hospital of Traditional Chinese Medicine. Clinical data of the patients in the two groups was comparatively analyzed. Multiple logistic regression analysis was used to explore the risk factors. Results The age, duration of diabetes, incidences of complications, count of white blood cells, level of fibrinogen, level of high-sensitivity C-reactive protein (hs-CRP) and level of glycated hemoglobin (HbA1c) in diabetic foot group were significantly higher than those in non-diabetic foot group (P<0.05), while the ankle-brachial index, level of hemoglobin and level of albumin in diabetic foot group were significantly lower than those in non-diabetic foot group (P<0.05). The independent risk factors of diabetic foot were Wanger grade, age, ankle-brachial index, hs-CRP, albumin and HbA1c (P<0.05). HbA1c and hs-CRP level were independent risk factors of disease severity in patients with diabetic foot; the difference of prognosis in patients with different Wanger grading was statistically significant (Z=–4.394, P<0.001). Conclusions The risk of diabetic foot in diabetic patients increases with older age, the more serious Wanger grade, the higher hs-CRP and HbA1c level, and the lower ankle-brachial index and albumin level. Taking precautions based on the patient’s situation is conducive to early prevention of amputation in diabetic patients with diabetic foot.
目的:调查截肢患者及其家属术前、术后的心理状态与需求,为探寻如何改进护理方法提供依据。方法:采用问卷调查法,将85例截肢患者及其家属125人作为调查对象,分别对截肢患者进行心理干预前后的影响,情绪变化,以及认知需求,用百分构成法统计分析,经χ2检验,Plt;0.005。结果:患者及家属均难以接受截肢这种手术方式,迫切需要了解相关知识,做好患者及家属的心理护理,满足其认识需求尤其重要。结论:患者及家属对截肢手术有不同程度的恐惧和忧虑,经护士耐心、连续的心理护理为患者重归社会树立了信心。