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Niemal 40 proc. pacjentów z cukrzycą przechodzi powtórną amputację. Jak temu zapobiec?

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Około 4 na 10 pacjentów chorych na cukrzycę, którzy przeszli pierwotną amputację kończyny, w przeciągu 5 lat przejdzie powtórną amputację – wynika z badań BJM Diabetes Research & Care. Naukowcy przeprowadzili przegląd literatury w celu określenia, jak często dochodzi do reamputacji u pacjentów z cukrzycą.

Analiza naukowców obejmowała 205 artykułów naukowych. Zdaniem badaczy wskaźnik reamputacji wśród osób z cukrzycą wzrósł w przeciągu pięciu lat z 19 proc. do 37,1 proc. Naukowcy z BJM przeanalizowali badania, które wskazywały m.in., że wśród ponad 71 tys. pacjentów z cukrzycą, którzy poddani byli amputacji,  26 proc. wymagało reamputacji w ciągu 12 miesięcy. Kolejne analizy ujawniły natomiast, że jeden na pięciu pacjentów wymaga powtórnej amputacji.

Amputacje najczęściej związane ze stopą cukrzycową

Zespół stopy cukrzycowej jest jednym z najpoważniejszych powikłań cukrzycy. Objawia się występowaniem owrzodzeń, martwicy, zniekształceń, a także zakażeń rany kończyny dolnej. W praktyce klinicznej wyróżnia się trzy postaci ZSC: niedokrwienną, neuropatyczną i mieszaną.

W Polsce na cukrzycę cierpi ok. 2,5 – 3 mln osób, czyli ok. 6 proc. społeczeństwa. U ok. 15 proc. cukrzyków rozwija się zespół stopy cukrzycowej. Schorzenie częściej dotyka osoby z cukrzycą typu 2. Około 85 proc. amputacji u pacjentów z cukrzycą spowodowanych jest stopą cukrzycową.

W Polsce wykonuje się 170 amputacji na 1 tys. pacjentów rocznie. W ciągu 3 lat od wykonania amputacji u 50 proc. pacjentów konieczne jest dokonanie powtórnej amputacji (źródło: Amputacja kończyny dolnej jako najcięższe powikłanie cukrzycy).

Amputacja kończyny tylko w ostateczności

Co roku na całym świecie ponad milion osób poddawanych jest amputacji kończyny dolnej w następstwie powikłań cukrzycy. Oznacza to, że co 20 sekund dochodzi do usunięcia nogi. Amputacja kończyny przy ZSC stosowana jest w celu poprawy zdrowia i funkcjonowania, a także kiedy rana doprowadziła do deformacji kończyny. Decyzję o operacji podejmuje się w ostateczności, w wyniku niepowodzenia leczenia lub gdy infekcja powoduje rozległe uszkodzenie tkanek i jest poważnym zagrożeniem życia.

W przypadku ZSC amputacje obejmować mogą pojedyncze palce, palce z częściami śródstopia, goleń, udo. Rozległość amputacji uzależniona jest od nasilenia zmian chorobowych, stopnia ukrwienia tkanek oraz rokowania dotyczącego gojenia się rany. Najczęstszymi powikłaniami po amputacji są: krwiaki, infekcje, martwica, przykurcze, nerwiaki, bóle. Przyczynami reamputacji mogą być: nieprawidłowe gojenie się rany pooperacyjnej, ognisko martwicze, infekcja, złe uformowanie kikuta lub blizny.

Profilaktyka może zapobiegać amputacjom

Współautor analizy BJM, dr Gary Rothenberg z University of Michigan Medical School w Ann Arbor, podkreśla, że by obniżyć wskaźniki powtórnej amputacji, należy bardziej skupiać się na opiece profilaktycznej pacjentów z cukrzycą.

Chorzy na cukrzycę powinni przynajmniej raz do roku przechodzić badania stóp. Wczesna diagnostyka i leczenie owrzodzeń pozwala zmniejszyć częstość amputacji o 85 proc.

Również pielęgnacja stóp odgrywa dużą rolę w zapobieganiu rozwojowi ZSC. Pacjentom z cukrzycą zaleca się dokładną pielęgnację stóp, skóry i paznokci, odpowiedni dobór obuwia, wkładek i skarpetek (bezszwowych, z naturalnych i dobrze przepuszczalnych włókien). Stopy należy obserwować codziennie – między palcami, paznokcie i podeszwy stóp. Cukrzycy powinni myć stopy w letniej wodzie z dodatkiem środka myjącego, który nie podrażni i nie wysuszy skóry, a umytą skórę zasypywać pudrem lub delikatnie natłuszczać. Paznokci nie powinno się obcinać, lecz piłować. Cukrzycy, zgodnie z zaleceniami klinicznymi, nie mogą używać maści rozgrzewających, plastrów na odciski, termoforów ani poduszek elektrycznych. Zaleca się również unikanie nadmiernego pocenia i odparzenia stóp.

Źródła:

podyplomie.pl

BJM Journals

B. Wanot, E. Nierobisz, A. Biskupek-Wanot, Amputacja kończyny dolnej jako najcięższe powikłanie cukrzycy, Medycyna Rodzinna 1/2017, s. 68-73

Dr n. med. G. Szczęsny, Amputacje urazowe kończyn, Chirurgia po Dyplomie, 2015, str. 13-20

Przeczytaj także: Opracowano technologię drukowania protez o właściwościach antybakteryjnych

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