季節變化對糖尿病足部潰瘍患者下肢截肢之影響

Effect of Seasonal Variations on the Incidence of Lower-extremity Amputations in Patients with Diabetic Foot Ulcer

本研究探討季節變化對糖尿病足部潰瘍患者下肢截肢之影響，以病歷回溯方式收集2004年1月至2007年12月於某醫學中心住院之糖尿病足部潰瘍患者之資料。共分析857位患者之資料，統計分析結果顯示：重大截肢率具季節性之變化，糖尿病足部潰瘍患者併發周邊動脈灌注不全之比例亦具季節性之變化，周邊動脈灌注不全與重大截肢具相關性，併發周邊動脈灌注不全患者之重大截肢率較高。春季求治之糖尿病足部潰瘍患者中併發周邊動脈灌注不全者較多，重大截肢率亦較高。由於研究場所為專責之糖尿病足部潰瘍後送單位，春季求治之患者可能於冬季即已於基層醫療院所求治，因此建議於冬春兩季，醫護人員應更積極評估患者周邊動脈血循，並積極提供改善血循之相關措施，以提升治療成效。

The aim of this study was to investigate the association between seasonal variations and the occurrence of lower-extremity amputation in patients with diabetic foot ulcer. This was a retrospective study of 857 diabetic foot ulcer patients who were admitted to a medical center between January 2004 and December 2007. The results revealed that there was a seasonal variation in the rate of major lower-extremity amputations. Moreover, the seasonal distribution of the percentage of patients with peripheral vascular insufficiency exhibited a significant variation. Peripheral vascular insufficiency was found to be associated with major amputation. The rate of major amputation was higher in patients with peripheral vascular insufficiency than in those without the condition. In spring, the incidence of poor peripheral perfusion was high, which corresponded with the higher rate of major lower-extremity amputations. Since the patients included in this research setting might have received medical treatment in a primary care setting for a certain period of time, we recommend aggressive assessment and treatment of peripheral vascular insufficiency in patients with diabetic foot ulcer, particularly during spring and winter.