糖尿病足部溃疡，是一种糖尿病并发症，多与周边神经病变和周边血管病 变相关。若不及时诊断与治疗，可能会导致组织坏死，引发坏死性筋膜炎，需 住院照护或有截肢的风险。 本篇病例报告为一位63岁男性，过去有糖尿病、高血压、心律不整、痛风 、类天疱疮、慢性阻塞性肺病之病史，半个月前因左下肢伤口肿痛至急诊就医 ，左足背呈现开放性伤口与坏死组织，第四脚趾严重坏疽，左足踝多处脓疱渗 液，脚趾至小腿附近的感觉丧失。西医诊断为糖尿病足合并坏死性筋膜炎，於 整形外科住院，使用抗生素治疗，并紧急进行筋膜切除术手术。 後续患者欲搭配中医治疗，故会诊中医合并中药治疗。会诊访视患者，其 左下肢伤口肿痛，伤口处无热感，左足第四脚趾坏疽，左足踝红与脓疱渗液， 下肢水肿。身体躯干多处红痒水疱与渗液。综合诊断患者之中医证型为脾虚湿 盛、湿热瘀阻，给予阳和汤加减清热解毒、健脾祛湿之中药治疗。配合西医感 染控制与清创等手术，逐渐改善患者的伤口肿痛症状，皮肤水疱也渐结痂，期 望共同帮助患者改善症状以利出院。 【关键词】糖尿病足、坏死性筋膜炎、中西医结合、中药、阳和汤 |
Diabetic foot ulcers, a complication of diabetes mellitus (DM), are often associated with peripheral neuropathy and vascular disease. Without prompt diagnosis and treatment, these ulcers can lead to tissue necrosis and subsequent necrotizing fasciitis, necessitating hospitalization or posing a risk for amputation. The case report discusses a 63-year-old male patient with a medical history of DM, hypertension, arrhythmia, gout, bullous pemphigoid, and chronic obstructive pulmonary disease (COPD) who sought emergency care with lower left limb swelling and pain half a month ago. His left foot exhibited open wounds with necrotic tissue, severe gangrene of the fourth toe, oozing blisters around the left ankle, and sensory loss from the toes to the calf. The patient was diagnosed with diabetic foot complicated with necrotizing fasciitis and was treated with antibiotic treatment and emergency fasciotomy. Seeking an integrated treatment with Traditional Chinese Medicine (TCM), our patient received TCM consultation and herbal treatment. Follow-ups showed his lower limb wound swelling and pain, lack of heat sensation, gangrene of the fourth toe, oozing blisters, ankle redness, and lower limb edema. Further, his trunk areas displayed redness, itching, water blisters, and oozing. TCM diagnosed spleen vacuity with damp encumbrance and damp-heat stasis obstruction. The treatment involved modifying Yanghe Decoction, including a formula for clearing heat and resolving toxins, fortifying the spleen and transforming dampness. Integrated with Western Medicine for infection control and surgical debridement, the patient gradually improved wound swelling and pain symptoms. Concurrently, the scabbing of skin blisters was observed, stabilizing the patient’s condition for discharge. 【Keywords】Diabetic Foot； Necrotizing Fasciitis； Integrated Medicine； Traditional Chinese Medicine (TCM)； Yanghe Decoction |
282.5中西医治疗糖尿病足合并坏死性筋膜炎之病例报告
