Kev soj ntsuam cov neeg mob ntshav qab zib muaj kev pheej hmoo ntawm kev tsim kab mob ko taw hauv Freetown, Sierra Leone
Mar 16, 2022
joanna.jia@wecistanche.com/ WhatsApp: 008618081934791
Abstract
Taw qhia:Mob ntshav qab zib Mellitusyog ib qho teeb meem kev noj qab haus huv thoob ntiaj teb, txawm hais tias cov ntaub ntawv nthuav dav tam sim no tsis muaj Sierra Leone muaj ntau zuj zus ntawm kev kuaj mob thiab tsis tau kuaj pom.ntshav qab zib. Tsis muaj kev kawm thiab kev saib xyuas tus kheej, kev coj tus cwj pwm tsis zoo ntawm txoj kev noj qab haus huv tuaj yeem yog qhov tseem ceeb ua rau muaj kev pheej hmoo ntawm mob ntshav qab zib ko taw. Lub hom phiaj: txhawm rau txheeb xyuas cov neeg mob nrogntshav qab zibmuaj kev pheej hmoo ntawm kev txhim kho ko taw ulcers, ntshav qab zib neuropathy, kab mob peripheral artery thiab soj ntsuam kev koom tes ntawm kev ywj pheej muaj feem cuam tshuam nrog kev txhim kho ntawm ko taw rwj thiab lwm yam kev kho mob ntsig txog. Txoj Kev: Txoj kev tshawb no tau ua tiav ntawm ob qhov chaw, Connaught tsev kho mob thiab chaw kho mob hauv Freetown. Ib daim ntawv nug tus qauv tau muab rau kev soj ntsuam kev pheej hmoo ntawm cov kab mob ntshav qab zib. Tag nrho ntawm 231 tus neeg tuaj koom (hnub nyoog 45-75 xyoo) tau raug xaiv los ntawm kev ua haujlwm random sampling. Cov ntaub ntawv piav qhia tau siv los txheeb xyuas cov ntaub ntawv siv SPSS. Cov txiaj ntsig: Feem ntau ntawm cov neeg koom (64.5 feem pua) tau kuaj pom tias muaj ntshav qab zib nyob rau hauv 1-5 xyoo, 5.5 feem pua thiab 13.4 feem pua tau mob qhov muag thiab raum raws li. Kev ntsuam xyuas kev tiv thaiv tau qhia tias 38.5 feem pua tau poob ntawm kev tiv thaiv kev hnov lus thiab 19 feem pua tau xav tias muaj kab mob peripheral arterial uas tsis muaj mem tes nyob rau tom qab tibial hlab ntsha thiab dorsal hom. Ae, kev ua haujlwm, xyoo txij li kuaj pom, thiab hom ntshav qab zib tau cuam tshuam nrog kev pheej hmoo siab ntawm kev tsim cov kab mob ntshav qab zib ko taw nrog P-value < 0.005.="" risk="" categorization="" ntawm="" cov="" neeg="" tuaj="" koom="" qhia="" 76="" feem="" pua="" ntawm="" cov="" kev="" pheej="" hmoo="" tsawg="" thaum="" cov="" neeg="" nyob="" nruab="" nrab,="" siab,="" thiab="" kev="" pheej="" hmoo="" siab="" tshaj="" yog="" 20="" feem="" pua,="" 17="" feem="" pua="" thiab="" 3.5="" feem="" pua.="" cov="" tib="" neeg="" uas="" muaj="" kab="" mob="" hauv="" lub="" raum="" ua="" ntej,="" teeb="" meem="" qhov="" muag,="" thiab="" keeb="" kwm="" ntawm="" kev="" txiav="" tawm="" yav="" dhau="" los="" tau="" poob="" ntau="" dua="" ntawm="" kev="" tiv="" thaiv="" kev="" hnov="" lus,="" tsis="" muaj="" mem="" tes,="" thiab="" tingling="" hnov="" ntawm="" sab="" sab.="" xaus:="" muaj="" qhov="" xav="" tau="" zoo="" rau="" cov="" neeg="" ua="" haujlwm="" saib="" xyuas="" kev="" noj="" qab="" haus="" huv="" los="" ua="" cov="" kws="" qhia="" ntshav="" qab="" zib="" kom="" muaj="" kev="" pabcuam="" zoo="" xws="" li="" kev="" kuaj="" ntshav="" qab="" zib="" ko="" taw="" txhawm="" rau="" tiv="" thaiv="" cov="" kab="" mob="" ntshav="" qab="" zib="" uas="" ua="" rau="" txiav.="" tshawb="" nrhiav="" cov="" neeg="" mob="" ntshav="" qab="" zib="" uas="" muaj="" kev="" pheej="" hmoo="" rau="" mob="" ntshav="" qab="" zib="" ko="" taw="" yuav="" mus="" ntev="" los="" tiv="" thaiv="" kev="" txiav="" tawm="" yav="" tom="" ntej="" thiab="" lwm="" yam="" teeb="" meem="" cuam="">
Ntsiab lus:Mob ntshav qab zibMellitus, Peripheral Arterial Disease, Poob Kev Tiv Thaiv Kev Ruaj Ntseg, Mob Ntshav Qab Zib Foot Ulcers
Cistanchetubulosativ thaiv kab mob raum, nyem qhov no kom tau txais cov qauv
I. Kev Taw Qhia
Mob ntshav qab zibmellitusua rau muaj mob hnyav ntxiv lossis raug nqi; nce kev tuag vim nws txoj kev ua phem rau lub neej [1]. Kev nce qib ntawm cov piam thaj hauv cov ntshav tsis tu ncua ua rau muaj kev puas tsuaj rau vascular uas ua rau muaj feem cuam tshuam rau lub raum thiab qhov muag, thiab tom qab ntawd lwm yam teeb meem [2]. Hauv kev tshuaj xyuas thiab ntsuas ntsuas ntsuas, lub ntiaj teb kev kis tus mob ntshav qab zib ko taw yog 6.3 feem pua thiab ntawm Africa yog 7.2 feem pua [3].Nyob hauv cov teb chaws tsim kho, mob ntshav qab zib ko taw (DFU) yog qhov ua rau muaj kev tsis taus, kev tuag, thiab kev tuag. ntawm cov neeg mob ntshav qab zib, thiab nws tau kwv yees tias 15 feem pua ntawm tag nrho cov neeg muajntshav qab zibyuav muaj qhov txhab ntawm qee theem ntawm lawv lub neej [4]. Hauv Sierra Leone txawm tias kev tshawb fawb tsis tau ua tiav los ua pov thawj qhov no, muaj ntau tus neeg mob thiab tsis tau kuaj pom.ntshav qab zibmellitus, Ntawm lwm yam, kev nkag mus rau kev kho mob tsis zoo, cov nyiaj tau los tsawg ntawm cov tib neeg, tsis muaj kev kawm txog ntshav qab zib thiab nws qhov tshwm sim, thiab tsis muaj kev cob qhia cov neeg ua haujlwm kho mob yog ib qho laj thawj tseem ceeb cuam tshuam nrog qhov no. Yog li ntawd, cov tebchaws tau nyiaj tsawg xws li Sierra Leone lossis sub-Saharan Africa tau kwv yees tias yuav ntsib tus kabmob loj tshaj plaws los ntawm 2030 piv rau cov tebchaws tsim [5].
Mob ntshav qab zib neuropathy(DN) yog thawj lossis feem ntau cov teeb meem ntawm DM thiab nws yog qhov ua rau muaj feem cuam tshuam ntawm ceg ceg [6]. Mob ntshav qab zib peripheral neuropathy (DPN) feem ntau cuam tshuam nrog lub hnub nyoog, lub sijhawm muaj ntshav qab zib, txiv neej poj niam txiv neej, haus cawv, tswj glycemic, lossis haus luam yeeb [7]. Los ntawm kev tshawb fawb ua tiav hauv 2014-2016 ntawm 34, cov tsev kho mob tub rog [8], 21 kev txiav tawm tau tshwm sim los ntawm kev mob ntshav qab zib ko taw. Kev tshawb fawb qhia tias mob ntshav qab zib ko taw rwj (DFU) cuam tshuam los ntawm ntau yam xws li tus neeg mob lub hnub nyoog, kev kawm txuj ci, BMI, hom ntshav qab zib mellitus, tus neeg mob tus cwj pwm ntawm kev saib xyuas tus kheej ntawm ko taw, thiab muaj qhov nyuaj peripheral neuropathy [9,10,11. , 12] ib. Kev txom nyem thiab tsis huv yuav cuam tshuam nrog ko taw ulceration [13]. Ntau tus neeg nyob hauv Sierra Leone nyiam taug kev hauv tsev lossis hnav khau tsis muaj kev tiv thaiv uas ua rau lawv muaj mob ko taw hauv txoj kev. Cov neeg mob uas tsis tau txais kev saib xyuas ko taw txuas ntxiv, kev qhia, lossis kev kawm feem ntau muaj kev pheej hmoo ntawm kev kis kab mob ko taw uas feem ntau tsis muaj nyob hauv cheeb tsam, cheeb tsam, lossis cov chaw kho mob thawj zaug [14]. Qhov no feem ntau yog cov xwm txheej hauv Sierra Leone, tsis tshua muaj neeg saib xyuas kev noj qab haus huv tau koom nrog kev kuaj ntshav qab zib ko taw rau lawv cov neeg mob.
Kev kuaj mob ntshav qab zib rwj lossis DPN yog qhov tseem ceeb heev los tiv thaiv cov kab mob ko taw yav tom ntej. Nws koom nrog kev siv cov cuab yeej tshuaj ntsuam xyuas yooj yim thiab cov txheej txheem xws li kev tshawb nrhiav ntawm ko taw rwj, pob taws-brachial siab index (ABPI) txhawm rau kuaj PAD, kev siv 10g monofilament. tuning diav rawg los yog biothesiometer txhawm rau kuaj pom cov teeb meem nrog kev tiv thaiv kev xav. Tsis tas li ntawd, raws li Cov Lus Qhia Zoo Tshaj Plaws rau Kev Tiv Thaiv Thiab Kev Tswj Xyuas ntawm DFUs[15].kev soj ntsuam tus neeg mob kom paub meej txog yam uas yuav cuam tshuam rau ntawm daim tawv nqaij thiab kho qhov txhab yuav tsum suav nrog keeb kwm thiab kev noj qab haus huv tam sim no (lub cev thiab kev xav), lub taub hau-rau- Kev ntsuam xyuas cov ntiv taw ntawm daim tawv nqaij, kev ntsuam xyuas qhov txhab (yog tias tsim nyog), kev tshawb xyuas ntawm ib puag ncig xws li kev lag luam hauv zej zog, kab lis kev cai, kev saib xyuas thiab kev nkag mus rau cov kev pabcuam, thiab cov txheej txheem xws li tsoomfwv cov cai, kev txhawb nqa, thiab kev pabcuam. Cov chaw kho mob ntshav qab zib tsis tshua muaj nyob hauv Sierra Leone, tsuas muaj qee qhov uas muaj nyob hauv Freetown thiab tsis tshua muaj nyob hauv cov xeev. Kev ntsuas ko taw dav dav tsis yooj yim ua txhua qhov chaw los tiv thaiv DFUs, thiab cov kws kho mob feem ntau tsis muaj kev txawj ua li ntawd.
Txoj kev tshawb no tshawb xyuas tus neeg mob S uas muaj kev pheej hmoo ntawm kev tsim kab mob ntshav qab zib ko taw thiab nws cov kev pheej hmoo cuam tshuam ntawm Tsev Kho Mob Connaught thiab chaw kho mob nyob rau sab hnub poob ntawm Freetown. Kwv yees li 85 feem pua ntawm kev txiav tawm yog ua ntej los ntawm kev txhim kho ntawm tus kab mob neuropathic ko taw [16]. Yog li ntawd, kev txheeb xyuas cov neeg uas muaj kev pheej hmoo siab ntawm kev tsim mob ko taw thiab muab cov lus qhia thaum ua kev tshawb fawb tuaj yeem mus ntev hauv kev tiv thaiv kev txiav cov ceg, qhov kev tshawb fawb no kuj tseem tuaj yeem ua qhov kev tshawb fawb ua ntej los tshawb xyuas ntxiv qhov cuam tshuam ntawm kev txais yuav kev ntsuam xyuas ko taw hauv cov kev tiv thaiv ntawm DFUs raws li kev tshawb nrhiav kev cuam tshuam.
II. Txoj kev
Ib qho kev tsim qauv sib txuas rau yav tom ntej tau siv qhov twg cov neeg mob uas taug kev mus rau hauv ob qhov chaw raug xaiv los ntawm cov txheej txheem random sampling. Txog 50-60 cov neeg mob los ntawm ntau qhov chaw ntawm Freetown uas tsis tuaj yeem them tus glucometer tuaj xyuas lub tsev kho mob txhua hnub Wednesday. Cov neeg tsim nyog tau txais kev tso cai los koom nrog hauv txoj kev tshawb fawb uas tau mus xyuas ob lub tsev kho mob rau kev soj ntsuam kev soj ntsuam tau raug xaiv los ntawm qhov tsis sib xws. Tus qauv loj tau txiav txim siab raws li lub sijhawm ntawm txoj kev tshawb fawb uas yog peb lub hlis txij lub Xya Hli mus txog rau lub Cuaj Hli 2019. Yog li ntawd, cov kev kawm tau raug tso npe sib law liag los ntawm cov txheej txheem sampling. kom txog rau thaum qhov xav tau qhov loj me ntawm 231 cov neeg koom tau txais.
Semmes Weinstein Monofilament Test rau lub teeb pom kev zoo thiab 128Hz tuning diav rawg los ntsuas qhov kev vibration. Ib daim ntawv pom zoo qhia tau zoo thiab daim ntawv nug tseem suav nrog ua cov cuab yeej kawm. Cov lus nug suav nrog cov ntsiab lus ntawm pej xeem thiab keeb kwm kev noj qab haus huv nrog rau kev soj ntsuam ntshav qab zib ntev ntev, hom ntshav qab zib, ko taw deformity, cov tsos mob neuropathy, vascular tsos mob, keeb kwm ntawm ko taw rwj, keeb kwm ntawm retinopathy thiab nephropathy, thiab lwm yam yuav tsum ua kom tiav los ntawm txhua tus neeg mob. Daim ntawv nug muaj ib ntu cais uas yuav tsum tau sau los ntawm tus neeg soj ntsuam vim nws koom nrog kev tshuaj xyuas lub cev thiab pom ntawm ceg thiab taw. Kev kuaj pom pom zoo li qhov pom ntawm daim tawv nqaij hloov pauv, cov qauv deformities, fungal toenails, thiab kev tshuaj xyuas lub cev zoo li qhov kub ntawm cov ceg yuav tsum tau sau tseg. Kev soj ntsuam kev soj ntsuam lossis kev tshuaj ntsuam xyuas kev tiv thaiv kev hnov mob (peripheral neuropathy) thiab kab mob peripheral arterial kuj suav nrog. Cov kws tshawb nrhiav tau raug qhia kom ua qhov kev xeem ua ntej los ntawm kev muab daim ntawv nug rau ob peb tus neeg mob uas pom zoo ua qhov kev kawm. Los ntawm qhov kev sim ua ntej no, peb tuaj yeem soj ntsuam daim ntawv nug thiab txheeb xyuas qhov yuam kev lossis thaj chaw uas xav tau kev qhia ntxiv.
Cov kws saib xyuas neeg mob tau siv cov lus qhia hauv qab no hauv kev kuaj ntshav qab zib ko taw:
1. Lawv kov lub monofilament rau tus neeg mob txhais caj npab lossis txhais tes (tsis txhob txhais tes yog tias tus neeg mob ntshav qab zib muaj hnab looj tes thiab khoom noj ntshav qab zib) yog li lawv nkag siab tias yuav xav li cas thaum kuaj monofilament ntawm ko taw.
2. Ua ntej lawv kov cov monofilament ntawm tus neeg mob ko taw, cov neeg mob tau hais kom kaw lawv lub qhov muag thiab tom qab ntawd qhia kom hais tias "yog" thaum lawv hnov qhov kev xav ntawm monofilament ntawm lawv ko taw.
3. Lub monofilament tau muab tso rau ntawm ko taw thiab kov daim tawv nqaij ib zaug kom txog thaum lub monofilament khoov mus rau hauv C-puab. Cov monofilament yuav tsum tsis txhob siv rau ntawm lub qhov txhab, callus, caws pliav, lossis cov ntaub so ntswg necrotic.
4. Hais txog 4 qhov pom tau raug sim qhov chaw raws li qhia hauv daim duab (Daim duab 3).
5. Cov lus teb tau muab sau rau ntawm daim ntawv nug nrog "ntxiv" rau yog thiab "-"rau tsis tau.
6. Yog hais tias lub monofilament tsis hnov nyob rau hauv ib cheeb tsam ntawm ko taw, qhov no qhia tias tsis muaj kev tiv thaiv sensation (LOPS) nyob rau hauv cheeb tsam ntawd.
Kev siv Tuning Fork
1. Cov neeg mob tau hais kom kaw lawv lub qhov muag.
2. Tus neeg soj ntsuam ces kaw lub 128 Hz tuning diav rawg. 3. Tom qab ntawd tus diav rawg tau muab tso rau ntawm tus neeg mob lub sternum thiab paub tseeb tias tus neeg mob tuaj yeem hnov nws buzzing.
4. Cov neeg mob tau hais kom qhia thaum lawv hnov qhov kev vibration ntawm lawv ko taw thiab qhia thaum twg nws nres.
5. Tom qab ntawd qhov kev xav tau raug soj ntsuam los ntawm kev tso lub vibrating tuning diav rawg mus rau qhov chaw phalanx ntawm tus ntiv taw zoo.
6. Yog tias qhov kev hnov lus tsis zoo, tus neeg mob yuav tsum hais tias lawv hnov lub suab nrov nrov.
7. Tus neeg tshawb xyuas mam li maj mam muab nws txhais tes tso rau ntawm tus ntiv tes xoo kom nws tsis txhob vibrating. Yog tias tus neeg mob qhov kev hnov lus tsis zoo, lawv yuav tsum muaj peev xwm paub txog thaum qhov kev vibration tau nres.
8. Yog tias qhov kev hnov lus tsis zoo, qhov kev ntsuam xyuas tau txuas ntxiv mus ntxiv (piv txwv li, proximal phalanx)
9. Qhov kev ntsuam xyuas tau rov ua dua ntawm lwm tus ko taw. Cov ntaub ntawv khaws cia tau nkag mus siv EPI-INFO version 3.5.3 thiab xa tawm mus rau SPSS statistical version 20 software rau kev tshuaj xyuas ntxiv. Kev piav qhia cov txheeb cais tau ua tiav los ua tus yam ntxwv ntawm kev tshawb fawb pej xeem siv ntau qhov sib txawv. Kev kuaj Chi-square tau siv los txheeb xyuas qhov kev pheej hmoo ntawm ntshav qab zib neuropathy rau ntawm kev sib raug zoo-cov pej xeem thiab kev kho mob sib txawv. Qhov twg tsim nyog cov kab ntawv sib txuas tau siv los tshawb xyuas qhov sib txawv ntawm cov kev ywj pheej sib txawv xws li hnub nyoog, xyoo txij li kev kuaj mob, kev tawm dag zog, qhov muag, thiab kab mob raum mus rau lwm qhov sib txawv xws li mem tes ntawm qhov kawg thiab LOPS. Risk categorization (Tsawg, nruab nrab, siab. siab tshaj qhov kev pheej hmoo) tau txheeb xyuas siv cov ntaub ntawv txheeb cais. Qhov sib txawv nrog p-tus nqi ntawm<0.05 was="" considered="" statistically="">
Kev pheej hmoo stratification tau ua tiav siv IDF cov lus qhia 2017on ntshav qab zib ko taw thiab PAD, yog li cov neeg mob pom tias muaj kev pheej hmoo ntawm kev mob ntshav qab zib ko taw tau raug cais raws li cov txheej txheem kho mob ntsig txog cov tsos mob. Tsis tshua muaj kev pheej hmoo: ib txwm cog paj hnov; Kev pheej hmoo nruab nrab: Poob kev tiv thaiv kev hnov mob siab nrog kev kub siab lossis kev tsis zoo (PAD) lossis cov pob qij txha deformities lossis Onychomycosis; Kev pheej hmoo siab: keeb kwm ntawm ulceration, amputation, lossis neuropathic Fracture
III. TSEEM CEEB
Ntau tus poj niam koom nrog hauv kev kawm 134 (58 feem pua) ntau dua li txiv neej 97 (42 feem pua), ntau tus neeg mob ntshav qab zib 88 (31.8 feem pua) ntawm cov hnub nyoog ntawm 55-65 xyoo nyob rau hauv txoj kev tshawb no, thaum muaj hnub nyoog ntawm 45-55thiab 65-75 yog 69 (29.9 feem pua) thiab 73 (36.1 feem pua) raws li. Tsuas yog 26 (11.3 feem pua) haus luam yeeb thiab tsuas yog 29 (12.6 feem pua) haus cawv. Cov uas tsis muaj zog lub cev yog 38 (16.5 feem pua). Qhov zaus ntawm kev ua raws li kev noj zaub mov noj qab haus huv tau soj ntsuam qhov twg 128 (55.4 feem pua) qee zaum ua raws li kev noj zaub mov zoo thaum tsuas yog 1 (0.4 feem pua) ua raws li tsis muaj kev npaj noj zaub mov txhua.
Feem ntau ntawm cov neeg mob tau kuaj pom muaj ntshav qab zib hom 2 thaum tsuas yog 21 (9.1 feem pua) muaj ntshav qab zib hom 1. Ntau tus neeg koom nrog 149 (64.5 feem pua) tau kuaj pom hauv l-5 xyoo thiab 24.2 feem pua hauv 6-10 xyoo.9.5 feem pua tau kuaj pom hauv 11-15 xyoo. Kev ntsuas qhov zaus ntawm kev saib xyuas cov ntshav qabzib qhia tau tias 119 (51.5 feem pua) saib xyuas lawv cov ntshav qab zib txhua lub lim tiam.69 (29.9 feem pua) txhua lub hli, 40 (17.3 feem pua) ua txhua hnub thiab tsuas yog 3 (1.3 feem pua) ua ntau tshaj ib zaug ib zaug. hli. Kev soj ntsuam ntawm yav tas los kuaj mob ntshav qab zib qhov muag pom tau tias 82 (35.5 feem pua) muaj teeb meem qhov muag. Ntawm cov neeg mob raum yog cov neeg tsawg 31 (13.4 feem pua). Kev ntsuam xyuas ntawm ko taw deformity (xws li lub taub hau metatarsal tseem ceeb, hammertoe, siab nruab nrab koov, ntsia thawv hloov, dermopathy) qhia tias 64 (27.7 feem pua) muaj cov qauv deformity. Cov ncauj lus uas muaj mob ko taw yav dhau los yog 35 (15.2 feem pua). Cov keeb kwm yav dhau los ntawm amputation depicts tias tsuas yog 93.9 feem pua ) muaj kev txiav tawm yav dhau los. Kev ntsuam xyuas tus ntiv taw qhia tau hais tias 27 (11.7 feem pua) cov neeg mob ntshav qab zib muaj cov kab mob fungal.
Table 1 qhia meej meej txog qhov sib txawv uas cuam tshuam nrog kev soj ntsuam ntawm cov neeg mob ntshav qab zib uas muaj kev pheej hmoo ntawm kev tsim DN thiab PAD. Kev ntsuas kev tiv thaiv kev hnov qab qhia tau tias 42 (18.2 feem pua) tsis muaj kev vibration thiab 47 (20.3 feem pua) tau poob qhov kev xav hauv ntau tshaj ib qhov chaw. Thaum kev ntsuam xyuas rau PAD 44 (19 feem pua) tsis muaj lub plawv dhia hauv Posterior Tibial Artery (PTA) thiab Dorsalis Pedis (DP). Cov tsos mob tshwm sim tshaj plaws los ntawm cov neeg koom nrog hauv qis qis yog qhov kub siab 86(37.2 feem pua), tingling sensation 67 (29%), thiab ko taw mob 44 (19.0 feem pua ) . Ntawm cov tawv nqaij hloov pauv, cov tawv nqaij qhuav yog feem ntau. Feem ntau ua ke nrog edema 35 (15.2 feem pua), tsuas yog 13 (5.6 feem pua) thiab 12 (5.2 feem pua) zoo ib yam muaj kab mob fungal thiab com feem.
Cov lus 2 hauv qab no tau qhia tias hnub nyoog, kev ua haujlwm, xyoo txij li kev kuaj mob, thiab hom ntshav qab zib tau cuam tshuam nrog kev pheej hmoo siab ntawm kev mob ntshav qab zib ko taw nrog P-tus nqi < 0.005.="" hauv="" qab="" no="" qhia="" txog="" kev="" pheej="" hmoo="" categorization="" rau="" ntshav="" qab="" zib="" rwj="" raws="" li="" idf="" 2017="" diabetic="" foot="" clinical="" practice="" guidelines.="" cov="" neeg="" koom="" nrog="" kev="" pheej="" hmoo="" tsawg="" yog="" 76="" feem="" pua="" thaum="" cov="" neeg="" nyob="" nruab="" nrab,="" siab,="" thiab="" muaj="" kev="" pheej="" hmoo="" siab="" tshaj="" yog="" 20="" feem="" pua="" .17="" feem="" pua="" thiab="" 3.5="" feem="">
Table 3 Hauv qab no qhia txog kev pheej hmoo categorization rau mob ntshav qab zib rwj raws li IDF 2017 Diabetic foot Clinical Practice Guidelines. Cov neeg koom nrog kev pheej hmoo tsawg yog 76 feem pua thaum cov neeg nyob nruab nrab, siab, thiab muaj kev pheej hmoo siab tshaj yog 20 feem pua .17 feem pua thiab 3.5 feem pua.
Cov neeg koom nrog cov hnub nyoog laus dua (65-75 xyoo) muaj LOPS ntau dua (37 feem pua) ntawm ntau dua 2 qhov chaw piv rau cov hnub nyoog qis dua, cov hnub nyoog laus kuj tseem cuam tshuam nrog cov mem tes tsis pom thiab kev vibration ntau dua. Cov neeg haus luam yeeb thiab haus cawv muaj feem cuam tshuam nrog LOPS, tsis muaj lub plawv dhia, thiab cov tsos mob ntawm DN LOPS ntawm cov neeg uas siv lub cev muaj zog yog 13 feem pua piv rau cov uas tsis muaj zog lub cev uas muaj kwv yees li. 58 feem pua ntawm LOPS. Cov neeg koom nrog lub cev tsis ua haujlwm muaj qhov tsis muaj zog ntawm 58 feem pua. Subiects kuaj mob ntshav qab zib 1l-15 xyoo dhau los muaj qhov loj tshaj LOPS (86.40 feem pua), Cov tib neeg uas muaj mob raum ua ntej muaj LOPS ntau dua (80.6 feem pua) thiab tsis muaj pulse (80.6 feem pua). Cov neeg uas muaj teeb meem qhov muag muaj LOPS ntau dua (39 feem pua) siv cov monofilament thiab 35.4 feem pua ntawm kev siv lub diav rawg. Qhov teeb meem ntawm qhov muag kuj tseem cuam tshuam nrog kev tsis muaj mem tes ntau dua (37.8 feem pua) thiab tingling (34 feem pua). Cov neeg laus uas muaj keeb kwm yav dhau los ntawm kev txiav tawm tau muaj ntau dua LOPS (78 feem pua) tsis muaj pulse (78 feem pua) ua ke nrog cov tsos mob tingling ntau dua.
IV. Kev sib tham
Feem coob ntawm cov neeg koom (91 feem pua) hauv txoj kev tshawb no muaj hom 2 mob ntshav qab zib vim nws yog hom mob ntshav qab zib ntau tshaj. DPN ntawm ko taw ua rau poob ntawm kev tiv thaiv kev hnov qab (LOPS) ua rau ob npaug ntawm qhov yuav tshwm sim ntawm ko taw rwj thiab tripling qhov kev pheej hmoo ntawm kev txo qis qis (LEA) [17]. Qhov kev pheej hmoo ntawm kev tsim mob ntshav qab zib ko taw ulcers (DFU) tuaj yeem suav nrog rau tus neeg mob lub hnub nyoog, lub cev tsis muaj zog, ntev xyoo txij li kev kuaj mob, keeb kwm yav dhau los ntawm kev txiav tawm, kab mob raum thiab qhov muag. Cov kev tshawb pom no yog nyob rau hauv txoj kab nrog rau lwm cov kev tshawb fawb uas qhia tau hais tias muaj ntau yam predisposing yam rau DFU yog zoo tsim thiab muaj xws li ua ntej lub hnub nyoog, ntev ntawm cov ntshav qab zib, tsis zoo glycemic tswj, muaj cov neuropathy, thiab peripheral vascular kab mob [18]. Piv txwv li, tsab ntawv tshaj tawm yav dhau los qhia tias tus neeg mob ntshav qab zib muaj 25 feem pua ntawm kev pheej hmoo ntawm kev tsim DFU [19].Hauv Sierra Leone thiab lwm thaj chaw ntawm Africa. Qhov kev nthuav dav ntawm DFUs yuav tsum tau nce ntxiv vim tias muaj kev noj qab haus huv tsis zoo thiab kev tsim kho vaj tse. Kev kuaj ntshav qab zib ko taw tsis yog ua tiav raws li kev kuaj xyuas niaj hnub ntawm cov neeg mob ntshav qab zib hauv cov tebchaws no. Txhua tus neeg uas muaj kab mob peripheral neuropathy feem ntau xav tias yuav tsum hnav khau kom zoo thiab tshuaj xyuas lawv ob txhais taw txhua hnub txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau ua haujlwm tsis zoo hauv cov tebchaws no. Txhua tus neeg uas muaj mob ko taw lossis mob qhib kuj tseem yuav raug txwv rau cov dej num tsis hnyav (ADA 2016). Cov kws kho mob lub cev thiab lwm tus kws kho mob hauv Sierra Leone yuav tsum paub txog cov lus qhia no thiab nkag siab tias yuav siv lawv li cas hauv kev kho mob thiab kev txhawb nqa kev noj qab haus huv lossis kev noj qab haus huv.ADA 2017 lees paub tias vim tsis muaj kev cob qhia, nws tau kwv yees tias tsawg dua. ib feem peb ntawm cov kws kho mob paub txog cov tsos mob ntawm tus mob ntshav qab zib peripheral neuropathy, txawm tias nws muaj cov tsos mob, thiab sib tham nrog lawv cov neeg mob [20].
Hauv kev tshawb fawb tam sim no ntau tus poj niam muaj kev pheej hmoo ntawm kev tsim DFU, cov poj niam tau pom tias muaj cov tsos mob ntshav qab zib neuropathy ntau dua, PAD vim tsis muaj cov mem tes hauv PTA thiab DP ua ke nrog ntau dua LOPS. Qhov no yuav yog qhov xwm txheej vim tias tsawg dua cov poj niam koom nrog kev ua si ntawm lub cev, tswj glycemic tsis zoo, thiab tswj lipid vim lawv txoj kev noj zaub mov thiab kev ua neej feem ntau [21]. Lwm cov kev tshawb fawb pom tau tias cov poj niam uas muaj ntshav qab zib tau tswj hwm lawv cov ntshav siab, lipid, thiab qib glycemic piv rau cov txiv neej [21]. Qhov no tuaj yeem piav qhia vim li cas peb txoj kev tshawb fawb tam sim no tau pom tias ntau tus poj niam muaj keeb kwm ntawm kev txiav tawm piv rau cov txiv neej: txawm li cas los xij qhov no tsis sib xws nrog lwm cov kev tshawb fawb uas pom tias cov txiv neej saib xyuas lawv txhais taw tsawg dua uas ua rau muaj kev cuam tshuam ntau dua ntawm lawv [22]. [23]. Li no qhov no muab lub sijhawm rau kev tshawb fawb ntxiv los tshawb xyuas qhov tshwm sim ntawm kev txiav tawm ntawm ob tus poj niam thiab txiv neej thiab tshawb nrhiav cov xwm txheej uas ua rau muaj kev nce ntxiv.
Table 1: Kev ntsuam xyuas rau Diabetic Neuropathy (DN) thiab Peripheral Arterial Disease (PAD)
Table 2: Chisquare rau kev pheej hmoo ntawm DN thiab kev noj qab haus huv-piv txwv thiab kev kho mob sib txawv
Table 3: * Risk Stratification rau cov neeg koom nrog kev pheej hmoo ntawm kev tsim mob ntshav qab zib ko taw
Kev haus luam yeeb yog ib qho ntawm cov kev pheej hmoo loj rau kev tsim DN[24]. Txoj kev tshawb no qhia tias kev haus luam yeeb muaj feem xyuam nrog qee qib ntawm LOPS, cov tsos mob ntawm DN, thiab cov mem tes tsis pom ntawm PTA thiab DP. Txawm li cas los xij, qhov nthuav dav ntawm kev sib koom ua ke ntawm yav dhau los tau tsawg dua piv rau cov neeg tsis haus luam yeeb. Qhov no tej zaum yuav yog vim li cas cov neeg haus luam yeeb tsawg dua koom nrog hauv txoj kev tshawb fawb piv rau cov neeg tsis haus luam yeeb. Cov kev tshawb fawb tau lees paub tias cov neeg haus luam yeeb muaj hnub nyoog qis dua ntawm kev txiav txim siab piv nrog cov neeg tsis haus luam yeeb [251 thiab kev haus luam yeeb tau txhim kho kev tsis muaj sia nyob hauv cov neeg mob ntshav qab zib [26]. Mob ntshav qab zib muaj feem xyuam nrog cov teeb meem macrovascular xws li atherosclerosis thiab kev haus luam yeeb kuj tau cuam tshuam ua rau yav tom ntej yog li kev haus luam yeeb ua rau muaj kev pheej hmoo ntxiv hauv kev tsim cov plaques thiab nce kev tuag hauv cov neeg mob ntshav qab zib [27].
Cov kab lis kev cai ntawm kev ua lub cev tsis tu ncua hauv Sierra Leone tseem tab tom hloov zuj zus. Los ntawm kev soj ntsuam, tib neeg ntseeg tias kev tawm dag zog tuaj yeem pab tau ib zaug hauv ib lub lis piam uas yog tus qauv hauv Sierra Leone. Lub koom haum American Diabetes tau pom zoo 50 feeb ntawm kev tawm dag zog ib lub lis piam thiab tsis txhob mus ob hnub sib law liag tsis muaj kev tawm dag zog. Sib nrug los ntawm kev ua lub cev tsis muaj zog, kev qhia txog ntshav qab zib tsawg muaj rau cov neeg mob, kev noj zaub mov zoo, khoom noj khoom haus kim, thiab kev coj noj coj ua tsis zoo yuav yog qhov tseem ceeb uas yuav ua rau muaj ntshav qab zib ntau ntxiv hauv Sierra Leone. Txawm hais tias tsis muaj pov thawj los txhawb qhov no, cov ntsiab lus hais saum toj no kuj tseem tuaj yeem ua rau muaj kev tswj tsis tau zoo hauv cov uas twb muaj mob ntshav qab zib. Ntau qhov kev sim loj randomized tswj tau tsim tau tias kev tawm dag zog aerobic txhim kho lub cev muaj zog, tswj glycemic, thiab insulin rhiab heev rau cov neeg mob ntshav qab zib [28]. Yog li ntawd, kev tawm dag zog yog pom zoo ua ib txoj hauv kev rau cov neeg mob ntshav qab zib kom txhim kho glycemic tswj thiab txo qis cov teeb meem ntshav qab zib. Yog li, txoj kev tshawb no qhia txog cov neeg uas lub cev tsis muaj zog thaum cov neeg mob tau ntsib ntau dua LOPS. Tsis pom kev mem tes (ntawm PTA thiab DP) thiab kev hnov mob ntau dua nyob rau hauv cov extremities piv rau cov uas tau siv lub cev. Cov kev tshawb pom saum toj no yog cov cim qhia txog kev mob ntshav qab zib.
Kev tawm dag zog tuaj yeem nyuaj heev rau cov neeg mob nrog DN uas tuaj yeem txwv lawv txoj kev mus los thiab ua rau lawv tus mob hnyav dua. Cov qauv ntawm Kev Kho Mob hauv Kev Mob Ntshav Qab Zib txoj hauj lwm nqe lus tshaj tawm los ntawm American Diabetes Association (ADA) suav nrog cov lus pom zoo tias thaum muaj mob hnyav peripheral neuropathy, nws yuav yog qhov zoo tshaj plaws los txhawb cov dej num tsis hnyav xws li ua luam dej, caij tsheb kauj vab, lossis caj npab ce "vim tias muaj kev pheej hmoo ntawm daim tawv nqaij tawg, kis kab mob, thiab Charcot sib koom ua puas tsuaj. Txawm li cas los xij, muaj kev tsis sib haum xeeb ntawm txoj haujlwm no uas qhia tau hais tias kev tawm dag zog yuav muaj txiaj ntsig zoo ntawm cov neeg uas muaj DN vim nws txhim kho cov ntshav ncig hauv qhov kawg thiab ntau. Lwm cov txiaj ntsig [29]
Raws li WHO 2018 [30], tag nrho lub neej expectancy ntawm Sierra Leoneans yog 53.1 xyoo. Kev tuag vim yog DM hauv Sierra Leone mus txog 1,433 lossis 1.77 feem pua ntawm tag nrho cov neeg tuag. Lub hnub nyoog-hloov tus nqi tuag yog 55.85 rau 100,000 cov pej xeem nyob qib uas nyob qib Sierra Leone 33t hauv ntiaj teb. Txoj kev tshawb no qhia meej tias muaj hnub nyoog nce ({14}} xyoo) tau txuam nrog LOPS loj tshaj. Qhov no yog nyob rau hauv txoj kab nrog rau lwm cov kev tshawb fawb uas paub meej tias muaj hnub nyoog cuam tshuam txog kev poob siab ntawm kev vibration, nrog yuav luag ib feem peb ntawm cov laus dua 65 xyoo thiab ib feem peb ntawm cov laus dua 75 xyoo muaj qhov tsis hnov tsw vibration ntawm kev kuaj mob. [31]. Cov neeg laus muaj qhov tsis tshua muaj lub cev ua haujlwm lossis ua raws li txoj haujlwm ntev lub neej uas koom nrog kev tswj ntshav qab zib. Cov kev tshawb fawb tau pom tias muaj kev cuam tshuam ntawm lub hnub nyoog uas tseem muaj ntxiv txawm tias tom qab hloov kho rau lwm yam, tseem ceeb heev, xws li kev tswj glycemic lossis ntshav qab zib ntev [32]. Los ntawm txoj kev tshawb no tam sim no, nws tau pom tias cov neeg laus muaj qhov loj tshaj ntawm ib qho ntawm cov tsos mob ntawm peripheral neuropathy uas yog mob neuropathic. Ntawm cov neeg mob ntshav qab zib neuropathy, 11 feem pua rau 26 feem pua tau mob neuropathic. Tsis tas li ntawd, txoj kev tshawb fawb pom tau tias muaj kev nce siab hauv cov mem tes tsis tuaj yeem vim muaj hnub nyoog nce siab ntawm cov neeg kawm. Cov kev tshawb fawb tau pom pom tias qhov no muaj kev sib koom ua ke ntawm kev muaj hnub nyoog nce thiab qhov muaj feem ntau ntawm PAD[33].
Mob ntshav qab zib ntev ntev yog qhov tseem ceeb thiab tsim muaj txiaj ntsig zoo ntawm Distal Symmetrical Peripheral Neuropathy (DSPN). tsis hais tus neeg mob lub hnub nyoog li cas. Ib lub koom haum muaj zog tau tshaj tawm ntawm PDN thiab lub sijhawm muaj ntshav qab zib, tshwj xeeb tshaj yog tom qab 10 xyoo ntawm kev hloov pauv [34,35]. Txoj kev tshawb no ua raws li qhov kawg uas qhia tau hais tias cov neeg laus kuaj mob tom qab 10 xyoo muaj cov tsos mob zoo tshaj plaws ntawm DN xws li tingling sensation, LOPS, thiab tsis muaj mem tes.
Cov pejxeem feem ntau ntawm qhov muag tsis pom kev hauv Sierra Leone yog kwv yees li ntawm 0.7 feem pua cuam tshuam rau 43,842 tus neeg, thaum qhov feem ntau ntawm qhov muag tsis pom ntawm cov neeg muaj hnub nyoog 50 xyoo yog kwv yees li ntawm 5.9 feem pua , raws li cov ntaub ntawv tam sim no muaj nyob hauv tebchaws [ 36] ib. Tsis muaj cov ntaub ntawv hais txog hom kab mob qhov muag cuam tshuam nrog ntshav qab zib hauv Sierra Leone. Ntawm cov neeg koom nrog cov teeb meem qhov muag, qhov tseeb ntawm qhov muag tsis yooj yim tsis tau ntes hauv txoj kev tshawb fawb tam sim no. Mob ntshav qab zib ua rau glaucoma, cataract, thiab ntshav qab zib retinopathy (DR). DR yog qhov teeb meem microvascular feem ntau ntawm cov ntshav qab zib mellitus nrog nws qhov muaj feem cuam tshuam nrog lub sijhawm ntawm ntshav qab zib thiab kev tswj tsis zoo glycemic [37]. DR muaj feem cuam tshuam rau, nephropathy [38], kub siab [39], thiab dyslipidemia[40]. Cov kws tshawb fawb ntawm Johns Hopkins University hauv Baltimore qhia tias kev hloov pauv ntawm lub qhov muag tuaj yeem pab txheeb xyuas cov tib neeg uas muaj kev pheej hmoo rau kab mob peripheral artery (PAD ). Cov kev tshawb fawb tom qab tau tshawb pom ntxiv tias cov tib neeg uas muaj qhov txawv txav ntawm cov hlab ntsha me ntawm lub retina muaj ob npaug ntawm qhov sib txawv ntawm kev tsim PAD thiab yuav luag 3.5 npaug ntawm qhov tsis sib xws ntawm kev txhim kho limb ischemia. Kev sib koom ua ke ntawm kev puas hlwb thiab PAD yog qhov muaj zog tshaj plaws ntawm cov neeg mob ntshav qab zib. Qhov no yog ua raws li txoj kev tshawb fawb tam sim no uas qhia tau hais tias cov tib neeg uas muaj teeb meem ntawm qhov muag muaj lub plawv tsis tuaj ntau dua.
Feem ntau ua rau mob raum mob (CKD) yog ntshav qab zib. Cov neeg mob uas muaj CKD thiab ntshav qab zib mellitus tshwm sim ntev-nyob ntawm cov neuropathy ntawm qhov hnyav dua li cov neeg mob uas tsis muaj ntshav qab zib-CKD. Qhov no yog ua raws li txoj kev tshawb fawb tam sim no uas qhia tias cov neeg mob ntshav qab zib mellitus muaj cov kab mob hauv lub raum muaj qhov ntev-dependent neuropathy piv txwv li cov tsos mob zoo xws li tingling hnov lus pov thawj los ntawm kev poob ntawm kev tiv thaiv hauv ntau dua 2 qhov chaw. Hauv Sierra Leone, tsis muaj cov ntaub ntawv tam sim no ntawm lub nra ntawm tus kab mob raum. Txawm li cas los xij, raws li WHO cov ntaub ntawv tshiab tshaj tawm xyoo 2017 Cov Kab Mob Raum Tuag Hauv Sierra Leone tau mus txog 1,067 lossis 1.31 feem pua ntawm tag nrho cov neeg tuag. Lub hnub nyoog-hloov tus nqi tuag yog 30.74 rau 100,{13}} cov pej xeem uas nyob rau Sierra Leone 26" nyob rau hauv lub ntiaj teb no. Los ntawm kev soj ntsuam, feem ntau cov kab mob raum yog tshwm sim los ntawm kub siab thiab ntshav qab zib ntawm cov laus Sierra Leoneans. Nws tau hais tias tsuas yog ob Tam sim no cov chaw lim ntshav muaj nyob hauv lub tebchaws uas yog ib lub tsev kho mob ntiag tug hauv Freetown thiab lwm qhov nyob hauv Tsev Kho Mob Connaught uas cov tshuab ua haujlwm qee zaum muaj teeb meem. $100. Nws pom tseeb tias cov kab mob plawv (CVD) ntsig txog ischemic cov xwm txheej muaj ntau dua rau cov tib neeg uas muaj kab mob raum ntev (CKD)[41,42]. Kev muaj PAD hauv cov neeg mob CKD ua rau muaj kev pheej hmoo ntawm lub plawv nres, mob hlab ntsha tawg, thiab ua haujlwm tseem ceeb ua rau lub cev tsis muaj zog thiab kev tuag, nrog rau cov nqi no ntau dua li cov pej xeem sawv daws[43]. Yog li, txoj kev tshawb fawb tam sim no qhia pom tias tsis muaj cov mem tes ntawm cov neeg mob raum.
V. TSO CAI
Txoj kev tshawb no qhia meej meej pom tias muaj ntau tus neeg koom nrog kev pheej hmoo ntawm kev tsim kab mob ko taw. Hnub nyoog, kev ua haujlwm, lub sijhawm muaj ntshav qab zib, thiab hom ntshav qab zib tau cuam tshuam nrog kev pheej hmoo ntawm kev tsim DFU. Tsis tas li ntawd, cov neeg koom nrog lub cev tsis muaj zog muaj keeb kwm ntawm lub raum thiab qhov muag kab mob ua ke nrog kev pheej hmoo ntawm kev txiav tawm muaj qhov tseem ceeb LOPS, lub plawv tsis tuaj yeem nyob ntawm qhov kawg, thiab cov tsos mob ntsig txog DN, tshwj xeeb tshaj yog tingling.
Cov neeg mob ntshav qab zib mellitus yog qhov nyuaj heev los kho thaum lawv txhim kho neuropathy. Kev txheeb xyuas cov kev pheej hmoo hloov pauv tau rau kev txhim kho ntawm neuropathy thiab tswj tau zoo nyob rau theem pib yog qhov tseem ceeb rau kev tswj hwm ntshav qab zib kom zoo thiab tiv thaiv qhov tshwm sim loj ntawm DPN cuam tshuam thiab lub nra ntawm kev sib raug zoo. Yog li nws yog qhov tseem ceeb rau cov kws kho mob hauv Sierra Leone kom siv cov txheej txheem hauv lub cev, suav nrog kev txheeb xyuas thiab txo cov kev pheej hmoo, kev ua kom zoo ntawm kev tswj cov metabolism (piv txwv li, ntshav qabzib, ntshav siab, thiab cov roj cholesterol), cov neeg mob podiatric kev kawm, thiab lwm yam, kom zam dhau. qhov pib ntawm ko taw ulcerations, thiab txo cov limb amputation tus nqi thiab lwm yam kev tuag. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Kev Nyab Xeeb yuav tsum txhim kho nws cov kev pabcuam los ntawm kev muab cov ntawv pov thawj rau cov neeg ua haujlwm saib xyuas kev noj qab haus huv los ua cov kws qhia ntshav qab zib. Qhov no yuav mus ntev rau kev txo qis ntawm cov ntshav qab zib ntau ntau thiab nws cov teeb meem loj heev.
