I-Diabetesic foot syndrome (SDS) yisimo se-pathological sezinyawo, esenzeka ngokumelene nesizinda sezilonda zesifo sikashukela semikhumbi enobukhulu obuhlukahlukene, imicu yezinzwa, isikhumba kanye namathuluzi wethambo. Ukuxazulula kukhonjiswa ngokwakhiwa kwezinkinga ze-trophic kanye nezinqubo ze-purulent-necrotic.
Lesi sifo sithathwa ngokulandelayo:
- unyawo lwesifo sikashukela semvelo ye-ischemic;
- unyawo lwesifo sikashukela semvelo ye-neuropathic;
- ifomu elixubile lapho kuhlanganiswa khona i-vascular and neurological pathology.
Izimpawu nokwelashwa konyawo lwesifo sikashukela kuxoxwa ngazo esihlokweni.
Ukuxilongwa okuhlukile
Ukwelashwa konyawo lwesifo sikashukela kuya ngohlobo lwayo nendlela yokuthuthuka. Izici zefomu le-neuropathic zingokulandelayo:
- isikhumba semilenze sibomvu;
- Ukudalwa okuphambili kwezinyawo (iminwe ibe yisiyingi sesikhumba, amakhanda emathanjeni ayaphuma, kuvela "unyawo lukaCharcot);
- ukuvuvukala okubili kwenzeka, okungasebenza njengokubonakaliswa kokugula kwenhliziyo nezinso;
- ukwakheka nombala wepuleti lezipikili kuyashintsha, ikakhulukazi ukutheleleka ngefungal;
- ezindaweni zokucindezela okukhulu, ama-hyperkeratoses ashiwo (ukukhula kwesikhumba, okuvame ukuthamba);
- izilonda zenziwa endaweni ohlangothini lwesitshalo;
- ukuphefumula okwenziwe ngokungemthetho kugcinwe;
- isikhumba somile futhi somile.
I-Neuropathy ne-angiopathy yizinto ezimbili ezibalulekile ekwakhiweni kwesifo sikashukela sikashukela
Indlela ye-ischemic ye-pathology ibonakala ngokuboniswa okulandelayo:
- isikhumba sigqamile;
- akukho ukuguqulwa kwemilenze;
- i-puffness ingasho lutho, ibonakala uma kwenzeka ukutheleleka kwesibili;
- ukwakheka nombala wamapuleti ezipikili;
- ukukhula okukhulunyiwe okuzungeze ukushiyeka kwezilonda ezindaweni zokucindezela okukhulu;
- ukuba khona kwezindawo ze-necrosis;
- i-arterial pulsation incishiswa kakhulu, futhi esimweni esibucayi asikho ngokuphelele;
- izinyawo ziyabanda ngokuthinta.
Amasu wokuphatha isiguli
Ochwepheshe abaningana bayabandakanyeka ekwelashweni konyawo lwesifo sikashukela: udokotela wobudokotela, i-endocrinologist, i-angiosurgeon, i-podologist. Udokotela (noma udokotela womndeni) ubandakanyeka ekuxilongeni okuyinhloko kwesifo sikashukela sikashukela, enquma amaqhinga okuphathwa kweziguli, futhi abhekise koxhumana nabachwepheshe abanciphile. I-endocrinologist inemisebenzi efanayo. Ngaphezu kwalokho, lo dokotela ubhekana nalesi sifo esiyimbangela.
I-angiosurgeon ngokukhethekile i-vasology pathology, ithatha izinyathelo zokubuyisela ukulethwa kwegazi, futhi ezimweni ezibucayi iyabanjwa. I-podologist ngudokotela omsebenzi wakhe uhlanganisa ukunakekelwa kwezinyawo, ukwelashwa ngonyawo lwesifo sikashukela, ukwelashwa kwezipikili ezifakiwe, njll.
Ukwelashwa ngonyawo sikashukela kususelwa kumaphuzu amane ayinhloko:
- Ukuthola isinxephezelo sikashukela.
- Ukunakekelwa kwezinyawo okufanelekile ukugwema izinkinga.
- Ukwelashwa kwezidakamizwa.
- Izindlela ezingezona izidakamizwa.
Isinxephezelo sesifo esikhona
I-Hyperglycemia iyisisusa sokuthuthuka kwazo zonke izinkinga ezaziwayo zesifo sikashukela. Ukugcina amazinga kashukela egazini ngaphakathi kwemikhawulo eyamukelekayo kuvimbela ukuqhubekeka kokulimala kwe-vascular and nerve, lapho kuthuthukiswa khona unyawo lwesifo sikashukela.
Ngokusekelwe emiphumeleni yezindlela zokucwaninga zokuxilonga, i-endocrinologist inquma ukusebenza kwerejimeni yokwelashwa kwe-insulin noma ukuphathwa kwezidakamizwa ezinciphisa ushukela (kuya ngohlobo lwesifo esikhona). Uma kudingekile, kwenziwa ukulungiswa, ikhambi elilodwa lishintshwa ngomunye noma kufakwa isidakamizwa esingeziwe.
Ukuzihlola ngokwakho ushukela wegazi kuyindlela ebalulekile yokuvimbela unyawo lwesifo sikashukela
Kubalulekile! Kuyadingeka ukufeza amazinga kashukela wegazi angabi ngaphezu kuka-6 mmol / l, kanye ne-glycosylated hemoglobin (HbA1c) - hhayi ngaphezu kwe-6.5%.
Ukunakekelwa kwezinyawo
Bonke abanesifo sikashukela kufanele balandele imithetho yokunakekelwa kwezinyawo ukuvimbela ukuthuthukiswa kwezinkinga noma ukubambezela ukuqhubekela phambili kwabo. Ubulukhuni bokuqalisa buxhomeke ekutheni lithinte kanjani izinga lokuzwela kwesiguli. Isibonelo, isiguli esinokuzwela okujwayelekile singasika i-toenails yabo ngesikere, futhi ngesiphukile, bangakwazi ukufayela kuphela.
Iseluleko sabachwepheshe bezokunakekela izinyawo sinje:
Kungani imilenze ibuhlungu nesifo sikashukela- Ukukhetha izicathulo ezifanele. Amamodeli we-Orthopedic noma lawo enziwa ngokuya ngamapharamitha athile wesiguli angasetshenziswa. Mhlawumbe ukusetshenziswa kwabalungisi beminwe ye-coracoid, ama-bursoprotectors avikela izikhala ezihlukanisayo, ama-insoles we-orthopedic.
- Ukukhishwa ngesikhathi. Akunconywa ukuthi uvulela wedwa amabhlokhi, kungakuhle ukuthi unikeze udokotela le nqubo.
- Ukuqedwa kokuqina kwamapuleti ezipikili. Uma lesi simo sidalwa yisikhunta, kuyalulekwa ukwenza ukwelashwa nge-antimycotic. Ezinye izimbangela zidinga ukusikwa njalo kwesiqalo sesipikili.
- Ukuqeda isikhumba esomile kanye nemifantu. Kusetshenziswa ukhilimu omollient noma ukwelashwa kwe-antifungal (kuya ngesici se-etiological).
Ukwelashwa ngezidakamizwa
Izindinganiso ezisetshenziselwa izidakamizwa ekwelapheni unyawo lwesifo sikashukela zinezinkomba ezimbili ezisemqoka ezingasetshenziswa ngokuhlanganiswa. Lokhu kufaka imali yokuthuthukisa izinqubo ze-metabolic ezicutshini zemizwa nokusetshenziswa kwemithi ukuze kususwe izimpawu ngendlela yobuhlungu nokuphazamiseka kwemizwa.
Izidakamizwa ezithinta iMetabolism
Amaqembu asetshenziswe kabanzi ngemithi avela ku-alpha-lipoic acid namavithamini e-B-series. Ezinye izidakamizwa zazinqunyelwe phambilini, kepha akukho neyodwa yazo eyabonakala isebenza kahle. Ama-ejenti "we-Metabolic" anganciphisa ukuqhubekela phambili kwendlela ye-neuropathic ye-pathology futhi anciphise ukugqama kwezimpawu.
I-Alfa-lipoic acid (i-Berlition, i-Thiogamma, i-Espa-Lipon) inezakhiwo ezilandelayo:
- ubopha futhi asuse ama-radicals wamahhala;
- kuthuthukisa ukuhamba kwegazi ngemithambo ye-epineural (leyo ekhulisa izinzwa);
- ibuyisela ukuntuleka kwe-enzyme yeseli;
- ithuthukisa ijubane lokusakazeka kwe-excitability emithanjeni yezinzwa.
I-Thiogamma - okuvela ku-alpha-lipoic (thioctic) acid, eqeda umtholampilo we-diabetesic foot syndrome
Inani lamavithamini e-B-series egazini elinoshukela ancishiswa kakhulu. Lokhu kungenxa yokuphuma kwabo emchameni. Izindlela ezivame kakhulu ezenziwa ngama-vitamin monopreparations azixazululeki zamanzi futhi azingene kahle ekuvinjelweni kwegazi lobuchopho. Ukubhekana nalolu daba, kudalwe iNeuromultivit, iMilgamma, neBenfotiamine.
Ukwelashwa okubonakalayo
Lokhu kwelashwa akusetshenziswa kuzo zonke iziguli, ngoba ukuqina kwesigaba sokuqala kamuva kuthathelwa indawo ngokungabikho kobuhlungu ngokuphelele kanye nokwehla okukhulu kwazo zonke izinhlobo zokuzwela.
Iziguli ezinokubonakaliswa okucacile kwe-pathology ziphathwa ngama-antidepressants (amitriptyline, imipramine) kanye nama-anticonvulsants (carbamazepine, tegretol, phenytoin). Womabili la maqembu awasetshenziswa uma isiguli sine-glaucoma, ngoba singathinta ingcindezi ye-intraocular.
Okwamanje, asetshenziswa kabanzi:
- IGabapentin iyi-anticonvulsant engacindezela ubuhlungu be-neuropathic. Imiphumela emibi icishe ibe i-uncharacteristic. Isiyezi, isicanucanu, nobuthongo kungavela.
- I-Pregabalin - nayo ingeyeqembu lama-anticonvulsants, inomshini wokusebenza ofana neGabapentin.
- I-Duloxetine iyi-antidepressant enomphumela ophakathi. Ukuqapha kufanele kunikezwe abanesifo sikashukela abanemicabango ye-glaucoma nemicabango yokuzibulala ngokumelene nesizinda se-pathology sohlelo lwezinzwa.
Ukusungula
Kusha ekwelashweni kwesifo sikashukela sikashukela, i-Eberprot-P isidakamizwa saseCuba esiyisici sokuphindaphindeka sokukhula kweseli. Lo muthi oyingqayizivele wenzelwe ukwakhiwa kabusha kwamaseli okushesha kakhulu endaweni yesilonda se-peptic, esifakwe ngqo emaphethelweni enxeba, siguqula inalithi ngemuva kokubhobozwa ngakunye.
I-Eberprot-P - ithuluzi lomjovo wendawo, owethulwa emkhakheni wezimpawu zokulimala kwezilonda
Odokotela baseCuba basikisela ukuthi umuthi wehlisela isibalo sokushiswa kwezidingo ezidingekayo, unciphisa ubungozi bokunqunywa, futhi ugqugquzela ukwelashwa okusheshayo kwezilonda. ECuba, i-Eberprot-P iya kweziguli mahhala. Kwamanye amazwe, intengo yayo inyuka ifinyelela ezinkulungwaneni zamadola.
Ukubuyiselwa kokujikeleza kwegazi
Kubandakanya ukulawulwa njalo kwesisindo somzimba, ukuncipha kwaso ngokweqile, ukwenqatshwa kwemikhuba emibi, ukusekelwa komfutho wegazi ophelele. Ekwelapheni i-hypertension, ama-ACE inhibitors (Lisinopril, Captopril), ama-calcium antagonists (Verapamil, Nifedipine) asetshenziswa ngenxa yokuntuleka kokuphazamiseka kwawo ezinqubweni ze-metabolic. Ukusetshenziswa kwe-thiazide diuretics (hydrochlorothiazide) kukhombisile nomphumela omuhle.
Isinyathelo esilandelayo ukulengiswa kwephrofayili ye-lipid. Njengoba ucwaningo selukhombisile, indlela yokudla ngendlela yayo ayikwazi ukuthinta i-cholesterol yegazi kushukela abanesifo sikashukela ngendlela efanele. Imithi inikezwe ngokuhambisana nokwelashwa kokudla. Ngale njongo, ama-statins asetshenzisiwe (Simvastatin, Lovastatin).
Ama-antiplatelet agents
Imithamo emincane ye-acetylsalicylic acid inganciphisa ubungozi be-gangrene ezigulini ezinesifo sikashukela sikashukela. Uma kukhona ukungqubuzana kokwamukelwa kwayo, khetha i-Clopidogrel, i-Zilt.
Ukubuyisela i-microcirculation yegazi - okuyisigaba ekwelapheni unyawo lwesifo sikashukela
Ezimweni zobungozi obukhulu be-pathologies ye-inhliziyo, kanye nangemva kokungenelela kokuqina kokuqina, kusetshenziswa i-antithrombotic therapy (Aspirin + Clopidogrel).
Izidakamizwa ezisebenzayo
Leli qembu lemithi liyakwazi ukuthuthukisa i-microcirculation yegazi ezindaweni ze-ischemia ngenxa yomphumela walo ezimweni ze-rheological zegazi nethoni ye-vascular. Lokhu kufaka phakathi:
- I-Pentoxifylline (Wasonite, Trental);
- I-Sulodexide;
- Ukukhishwa kwe-Ginkgo biloba.
Ukusebenza kahle kwalezi zimali kuqinisekiswa yikhono lokwandisa ibanga lokuhamba kwesiguli nge-interlaindent claudication syndrome kaningana. Noma kunjalo, ukusetshenziswa kwabo kuyeluleka ezigabeni ezimbili zokuqala ze-pathology. Ngesilinganiso esibi kakhulu se-ischemia, kunqunywa ama-prostaglandins (Vazaprostan, Alprostan).
Ukuhlinzwa
Ngokuphikisana nesizinda sesifo sikashukela sonyawo, ukuhlinzwa kungaba nezinhloso eziningana: ukubuyisela ukulethwa kwegazi endaweni ethile, ukususwa okuphuthumayo komlenze ophansi ngezinkomba ezibucayi zenqubo ye-purulent-necrotic, nokulungiswa kwamathambo.
Izindlela eziphambili zokwakhiwa kabusha kokuhlinzwa:
- Ukuhlinzwa kwe-Bypass (aortic-femoral, iliac-femoral, femoral-femoral-popliteal) ukungenelela okuvame ukusetshenziswa okukuvumela ukuthi wakhe i-workaround yegazi.
- I-balloon angioplasty - "ukuvuvukala" okungumshini kwendawo ethintekile yomthambo obuyisela ukuphuma kwegazi. Kungenziwa njengokusebenza okuhlukile noma kuhlanganiswe nokufakwa kwe-stent (idivaysi ebamba indawo ebuyiselwe kusuka ekunciphiseni okuphindwayo).
- I-Sympatectomy kungukungenelela lapho i-lumbar ganglia eminingi ebhekele ukulawulwa kwephimbo lomthambo isuswa khona.
I-Balloon angioplasty - indlela yokwandisa ukucaciswa kwe-artery ethintekile
Ukuqunjelwa - ukususwa kwezicubu ezingasebenzi kanye nezinto zethambo le -ularular. Ukuphakama kokungenelela kunqunywa yi-angiosurgeon. Ukulungiswa kwamathambo kumelelwa yi-ankle ehlanganyele i-arthrodesis, i-Achilles tendon epulasitiki ukuhlinzwa.
Ukwelashwa kwezilonda ezi-ulcerative kanye ne-purulent-necrotic
Ukungenelela kwendawo kufaka phakathi ukususwa kwe-necrosis, ukuvuselelwa kwesilonda se-peptic, ukubukeka kwezilimo eceleni, ukugeza amanxeba nokugqoka. Izicubu “ezifile” zidinga ukususwa, ngoba zithathwa njengezinga eliphakeme lokwanda kwegciwane. Inqubo ingenzeka kusetshenziswa isikhafu, isikhafu, isipuni seVolkman, ukugqoka ngama-enzyme noma ama-hydrogels e-protein. Qiniseka ukuthi uhlola isilonda usebenzisa uphenyo lwenkinobho, ngoba ngisho nesici esibonakala sincane kungaba yi-fistula.
I-Excision yamabele emaphethelweni wesiphene - isigaba sokwelashwa kwesilonda onyawo sikashukela
Ukugeza isilonda kunciphisa inani le-microflora ye-pathogenic ebusweni bayo. Ukusebenza kahle kwaboniswa ngokuhluza ngesirinji nenaliti. Kuyaziwa ukuthi i-green iodine, iodine, i-potanganum permanganate solution kanye ne-rivanol zifakwa emithini yokwelashwa kwezinkinga zokulimala kwezilonda. I-hydrogen peroxide ingasetshenziswa kuphela esiteji sokuzihlanza, lapho okuqukethwe yi-purulent kanye nokuxinana kwegazi kukhona.
Izilonda zokugeza zingenziwa:
- isisombululo se-saline;
- I-Miramistin;
- I-Chlorhexidine;
- I-Dioxidine.
Ngemuva kwenqubo, isilonda kufanele simbozwe ngokugqoka. Uma i-gauze isetshenziselwa le njongo, kufanele ifakwe emafutheni ngamafutha ukuvimbela ukonakala kufinyelele kwisiphene. Kungenzeka unqume ama-antimicrobials (i-Betadine, i-Argosulfan), imithi elwa namafutha (i-Levomekol ointment), iziqobosho zokululama (i-Becaplermin ijeli), ama-proteinolytic agents (i-Chymotrypsin, i-Iruxol ointment).
Ukulayisha okungaphezulu
Akunandaba ukuthi amalungiselelo anamuhla asebenza kanjani, ngenkathi iziguli zilingana esilondeni, umuntu ngeke alindele ukwelashwa kwalo. Uma isilonda senziwe endaweni emlenzeni ophansi noma emuva, asikho isidingo semishini eyengeziwe yokulayisha. Lapho isendaweni esekela, kusetshenziswa i-bandage ekhethekile eyenziwe ngezinto ezenziwe nge-polymeric noma isihlangu. Njengomthetho, iminwe ishiywe ivulekile.
Kubalulekile! Isilinganiso sokuphulukiswa kwezilonda esikhona eminyakeni edlule ngokumelene nesizinda sendlela yokulayisha yizinsuku ezingama-90.
I-boot kungenye indlela yokulayisha umlenze obuhlungu
Ukulawulwa kokutheleleka
Izinkomba zokuqokwa kwamagciwane:
- isilonda esinezimpawu zokutheleleka;
- i-ischemic necrosis;
- isici eside esikhona samasayizi amakhulu asengozini enkulu yokutheleleka.
Ukuzikhethela kwezidakamizwa kusekelwe emiphumeleni ye-bacterial seeding kanye nokuzimisela kokuzwela kwe-microorganisms. Ama-Penicillins (Amoxiclav), cephalosporins (Ceftriaxone, Cefepim), fluoroquinolones (Ofloxacin, Ciprofloxacin), aminoglycosides (Amikacin, Gentamicin) ayathandwa.
Imithi elwa namagciwane iphuzwa ngomlomo futhi ilawulwa ngabazali. Isikhathi sokwelashwa kuya ngesimo sesiguli. Amafomu alula adinga ukuqokwa komuthi ngezinsuku eziyi-10-14, ezinzima - inyanga noma ngaphezulu.
Izindlela ezingezona izidakamizwa
Lezi zindlela ngeke ziphendule umbuzo wokuthi ungalapha kanjani unyawo lwesifo sikashukela, kepha kuzosiza ukunciphisa ukugqama kwesithombe sezempilo. Lokhu kufaka phakathi ukubhucungwa umzimba, ukuzivocavoca okwelapha, i-physiotherapy.
Massage
Ngaphambi kokuqala ukubhucungwa ngonyawo, izandla zabachwepheshe ziphathwa nge-talcum powder, i-baby powder noma ukhilimu wamafutha. Le ndlela izovikela imilenze yesiguli ekulimaleni okungenzeka futhi ithuthukise ukukwehla. Ngesikhathi senqubo, isiguli siphatha isikhundla esimnika ukungaphatheki kahle (elele emhlane, eceleni kwakhe, ehleli).
Ukuthuthukiswa kwamaphethelo aphansi kuqala ngesifunda semilenze engezansi ne-ankle kuhlangene, bese kukhuphuka kusuka emadolweni kuya endaweni ye-inguinal. Ukuzivocavoca ngezinyawo ngokwako kwenzeka okokugcina. I-phalanx ngayinye, izikhala ezihlukanisayo, isitshalo sangemuva nesasemuva, isithende siyafundwa.
Ukuzivocavoca ngezinyawo - indlela yokwelapha kanye ne-prophylactic yesifo sikashukela
Kubalulekile! Ekupheleni kwenqubo, isikhumba senziwe nge-ayisikhilimu.
Izindlela zokuzivocavoca zokwelapha
Umgomo ukuthuthukisa i-microcirculation yegazi ezindaweni ze-ischemia, kepha umsebenzi obalulekile womzimba awuboniswa, ngoba kungaholela ekwandeni kobuhlungu nasezinkingeni. Ungenza izivivinyo:
- ukuguquguquka nokwelulwa kwezinzwane;
- ukudonsa kusuka esithendeni kuya ezinzwaneni, kuphumula unyawo phansi;
- ukunyakaza umlenze oyindilinga esikhundleni sokuhlala;
- ukuguquguquka nokwelulwa komlenze ku-ankle kuhlangene;
- ukunyakaza okuyindilinga ku-ankle ngokuhlanganyela.
Ukwelashwa komzimba
Sebenzisa izidakamizwa i-electrophoresis. I-Zinc, ithusi, i-potassium, okudingeka umzimba wabantu abagulayo, ifakwe esikhunjeni isebenzisa i-ngqo yamanje. Ukulungiswa kwe-Zinc kunomthelela omuhle esizweni se-pancreas, ithusi lifaka isandla ezinqubweni ze-metabolic, kunciphisa ushukela wegazi. Isifo sezinhlungu sikuvumela ukuthi umise i-novocaine-iodine electrophoresis, ukwethulwa kwesixazululo se-5% sodium thiosulfate.
Enye indlela ephumelelayo yi-magnetotherapy. Inkambu eyakhiwa ngesikhathi senqubo inomphumela wokuvikela, i-analgesic, immunomodulating.
I-Hyperbaric oxygenation nayo isetshenziswa ekwelapheni unyawo lwesifo sikashukela. Le ndlela isetshenziselwa ukuqeda i-hypoxia yobunzima obuhlukahlukene. Iseshini ingahlala kuze kufike ehoreni eli-1. Izinqubo ezinjalo zidinga kusuka ku-10 kuye ku-14.
Izindlela zabantu
Ngeke kwenzeke ukwelapha i-pathology ngamakhambi esintu, kepha kungenzeka ukuthi kugcinwe amazinga wegazi ngezinga elamukelekayo futhi kunciphise ukuqhubeka kwesifo.
Inombolo yeresiphi. Isipuni samajikijolo omisiwe athululela amalitha ayi-0,5 amanzi abilayo. Faka kubhavu wamanzi bese ugcina okungenani imizuzu engama-20. Ngemuva kokuhlunga umhluzi ophumele, ungacubungula amaphutha nezilonda.
Amajikijolo e-bird cherry - isitolo sama-tannins anikela ekulimaleni kokulimala
Inombolo yeresiphi 2. 2 tbsp chitha u-linden uju kwilitha lamanzi afudumele. Thatha izinyawo zokugeza ngezinyawo ngesisombululo esikhona (imizuzu eyi-15 nsuku zonke).
Inombolo yeresiphi 3. Lungisa ingxube yezimbali ze-chamomile ezomile, amaqabunga e-rosemary kanye nembewu yesinaphi ngesilinganiso 2: 1: 2. Thela amalitha ayi-0,5 amanzi afudumele ubusuku bonke. Ngokufakwa okufakwayo, yenza izingcindezi zezindawo ezinokulimala kwezilonda.
Funda kabanzi mayelana nokwelapha unyawo lwesifo sikashukela ekhaya kulesi sihloko.
Ngeshwa, akunakwenzeka ukwelapha isifo sikashukela sonyawo, noma kunjalo, kungenzeka ukuguqula ikhwalithi yempilo yesiguli. Lokhu kudinga ukuxilongwa ngesikhathi, ukuhambisana nezincomo zodokotela, ukunakekelwa kwezinyawo njalo.
