[fusion_builder_container admin_label=”Article Intro” hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” background_color=”#ffffff” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” border_style=”solid” margin_top=”-90px” padding_right=”0px” padding_bottom=”0px” padding_left=”0px” admin_toggled=”yes” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” type=”flex”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”yes” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_image_id=”” background_color=”rgba(255,255,255,0)” background_image=”” background_position=”left top” undefined=”” background_repeat=”no-repeat” hover_type=”none” border_color=”#3bc863″ border_style=”solid” border_position=”top” border_radius_top_left=”” border_radius_top_right=”” border_radius_bottom_left=”” border_radius_bottom_right=”” box_shadow=”yes” box_shadow_vertical=”-5″ box_shadow_horizontal=”0″ box_shadow_blur=”15″ box_shadow_spread=”0″ box_shadow_color=”rgba(0,0,0,0.03)” box_shadow_style=”” padding_top=”40px” padding_right=”4%” padding_bottom=”20px” padding_left=”4%” margin_top=”0px” margin_bottom=”0px” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”true” first=”true” border_sizes_top=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””] 張阿姨被診斷出糖尿病，她聽從醫師的建議開始積極運動，因此每天早晨都到公園散步，原本一天都能走上四圈，約莫2000公尺的距離。但最近張阿姨只走一小段路，就會開始腳痛，必須停下來休息。張阿姨發現自己走的距離越來越短，有次竟然走不到50公尺，就開始感到痠痛，雖然坐下來休息一會兒又能繼續走，但走不到50公尺，那種難受的痠麻痛感又再度襲來。 [/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container][fusion_builder_container admin_label=”Featured Image” hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” background_color=”#ffffff” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” 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border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_imageframe image_id=”21230|full” max_width=”” sticky_max_width=”” skip_lazy_load=”” style_type=”” blur=”10″ stylecolor=”#fffcf9″ hover_type=”zoomin” bordersize=”0″ bordercolor=”#fffcf9″ borderradius=”” align_medium=”none” align_small=”none” align=”center” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”Morbi vitae purus dictum, ultrices tellus in, gravida lectus. ” link=”” linktarget=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ 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照護線上編輯部

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照護線上編輯部

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column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””] [fusion_dropcap boxed=”no” boxed_radius=”” class=”” id=”” color=””]張[/fusion_dropcap]

阿姨就診後得知來這是「下肢周邊動脈阻塞」，也就是俗稱的「腳中風」，屏東基督教醫院張雲德主任評估後認為要盡快處理。張阿姨接受微創手術，使用氣球導管擴張術將血管的管徑擴張開來，並使用塗藥球囊降低再次阻塞的可能。

術後張阿姨復原得很順利，很快又能回到公園運動，即使走4000公尺都沒有問題，相當開心！ .

過高的血糖會傷害血管，造成足部病變

過高的血糖對全身上下的器官都會造成損傷，其中一個糖尿病患者最容易遭遇的問題就是「糖尿病足」。當血糖過高，全身血管就像是泡在糖水裡，會使血管壁發炎、受損，並引發血小板聚集而導致「動脈粥狀硬化」，使血管的管徑越來越狹窄。由於腿部的血管負責肌肉的血液供應，當動脈狹窄血液循環不足時，便會出現各種問題。

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. 中國醫藥大學附設醫院內科部心臟血管系週邊血管科徐中和主任解釋，腿部的神經同樣需要血液才能獲取足夠的氧氣與養分，隨著血管窄化阻塞，神經會出現病變，使患者感覺變遲鈍，容易出現麻木或燒灼般的痛感。此外，由於腿部皮膚毛囊的功能也會變差，使患者的腳毛脫落。

下肢冰冷，當心動脈阻塞、腳中風

張雲德主任指出，患者高血糖的時間越久，腿部的血液循環越不好，容易出現下肢動脈阻塞的問題。血液循環差的部位皮膚顏色變得暗沉，摸起來也會發現腳比較冰冷。在冬天較寒冷時，如果發現兩隻腳的溫度差異很大，是下肢動脈阻塞的警訊。因為血流供應不足，患者只要走一段路，腳就會因為缺血而變得無力、痠痛，需要停下來休息，才有辦法繼續行走。

下肢動脈阻塞的另一個徵狀是傷口難以癒合。當我們受傷時，傷口需要有充足的血液循環，才有辦法修復組織。倘若下肢動脈狹窄、阻塞，血液循環太差，傷口便難以復原，甚至可能從一個小傷口，漸漸變成慢性潰瘍。

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. 新北市立土城醫院心臟內科李信賦主任表示，臨床上可以把下肢動脈疾病的嚴重度分成四期。

第一期，下肢動脈狹窄初期可能沒有明顯症狀。

第二期，患者出現「間歇性跛行」，也就是在走路或運動時，下肢肌肉會感到痠痛，需要稍加休息，症狀才會緩減。隨著動脈狹窄的程度惡化，患者能夠行走的距離會越來越短。

第三期，患者連在休息或夜間睡覺等非活動的時候，也會感到腿部疼痛。

第四期，腿部遠端組織開始出現難以癒合的潰瘍、甚至壞死，若沒有積極介入處理，患者可能因大範圍缺血，或因傷口引發次發性感染，導致截肢的命運。

李信賦醫師提醒，尤其像冬天氣溫降低，熱漲冷縮的原理讓血管收縮得更為嚴重，糖友更需要加強注意照護，原本已經狹窄的血管可能完全阻塞、症狀加劇，甚至造成腿部急性缺血、壞死，相當棘手。如果原本就有心血管病史，亦可能導致下肢動脈阻塞的病情急速惡化。此外，糖尿病、高血壓、高血脂、年紀大、抽菸等因素皆會影響血管健康，加重下肢周邊動脈疾病的進展，務必提高警覺。 .

及早打通血管，才能避免截肢

張雲德主任說明，當糖友發現有糖尿病足問題時，控制好血糖仍是當務之急，以及務必戒菸。若經過檢查之後，狹窄的狀況較嚴重，或出現難以癒合的傷口，就要考慮用介入性治療處理。

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. 徐中和主任說明，介入性治療其中一個較常聽到就是「氣球導管擴張術」，患者接受局部麻醉，醫師從鼠蹊部開一個小傷口放進導管，找到動脈血管阻塞的位置，再撐開氣球將鈣化的斑塊擠小壓扁，這樣就能擴張血管的管徑，必要時則會放入支架維持血管暢通。

介入性治療完成之後，患者的症狀大多可以改善，然而隨著時間經過，血管內皮細胞會繼續增生，術後可能會有再狹窄、再阻塞的可能。李信賦主任說，為了降低再次阻塞的機會，另一個選擇是塗有藥物的球囊。在撐開血管時，會釋放藥物進入血管壁，抑制細胞增生，有助於維持血管的暢通率。

由於部分患者的血管鈣化特別嚴重，僅僅使用氣球擴張術，無法將血管完全撐開，可以考慮使用斑塊旋切裝置執行斑塊清除術，先刮除血管內堅硬的斑塊，再用塗藥球囊或塗藥支架，以維持血管暢通。 .

做好血管保養，常保雙腳勇健

臨床上偶爾會遇到糖尿病友因為腳上出現小範圍的擦傷、燙傷，卻遲遲無法癒合，後續又遭到細菌感染，演變成蜂窩性組織炎、壞死性筋膜炎、敗血症，甚至需要截肢保命。因此，糖友一定要好好保養血管，並學習照顧自己的雙腳：養成每天檢查雙腳的習慣，以免因為神經麻木，而疏忽腿部傷口。平時盡量不要赤腳走路，穿襪子與包鞋可以多一層保護。如果想要泡腳、泡溫泉，記得先用手肘測試水溫，避免在不自覺中燙傷。

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. 萬一發現腳部出現傷口，請找醫師評估，不要覺得是小傷口，就疏於照顧，倘若拖到傷口惡化、感染，恐怕難以收拾。

如果發現自己或家人的雙腳溫度不同、腳毛脫落，或走路出現間歇性跛行的狀況，要小心下肢周邊動脈狹窄，務必及早就醫、即早治療！

【本文由「照護線上」授權轉載，原文出處：血糖超標，血管遭殃，預防肢體中風　醫師圖解。】

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