| Summary: | 碩士 === 中山醫學大學 === 醫學研究所 === 90 === Abstract
The prevalence of diabetes mellitus has increased in Taiwan recently. Foot infection and gangrene are frequent complication of DM patients. In many reports, hyperbaric oxygen therapy(HBOT) has been approved as an adjunctive therapy in the management of diabetic foot. But few publications show how to improve the success rate of HBOT in diabetic foot. The purpose of this study is an attempt to evaluate the failure factors of HBOT. From July 1999 to Dec. 2001, we retrospectively collected data on 49 patients with diabetic foot treated by HBOT. There were 19 females and 30 males, with an average age of 66.7 years. We defined successful treatment as wound healing or a low level amputation. Independent sample t-test and Fisher’s exact test were used to compare the successful cases with the failed cases according to age, blood sugar, peripheral vessel disease, leukocyte count, bacterial numbers and uremia. Using a Statistic Correlation to find the significant factors between success group and failure group related with the result of treatment. Logistic regression was used to identify the prognostic factors associated with the outcome of treatment. Of the 49 patients, 31 patients(success rate:63.3%) succeeded and 18 patients(failure rate:36.7%) failed in treating their diabetic foot by HBOT. We analyzed the data statistically and found the most important prognostic factor of treatment was peripheral vessel disease in hyperbaric oxygen therapy. Although many reports claimed that adjunctive hyperbaric oxygen therapy is a useful tool in treatment of diabetic foot, currently it is not recognized as a routine adjunctive method. The reason is that we can’t clearly predict HBO treatment result and it is costly in Taiwan. According to this study, we understand that peripheral circulation is the most important prognostic factor. Therefore, careful evaluation and preparation of patients is necessary before using HBOT. A treatment protocol for HBOT is proposed in Fig 1.
Key words: Diabetic foot, Hyperbaric oxygen therapy, low level amputation, peripheral vessel disease, and leukocyte count
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