糖尿病怎会“跑”到脚上

随着人们生活水平的提高,糖尿病的发病率正以惊人的速度发展,糖尿病各种慢性并发症也相应增加,成为威胁糖尿病患者的隐形杀手。

某女性糖尿病患者,75岁,糖尿病史20余年,长期服用优降糖及各种降糖中药治疗,近3年来空腹血糖一直在12~15毫摩尔/升(220~270毫克/分升)。后来右足拇趾因剪趾甲,导致局部破溃后长期不愈,拇趾颜色变黑坏死,于是前来我院就诊。

这位患者入院经检查诊断为“2型糖尿病合并双下肢闭塞性动脉硬化症,糖尿病足5级”。在诊治过程中,她提出一个令其百思不解的问题:“我的糖尿病怎么‘跑’到脚上去了?”这个问题听起来很可笑,但它却在很大程度上反映了一些患者对糖尿病的无知。

随着人们生活水平的提高,糖尿病的发病率正以惊人的速度发展,糖尿病各种慢性并发症也相应增加,成为威胁糖尿病患者的隐形杀手。闭塞性动脉硬化就是糖尿病累及周围大血管的一个并发症,正如文章开头提到的患者那样,闭塞性动脉硬化发展到一定程度,可导致肢端坏死,严重者导致截肢,成为患者致残致死的一个重要原因。

闭塞性动脉硬化是动脉粥样硬化病变累及周围动脉并引起慢性闭塞的一种疾病。由于动脉粥样斑块及其内部出血或斑块破裂,导致形成继发性血栓而逐渐产生血管腔狭窄或闭塞,导致肢体缺血等临床表现。该病多见于老年人,发病年龄多在50~70岁之间,患者中20%伴有糖尿病。糖尿病患者发生本病者比无糖尿病患者高11倍,且发病年龄更早,更易影响较小口径和较远侧部位的动脉。因此,糖尿病“跑”到脚上去,也就不足为奇了。

闭塞性动脉硬化按症状可分为四个阶段:

  第1期 患者可表现为双下肢、双足麻木,发凉,下肢酸胀,尤以小腿明显。
  第2期 双下肢贮备血流不足,剧烈活动时不能维持足够的血流量,患者可表现为间歇性跛行,如行走一段距离后因疼痛而被迫停下,休息后疼痛缓解。
  第3期 缺血进一步发展,残存血流量低于静息状态时组织代谢的需要,表现为静息性疼痛,尤以夜间明显。
  第4期 不能提供组织存活必需的血流量,肢端及接触皮肤开始出现营养障碍性损害,临床表现为肢端坏死或坏疽。
  如果以双下肢超声彩色多普勒检查结果来分,该病可分为四度:
  早期病变 血管腔狭窄低于正常人的25%,血流量少于正常人的35%;
  轻度病变 血管腔狭窄低于正常人的25~50%,血流量少于正常人的35~50%;
  中度病变 血管腔狭窄低于正常人的50~75%,血流量少于正常人的50~70%;
  重度病变 血管腔狭窄低于正常人的75%以上,血流量少于正常人的70%以上。

闭塞性动脉硬化最严重的危害是导致肢端坏死、坏疽,尤其是糖尿病合并闭塞性动脉硬化,是糖尿病足发病的最根本原因。

患者一旦发生糖尿病足,治疗起来非常棘手,很多患者因此而被迫截肢,给生活带来诸多不便。因此,提醒广大糖尿病患者,一定要早期发现和治疗闭塞性动脉硬化症,一旦出现上面提到的各种症状,应及早就医。

目前,随着诊断技术的不断提高,该病的检出率也大大提高。早期可以通过无创性检查——超声彩色多普勒,可检查动脉、静脉的管径及流速,作出定量定位分析,从而使该病的诊断准确率大大提高。

一旦确诊为闭塞性动脉硬化,患者应戒烟(吸烟可致血管痉挛),治疗血脂异常症,控制糖尿病,保持患肢皮肤清洁、干燥和柔软,防止其受冻和外伤。如局部有感染或外伤,应迅速处理。除此之外,目前临床应用的大量血管扩张剂及抗栓剂,对早期病变疗效比较显著。近年来还开展了外科手术治疗及介入治疗等,效果也不错。

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