摘要
下肢動脈血管阻塞之嚴重合併症是肢端壞死，過去文獻顯示以上情況係造成下肢截肢之首要原因。烏脚病亦是一種下肢動脈血管阻塞疾病，以乾性肢端壞死及自然脫落為主要表現，這些現象是因微視及巨視血管病變造成血管阻塞、神經病變、甚至感染。嚴重的下肢動脈血管阻塞患者組織的氧含量低，組織氧欠缺致使傷口無法癒合，必須行斷肢保命處置。高壓氧治療能增加組織氧濃度，學理上應可進而促進傷口癒合，以提高缺血性病足之傷口癒合率。本研究的目的是探討高壓氧是否能促進下肢動脈血管阻塞之傷口癒合以減少截肢比率，並評估腳趾温度指標作為保留肢體之預測指標是否優於足踝對手臂血壓比例。本研究在2003年至2006年期間，共收集154位有足部傷口潰瘍之糖尿病或烏腳病患者(Wagner分級 II至V)，接受高壓氧治療。他們的潰瘍在0.25至25.0公分大，且持續至少四周。其中有75位病患接受外科方式介入處理，並且定時量測腳趾温度指標值及足踝對手臂血壓比例之指標值。本研究發現下肢動脈血管阻塞之患者，於外科方式介入處理後，合併執行高壓氧治療無法促進傷口癒合而減少截肢比率。本研究也發現介入處理後脚趾温度有明顯改善，由27.8±3.97℃ (95% 信賴區間23.95至 31.69)升至34.4±2.74℃ (95%信賴區間26.4至37.3) (P<0.001)；而足踝對手臂血壓比例對傷口癒合能力的預測並不具有統計學上意義(P=0.2)，因此腳趾温度指標值之改善確實比足踝對手臂血壓比例更有助於預測肢體能否成功地保留。

關鍵字：缺血性病足、外科介入療法、高壓氧

Abstract
Gangrene is a serious complication of lower limb peripheral vascular disease (PVD) and the leading cause of lower limb amputations in the literature. Blackfoot disease (BFD) is a PVD characterized by dry gangrene and spontaneous amputations of affected extremities. This is due to micro and macroangiopathy that leads to occlusion of blood vessels, neuropathy, and finally infections. In patients of serious PVD, the tissue concentration of oxygen is low, which makes the healing of the wound difficult, and therefore amputation becomes a necessary measure of life saving. Hyperbaric oxygen (HBO) increases tissue oxygen tension, which has been shown to be predictive of healing success. This study sought to determine whether post-intervention adjunct HBO for limb salvage in PVD patients could prevent leg amputation and facilitate wound healing and whether toe temperature was superior to ankle brachial pressure index (ABI) in predicting clinical success. Between 2003 and 2006, we recruited 154 patients with diabetes mellitus (DM) or BFD and with foot ulcers (Wagner grade II-V) to receive HBO treatment. The ulcers sizes were between 0.25 and 25.0 cm2, they were present for at least 4 weeks. Seventy-five patients received vascular exploration or intervention surgery, and received noninvasive measurements of toe temperature and ABI periodically. The results showed that post-intervention adjunct HBO for limb salvage in PVD patients could not prevent leg amputation and facilitate wound healing. The temperature improved from 27.8±3.97℃ (95% confidence interval [CI] 23.95 to 31.69) to 34.4±2.74℃ (95% CI 26.4 to 37.3, p＜0.001). The differences in ABI before and after the intervention were not significant for clinically success (p＝0.2). Toe temperature was superior to ABI measurement in predicting clinical success.

Keyword: peripheral vascular disease, surgical intervention procedure, hyperbaric oxygen

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