Serkan Akçay, İsmail Safa Satoğlu, Ece H, Serkan AKÇAY, Ece HARMAN, Ahmet KURTULMUŞ, Cemal KAZIMOĞLU

Diyabetik Ayak Ülserli Hastalarda Amputasyon Oranı ve Eşlik Eden Komorbiditelerin Retrospektif Analizi

Diyabetik ayak ülseri morbidite artışına, yaşam kalitesinde azalmaya, uzun hastane kalış sürelerine, yüksek tedavi maliyetlerine ve yüksek oranda alt ekstremite amputasyonuna yol açmaktadır. Bu çalışmanın amacı, diyabetik ayak tanısı ile hastaneye başvuran hastalarda uygulanan amputasyon oranını ve amputasyon uygulanan hastalarda en sık görülen risk faktörlerini belirlemektir. Ocak-Aralık 2011 tarihleri arasında İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi polikliniklerine diyabetik ayak ülseri tanısıyla başvuran ve kayıtlarına ulaşılabilen 131 hasta; (96 erkek, 35 kız) çalışmaya dâhil edildi. Hastaların yaş ortalaması 61.1(26-90) idi. Hastalar yaş, cinsiyet, sigara kullanımı, diyabetik komorbiditeleri, alkol kullanımı, enfeksiyon varlığı, yara kültüründe üreme olması, lökositoz varlığı, hipertansiyon, uygulanan tedavi metodu ve kullanılan antibiyoterapi parametreleri kaydedildi. Hastalar tedavi açısından debridman+medikal tedavi ve amputasyon tedavisi açısından iki gruba ayrıldı. Komorbid faktörlerin dağılımı istatistiksel olarak χ2 testi ile değerlendirildi. Diyabetik ayak konseyinden 66’sına ampütasyon ve 65’ine debridman –pansuman ve antibiyoterapi tedavisi verilmişti. Ampütasyon oranı %50 olup; 37’sine majör ampütasyon ve 29’una minor amputasyon uygulandı. Diyabete bağlı komorbiditeleri incelendiğinde en sık periferik arter hastalığı (102/131) %77, Diyabetes Mellitustan bağımsız komorbiditeler incelendiğinde; en sık %38 (50/131) oranı ile hipertansiyon görüldü. Ampütasyon grubunda Wagner-Meggit sınıflamasına göre en sık evre 4 yara varken debridman uygulanan grupta en sık evre 2 diyabetik yara görüldü. Patofizyolojik sınıflamaya göre ise hem ampütasyon grubunda hem de debridman uygulanan grupta en sık iskemik yara görüldü. Komorbid faktörlerin dağılımında istatistiksel anlamlı bir fark (p>0.05) bulunmadı. Literatürle karşılaştırıldığında amputasyon oranımız yüksek bulundu. Nedenleri incelendiğinde ampütasyon grubunda diyabetik ayak ülserlerinin ileri evrede olması, ortalama yaşın yüksek olması ve çoğu olgunun başka merkezlerde görülüp düzenli takiplerinin olmaması, bunun başlıca nedenleridir.

Anahtar Kelimeler:

diyabetik ayak, ampütasyon, eşzamanlı hastalık

A Retrospective Analysis of Amputation Rates and Comorbidity in Patients with Diabetic Foot Ulcer

Abstract Diabetic foot ulcers cause elongated hospitalisations with high treatment costs and high rates of lower extremity amputations resulting with increased morbidity and decreased quality of life. The aim of this study was to determine amputation rate in patients admitted to our hospital with the diagnosis of diabetic foot and the most common risk factors in patients with diabetic foot ulcers. 131 patients admitted to outpatient clinics of Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2011 and December 2011 with the diagnosis of diabetic foot ulcer were retrospectively analyzed. Of these 96 were males and 35 were females. Age, gender, smoking and alcohol habits, comorbid diseases, presence of infection, growth of microorganism in medium, presence of leukocytes, hypertension, method of treatment and regimes of antibiotics are recorded. Mean age was 61,1 ( 26-90). Patients are divided into two groups according to treatment protocols, first group was consist of debriated and medicaly treated patients, while the second group covered amputated patients. 66 were amputated and the rest 65 had debridement-wound care and antibiotherapy after they were evaluated in the diabetic foot council of our hospital. Rate of amputation was 50 %. 36 of the amputated patients had major and the others had minor amputations. Most common comorbidities that related and nonrelated to diabetes were peripheral arterial disease ( 102 out of 131; 77% ) and hypertension ( 50 out of 131; 38% ); respectively. Grading of diabetic ulcers according to Wagner-Meggit classification yielded that most commonly seen wounds were grade 4 in the amputation group and grade 2 in the debridement group. According to pathophysiological classification most common cause were ischemic wounds in both groups. Compared to the literature, our amputation rates are higher. This issue can be attributed to high rates of comorbid factors, higher age and irregular follow-up. diabetic foot, amputation, comorbidity

Keywords:

Diyabetik Ayak Ülserli Hastalarda Amputasyon Oranı ve Eşlik Eden Komorbiditelerin Retrospektif Analizi,

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