糖尿病足部潰瘍，是一種糖尿病併發症，多與周邊神經病變和周邊血管病 變相關。若不及時診斷與治療，可能會導致組織壞死，引發壞死性筋膜炎，需 住院照護或有截肢的風險。 本篇病例報告為一位63歲男性，過去有糖尿病、高血壓、心律不整、痛風 、類天疱瘡、慢性阻塞性肺病之病史，半個月前因左下肢傷口腫痛至急診就醫 ，左足背呈現開放性傷口與壞死組織，第四腳趾嚴重壞疽，左足踝多處膿疱滲 液，腳趾至小腿附近的感覺喪失。西醫診斷為糖尿病足合併壞死性筋膜炎，於 整形外科住院，使用抗生素治療，並緊急進行筋膜切除術手術。 後續患者欲搭配中醫治療，故會診中醫合併中藥治療。會診訪視患者，其 左下肢傷口腫痛，傷口處無熱感，左足第四腳趾壞疽，左足踝紅與膿疱滲液， 下肢水腫。身體軀幹多處紅癢水疱與滲液。綜合診斷患者之中醫證型為脾虛濕 盛、濕熱瘀阻，給予陽和湯加減清熱解毒、健脾祛濕之中藥治療。配合西醫感 染控制與清創等手術，逐漸改善患者的傷口腫痛症狀，皮膚水疱也漸結痂，期 望共同幫助患者改善症狀以利出院。 【關鍵詞】糖尿病足、壞死性筋膜炎、中西醫結合、中藥、陽和湯 |
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中西醫治療糖尿病足合併壞死性筋膜炎之病例報告
