Lebedev, S.A.

Lyashchenko, O.V.

Muntyan, S.A.

Nosenko, I.V.

Repository for DZ &quot;DMA&quot;

Im eniational research  and p ractice  confercncelH(})opMaTHBHicTb MCTÔ iy BH3HaHeHHH PEOK y noc;iHaHHi 3 Horo CKOHOMiqHi-C TK ), U lB H i lK iC T K )  i I ip O C TO TO K ) B H K O H a H H H , H 3  HaUJ n o f j l j j ; ! ,  AO3B 0 J1M TB B n p O B a H H TH  i io ro  B 3a K Jia /iax  c;iy>K5n K p o B i a j i j i  c K p H H iH ro B H x  jo c j iw jk c h h h x  i B U K o p H C To a y -  B a T H  B K O M n jie K c i 3 iH iu H M H  n o K a 3H M Ka M n xma o u iH K H  C Ty n c H H  n o p y iu e H b  b c hc -  TC M i e p u x p o H y  y  o p r a H i3M i a K T H B H H x  x io H o p iB  K p o B i.BM CHOBKM .1. 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M e ro a  BH3HaqeHH>i noKa3HHKa PEO K  e iH(j)opMaTHBHHM, CKOHOMiHHHM, npocTHM  y  BHKOHaHHi, m o, Ha Ham no rjia/ i, ii03B0;THTb, lUHpoKo R o ro  B n p o B a w T H  B sa K J ia a a x  cjiy>K5n K p o B i h k  C K p H n iH ro B H H  K O M n jie K c n o V  o u ih K H  c r a n y  3ao-  p o B ’ fl npH a o n y c K y  a o  y n a c T i y  f lO H a u ii aici h b h m x  iio H o p iB  KpoBi.JlirepaTvpa:1. / l e p n a K  K). K). M o p 4 ) O M e T p H M H H H  a n a j i i s  e p M T p o u H r i B  y  pei^jiapHMx i i o H O -  p i e  K p o B i .  A K T y a j T b H i  n H T a n n a  M e ; i H M H o i '  n a y K H  r a  i i p a K X H K H ;  3 6 i p H H K  H a y K .  npaub . 3 a n o p i > K ) K j j ,  2 0 0 9 . B nn . 76. T. 1 .  K h. 2 .  C. 1 0 8 - 1 1 3 .2. /^epnaK lO. K)., BHiiHoopeub C. B /JocjiU^KeHHa peojioriMHHx BjiacxHBOC- T C H  n e p n c j ] e p H H H O i  B e H 0 3 H 0 i  K p o s i  y  j i o H o p i B  K p o B i .  Y K p a V H C b K H H  > K y p H a j i  r e M a -  xojioriY x a  x p a H C ( j ) y 3 i o j i o r i i ' .  2010. >T2 4 (10). C. 26-30.104I iibliii. Republic o f  Poland M arch 9, 2017EXPERIENCE IN USING THE COMBINED METHOD OF TREATMENT OF DIABETIC FOOT SYNDROMEMuntyan S. A.Doctor o f Medical Sciences. Professor,Acting Chief Doctor Dnepropetrovsk Clinical Hospital on the Railway Transport o f the Branch «PIC» PAT «UkrzaHznytsia»Nosenko I. V,Surgeon o f the Highest Category Purulent-Septic Department Dnepropetrovsk Clinical Hospital on Railway Transport o f the Branch «PIC» PAT «L!krzaiiznytsia»Lebedev S. A.an Anesthesiologist o f the Highest Category Anesthesiology Department with Intensive Care Beds Dnepropetrovsk Clinical Hospital on Railway Transport o f the Branch «C()C» PA T « Ukrzaliznytsia»Lyashchenko O. V.PhD, Assistant o f the Department o f Anesthesiology’,Intensive ('are and Medicine o f Emergency Conditions Dnipropetrovsk Medical Academy o f Health Ministry o f Ukraine Dnipro, UkraineD iabetic  foot sy n d ro m e is one o f  the co m p lica tio n s o f  d iab e tes  m ellitu s, a long  w ith  d iabe tic  oph th a lm o p ath y , nep h ro p ath y , e tc ., w hich  is a  patho log ica l con d itio n  that has a risen  as a  resu lt o f  d am ag e  to  th e  p e ripheral n ervous system , arte ria l and m icrocircu la to ry  bed, m an ifested  by p u ru len t-n ec ro tic , u lce ra tiv e  p ro cesses and dam age to  the bones and jo in ts  o f  th e  foot. It a rises as a re su h  o f  the  v io la tion  o f  carb o h y d ra te  m etabo lism  in the  body  and th e  dev elo p m en t o f  d iabe tes m ellitu s, in the absence  o f  an ad eq u a te  co rrec tio n  o f  th is con d itio n  [4; 5; 6; 11; 12].A cute puru len t-in flam m ator> ' d iseases o f  the  sk in  and soft tissu es are frequen t com p an io n s o f  d iab e tes . E specia lly  d ifficu lt are pu ru len t n ecro tic  p rocesses on the low er lim bs, o ften  w ith  a  s ig n ifican t burden o f  the und erly in g  d isease  and the  th rea t o f  g en era lization  o f  in fec tion  [3]. It is in fection  that largely  de te rm in es th e  severity  o f  the course  o f  lesions o f  th e  low er lim bs o f  p a tien ts , and in co n d itio n s o f  d is­tu rbed  blood flow  it s ign ifican tly  w o rsen s the  p ro g n o sis o f  the  p robab ility  o f  su r­v ival o f  the lim b o r even  life  i ts e lf  [1; 2; 4; 9],T he  m icrob ial landscape  o f  p u ru len t n ecro tic  foci is p o ly v alen t in nature , and th ere  is a possib ility  o f  d iffe ren t s tra in s o f  m ic ro o rg an ism s on the su rface  and in the d ep th  o f  the u lcerative  defec t. A cco rd in g  to  b ac terio lo g ica l s tu d ies in pu ru len t foci,105rIn ten iational research  and practice  conl'erenccsuch patien ts have a m ixed  aero b ic-an ae ro b ic  in fection  in 9 0%  o f  cases, aerob ic  -  in 10%  [1,5,8J. In fec tious p rocess p ro m o tes th ro m b o sis  o f  a lready  changed  arteries due  to a the ro sc le ro sis , w h ich  leads to  the  p rogression  o f  ischem ia. C urren tly , p u ru*g  lent necro tic  lesions o f  the feet ag a in st the  b ack ground  o f  the SD S rem ain  the  m o s t i  com m o n  cause  o f  non trau m atic  am pu ta tion  o f  the  low er ex trem itie s  due to  the  de- - v e lo p m en t o f  gan g ren e  [2; 4; 6]. D u ring  the  first 5 y ears  a fte r am pu ta tion , up to 80%  o f  pa tien ts w ho  und erw en t high am puta tion  pe rish ed  [I IJ.T he risk  o f  d ev elop ing  V D S in p a tien ts w ith  d iabe tes m ellitu s w ith  m ore than 20  years  o f  ex p erience  increases to  7 5%  [3; 6; 7; 10]. G an g ren o u s lesion  o f  the foot in 3 0 -50%  o f  cases com p le tes  lim b am p u ta tio n s [1]. T o  save a lim b is 16 tim es m ore econom ica l than  to am pu ta te , to  reh ab ilita te  a  patien t, to  p ro v id e  social sup­port, and to  perfo rm  p rosth e tic s  [5; 6; 11].O b v iously , u nder such co nd itions, th e  m ost op tim al com plex  trea tm en t, w hich should  include both  su rg ical in te rven tions a im ed  at d ra in ag e  o f  puru len t foci and rem oval o f  necro tic  tis su es, and tim ely  ad eq u a te  an tibacteria l and h ypog lycem ic  therapy .In light o f  th e  ab ove, w e  w o u ld  like to  share th e  ex p erience  o f  trea tm en t u sing  a c o m b in ed  m ethodo logy :A patient o f  50 years turned to  the clinic w ith com plain ts o f  edem a, redness, the presence o f  a w ound w ith a  purulent discharge on the left foot, the sm ell o f  acetone from  the m outh. From  the  anam nesis it is know n that since 2014 he has diabetes m elli­tus type 2, takes hypoglycem ic preparations. For 1 m onth before hospitalization, being on rest injured left foot. A fter 3 w eeks 1 turned for help to one o f  the clinics w here af­te r exam ination  and consultation  the  patient w as offered a high am putation o f  the left low er lim b. T he patient refused to  perform  surgical treatm ent, and then turned to the purulent-septic  surgical departm ent o f  the DK B on the railw ay transport o f  the PA T «U krzaliznytsia»  o f  the «Z O Z » branch for m edical assistance.Local s ta tus du ring  h o sp ita liza tion : Both legs and feet are m odera te ly  ed em a­tous, hyp erp ig m en ta tio n  and  induration  o f  the low er th ird  and m iddle  th ird  o f  both sh ins. T h ere  is no V fin g er on the right foot. O n  the left foot in the  p ro jection  o f  I m eta tarsa l bone, pu ru len t-n ec ro tic  w ound  3.5 x 3.0 cm ; in the first in terd ig ital space  w ound  w ith  a tu rb id  d ischarge . T he low er ex trem itie s  are w arm  to the touch , the  pu lsation  on all segm en ts is p reserved . On the  R -gram  o f  the  bones o f  the  left foot -  the  osteo m y elitis  o f  the  bases o f  the m ain pha lan g es o f  the first and  second  fingers. In the  analyzes, the  p ic tu re  is as fo llow s:• T o ta l b lood  count: er> 'throcytes-3 .9  x 1012 / I, leukocy tes -5,5 x 109 / I, eo- sinoph ils-3% , s tab -2% , seg m en ted -5 5 % , ly m phocy tes-31% % , m o n o cy te s-7% , Hb- 124 g / 1 ,  C O E -45  m m / h .• G eneral urine analysis: prozor.-pr., PH -alkaline, w eight-1023, pro tein-0 .033g /1 , su g a r-1.5%, acetone-position  ( f  f+ ), e r -  0 -  1 in n / z, leu-3-4 in n /  s, epit.perihodnoy- neb.kol-in  n / s.• B lood g lucose  -  12,5 m m ol / 1;• C oagufogram : PT I-87% . A V R -57  p., F ibr.A -3 ,33  g /1 , M N O -1 ,2 .• B iochem ical A nalysis: B lood B ilirub in  Society . -  11.0 pm ol / I, A L T -0 .6  m m ol / l.h., thym ol tes t-3 .0  un its , urea  o f  blood -4 .6  m m ol /  I, u rea  n itrogen-2 .2  m m ol / 1, c rea tin in e  -9 3 .7  |.imol / 1.106L.iiblin. R epublic o f  Poland M arch 9 ,2 0 1 7• U SA S N / A II .04 .18: M ixed  ang iopathy  o f  the  M A / lim bs. T he w alls o f  the arteries are fib rously  com pacted , sm all a th e ro m ato u s p laq u es a long  the  cou rse  o f  llie O B A , PB A ; the m ain  blood flow  o f  the  feet is p reserved .T he com bined  p rocedure  included  a  necrace tex trec to m y  w ith  d ra in ag e  o f  the  first in terd ig ital space o f  the left foot, as w ell as the  use o f  d ru g  th erap y , w h ich  in­cluded: dex tran , sod ium  hydro g en carb o n ate , a -lipo ic  acid , cy tid ine5 -m onophosphate  d isod ium  salt, lincom ycin  hy d ro ch lo rid e , sod ium  cefo p e razo n e  + sulbactam  sodium , m etron idazo le , flu conazo le , a sco rb ic  acid , py rid o x in e  h y d ro ­ch loride, xy lito l + sod ium  ace ta te , su cc in ic  acid , w ater-sa lt so lu tio n s , levo floxac in  hem ihydrate , hum an b io sen te tic  insu lin  yi.T he  pa tien t w as d isch arg ed  w ith  im provem en t on the  14th day. T h e  w o u n d s o f  the left foot w ere  p ractica lly  healed  by secondar>' ten s io n , there  w as no sep ara tion . The pa tien t w as tran sferred  to tab le ted  h y p o g ly cem ic  d rugs (b lood  g lucose  -  8.2 m m ol /1).D iagnosis at d ischarge : o steo m y elitis  o f  1st and 2nd m eta tarsa l bones o f  the left foot against the  b ackground  o f  type  2 d iabe tes m ellitu s, severe  course, su b co m p en ­sation  stage (a t the tim e o f  deco m p en sa tio n , k e to acidosis).A fo llow -up  ex am in atio n  15 days a fte r the  p a tie n t’s d isch arg e  show ed  co m ple te  healing  o f  the  w ound  and co m ple te  recovery  o f  the  foot su p p o rt function .C onclusion : T he com bined  m ethod o f  trea tin g  th e  d iabe tic  foot sy ndrom e used by us m ade it possib le  to  avo id  radical surg ical trea tm en t in the form  o f  lim b am p u ­tation  and d isab ility  o f  th e  patient, w hich  saved  the  p a tie n t’s qua lity  o f  life.References:1. Sh lyapn ikov  S.A . « A n tib ac teria l therapy  o f  sepsis» . M ., 2002.2. S vetukhin  M .A ., Z em lyanoy  A .B . «T he  ro le  o f  antibacteria l therapy  in the com plex  trea tm en t o f  p a tien ts w ith  d iab e tic  fo o t sy n d ro m e .» M ., 1999.3. A m iraslanov  Y u.A ., I 'u rova T G , B orisov  l.V . A cu te  su rg ical in fec tion  in p a ­tien ts w ith d iabe tes m ellitus. /  / M aterials o f  the  In tern a tio n a l S c ien tific  and  P ra c ti­cal C ongress, ded icated  to  th e  40 th  ann iversary  o f  th e  d ep artm en t o f  w o u n d s and w ound in fections o f  the  Institu te  o f  Surgery . A .V . V ish n ev sk y  «D iab etes m ellitus and surg ical in fec tions» . M ., 2013.4. D edov 11, A n tsife rov  M B , G a lstyan  G R , T o k m ak o v a  A .Y u. «D iab etic  Foot Syndrom e)). M ., Federal D iabetes C en te r o f  th e  M in istry  o f  H ealth  o f  the R ussian  Federation , 1998.5. G rig o ry ev a  Y u.F ., B a ltrushev ich  O .A . «A ctual q u estio n s o f  co n tinu ity  o f  d i­agnostics and com plex  trea tm en t o f  patien ts w ith  d iab e tic  foot syndrom e)). M., 2000.6. G uriev a  l.V . ((Prevention, trea tm en t, m edical and social reh ab ilita tio n  and organ ization  o f  in te rd isc ip linary  care  for p a tien ts w ith  d iabe tic  foot syndrom e.)) D iss... d o c .m ed .n au k , M ., 2001 .7. G ladun  N .V ., K iriyak  S.E ., V askan A .T ., C u tch in iik  S .V ., B ernaz I.L., B ernaz  E.L . «S urg ical trea tm en t o f  troph ic  u lcers and gan g ren e  in p a tien ts w ith d i­abetes m ellitus.)) M ., 2000.107In lcm ational research  and p racticc  conference8. P anko  S .V ., O k u lich  V .K ., B ulavkin  V .P ., O ladko  A .A ., K arp itsky  A .S. «The na tu re  o f  m ic ro flo ra  and featu res o f  an tibacteria l therapy  in patien ts w ith  puru len t- necro tic  lesions o f  so ft tissu es w ith  d iabe tic  fo o t sy n d ro m e .» M ,  2000.9. T o k m ak o v a  A. Yu. «P rin c ip les  o f  local trea tm en t o f  tro p h ic  foo t u lcers in pa ­tien ts  w ith  d iab e tes  m ellitu s .»  M ,  2001.10. B latun  LA -  p e rsp ec tiv es o f  use in the  co m plex  trea tm en t o f  puru len t- necro tic  lesions o f  the  low er ex trem itie s  in patien ts w ith  d iab e tic  foot sy n d ro m e // W ounds and w ound  in fections. 2015.11. In ternational C o n sen su s on the D iabetic  F oo t (by  the In ternational W ork ing  G ro u p  on the D iabetic  Foot). 1999.12. B oulton  A., C o n n o r H ., C avanagh  P. «T he  fo o t in d iab e tes» . U K . W iley, 1994.OCOBJIMBOCTI XAPqOBOi AJIEPIH HACEJIEHHflyK P A IH H  (HA n P H K JlA ^ I X EPC OHC bKO I OB.1ACTI)HaxaiuoBa B. C.KaHdudam .\ieduHHHX hoyk, aciicm eH/n Ka4>edpn ciMeimoiM eduiinm t ma 3a^a!ibno i npoKmuKu OdechKuu HaifioHaibHuii MeduHHUu yHiaepcumem^a iiiL ib H y K  r .  O .KOHdudam MeduHnux itavK. acucmenm KO(j)e()pu ciAteunoiMeduiiUHU ma saPcvihHoi npuKmuKU (MechKuii naifiouaibHuu MeduHnuu yniaepcumem\1iipropoj A. B.ociicmeiim Ka(f)edpu ci.xteunoi Meduifunu ma 3aca.^hHoi npaKmimt OdechKuu Haifiona'ihHUU MeduHHuU yHieepcumemBa>Kopa f{. I.acnipaum Ka(f)edpu ciMeiiHoi MeduifUHu ma ja<^anhnoi npoKmuKU OdecbKuii HaijioHaibHuii AteduHHUu VHieepcumem M. 0()eca, VKpaiHaXapMOBa aneprifl xapaKTepinyexbCH niABHiuenoio MyxjinBicTK) oprauisMy zio xapM O BHX rip o /^ y K T iB  xa  p o 3b h x k o m  K J iiu iM H H x  c H M n x o M is  H e tie p e H O C H M O c xi i>K i, noB’flianHX 3 peaKu,icK) iMynHOi CHCxewH. 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Experience in using the combined method of treatment of diabetic foot syndrome

http://repo.dma.dp.ua/6045/1/Experience%20in%20using%20the%20combined%20method%20of%20treatment%20of%20diabetic%20foot%20syndrome..pdf

Experience in using the combined method of treatment of diabetic foot syndrome

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Experience in using the combined method of treatment of diabetic foot syndrome

Abstract

Similar works

Full text

Available Versions

Repository for DZ &quot;DMA&quot;

Repository for DZ "DMA"