| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 94 === Diabetes mellitus is a disease with high incidence, prevalence rate and multiple complications. Considerable variations are exist in medical service utilization and providing. Many patients missed the chance of saving their limbs when the diabetic foot happened. Major lower limb amputations may lead huge loss to the patients, their families and whole society. It needs further investigation to provide the patients and the physicians a clear guideline when facing the troublous disease.
The purpose of this research was to identify the major risk factors that lead the diabetes foot into major lower limb amputation. The final prognosis was divided into two parts as minor amputation and major amputation.
Research data were obtained from a medical center in Taipei, Taiwan, between Jan. 01, 1998 and Dec. 31, 2000. All of the inpatients with the diagnosis of diabetic foot (ICD-9-CM=250.7X) were all included. It was a retrospective research and accompany with telephone follow up. In this research, there were 165 patients and 272 times of inpatient courses included. The longest follow up was up to 100 months.
According to stepwise regression analysis, the results revealed that diabetic patients’ characteristic, clinical disease presentation, comorbidity, and medical service utilization would affect the prognosis.
The major risk factor in the aspect of diabetic patients’ characteristic was male gender. The odds ratio was 2.678.
In the aspect of clinical disease presentation were the WBC count and gangrene wound. When WBC count was between 10000 u/l and 20000 u/l, odds ratio was 4.517. When WBC count was over 20000 u/l, odds ratio was 18.638. When the gangrene wound presented, the odds ratio was 11.223.
In the aspect of comorbidity were past amputation history（odds ration=2.278）, hypertension（2.721）, chronic pulmonary disease（37.751）, ASA Class 4（7.418）and the Charlson comorbidity index over 9（3.323）.
The utilization of medical service could be divided into the patient’s aspect and the physician’s aspect. In the patient’s aspect was the time interval between symptom sign noted to asking for medical service. When the time period between one week and one month, the odds ratio was 3.555. When it was over one month, the odds ratio was16.914.
In the physician’s aspect was the time interval between patients arriving hospital to the very first surgical procedure. When it was between the 3rd to 7th days after admission, the odds ratio was 3.935. When it was over the 7th das, the odds ratio was 5.224. Otherwise, different surgical specialist wound also affect the prognosis（odds ratio=15.528）.
According to the research result, it described that the diabetes patients should control the disease carefully ordinarily to avoid any diabetic complications and comorbidities. When the complication of diabetic foot happened, prompt asking for medical service should not be forgot.
In another aspect, when the physician facing the disease, taking more aggressive, rapid and definite medical procedures may reduce the chance of major lower limb amputations.
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