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阅读经典病例，讨论临床见闻，欢迎在评论区发表对病例的看法！ 【译文】女性，80岁。有糖尿病和高血压病史，左足背部溃疡。使用50mg双氯芬酸钠和500mg对乙酰氨基酚疼痛可缓解。就诊当日足背皮肤溃烂区如图所示。请指出错误并向患者提供建议。 【原文】Female, 80 years old. She has diabetes and high blood pressure. She developed a ulcer on dorsal area of the left foot. On the day of the consultation the lesion was as shown in the image. She uses Diclofenac 50mg and Paracetamol 500mg to relieve pain. Point the error and say what advices you would give to that patient. 
[discussion]/【讨论】 1. Stop diclofenac sodium and take swab for culture after which specific antibiotic could be given with well control of diabetes and surgical care 停用双氯芬酸钠，取拭子进行培养，给予敏感抗生素治疗，做好糖尿病控制和外科处理。 2. Stop diclofenac. Monitor blood sugar and diet. Needs Abpi. Depending on outcome compression stocking stocking. Elevate leg when sitting . 停用双氯芬酸钠，控制血糖和饮食。需要Abpi（ABI?），根据结果选择是否使用弹力袜。坐位时抬高患肢。 3. Why stop diclofenac? 为什么停用双氯芬酸钠？ 4. Diabetics and hypertensive patients often have renal impairment, and diclofenac (NSAID) causes vasoconstriction of the afferent (entry) arterioles into the kidney glomeruli. This can seriously reduce perfusion of the kidney and damage the kidney/heart. 糖尿病和高血压患者常合并肾功能不全，而双氯芬酸钠（非甾体类抗炎药）可引起入球小动脉收缩，导致肾脏灌注量严重减少，损害心脏或肾脏。 5. In general, non-steroidal anti-inflammatory drugs (eg, Diclofenac) should be avoided by diabetic and hypertensive patients because they may increase the pressure and cause kidney problems, if there is an imperative need to use the medication, it should be used for the shortest possible time and In the lowest effective dose possible, always under medical supervision. 通常来说，非甾体类抗炎药（如双氯芬酸钠）因升高血压、导致肾功能障碍禁用于糖尿病和高血压患者，如果必须使用，应在医疗监测下尽可能短时程、低有效浓度应用。 6. Thickened toenails and a painful ulcer, diabetic and hypertensive. Probably has peripheral arterial disease. Would get ABI and arterial ultrasound done as well, probably a significant stenosis waiting to be found. 同时患有糖尿病和高血压，存在足背溃疡和增厚的趾甲，可能合并周围血管疾病，建议进行ABI和动脉超声，可存在血管狭窄。 7. In addition to: taking swab, starting antibiotics, stopping NSAIDs, good glycemic control, this patient needs U.S doppler of lower extremities to check for the flow. Furthermore, foot X-ray is important to rule out osteomyelitis. 除了取拭子进行培养、给予敏感抗生素治疗、停用非甾体抗炎药、控制血糖外，这个病人还需要进行下肢多普勒。此外，还有必要做足部X光检查排除骨髓炎。 8. Fast sugar and hbp control and close monitoring is needed to avoid amputation at early stage.... And avoid several drugs that may exarcabates hbp and high blood sugar and even damage other vital organs. Clindamycin and development if death tissues are found. 为避免早期截肢应快速控制血糖和高血压并密切监测，避免使用可导致高血糖高血压的药物，以免进一步损害其他重要脏器。若发现坏死组织，使用氯洁霉素。
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