Izilonda ze-Trophic - ukulimala kwesikhumba nezakhiwo ezijulile ngendlela yamanxeba okuphola wesikhathi eside. Ukulimala okunjalo kwenzeka ngenxa yokwephulwa kokuhlinzekelwa kwegazi engxenyeni ethile yomzimba. Ukwenza kwasendaweni okuthandayo izilonda eziyinqaba - izinzwane, izithende, imilenze ephansi. I-pathology efanayo isici sesifo sikashukela i-mellitus, kubhekwe ukuthi iyinkimbinkimbi nokubonakaliswa kwesifo sikashukela sikashukela.
Ukwelapha i-trophic ulcer in sikashukela kubhekwa njengenqubo ende ehlanganisa izindlela eziningana. Ukwelashwa kokubandakanyeka kufanele kwenzeke ngemodi enkulu, ngoba yiso kanye isici esinjalo esidala ukunqunywa kwamaphethelo aphansi.
Izimiso zokwelashwa
Ukuze ukwelashwa kwesilonda esiyinqaba kushukela kuphumelele, kufanele udlule kulezi zinyathelo ezilandelayo:
- ukuphathwa kahle kwendawo ethintekile;
- Ukuthululwa komlenze ophansi;
- ukuqothulwa kwe-microflora ye-bacterial;
- isinxephezelo sesifo esikhona;
- ukukhululeka kokuphelelwa yithemba;
- ukukhonjwa nokwelashwa kwama-pathologies we-concontitant angavumeli inqubo yokwelapha ukuthi ivele ngokuphelele (i-anemia, i-pathology yesibindi, ukwehluleka okungapheli kwe-renal).
Ngaphezu kwalezi zigaba, ukushiyeka kwe-ischemic trophic kudinga ukuvuselelwa (ukubuyiselwa kokujikeleza kwegazi esiswini esithintekile), ngoba kungukuvalwa kokukhanya kwemithambo okuholela ekukhuleni kwayo.
Ukukhetha kwemithi yokwelashwa kungukuphambi kodokotela oya khona
Uma amanxeba eyinkimbinkimbi ngezinqubo ezibalulekile ze-purulent, ukwelashwa kokuhlinzwa kanye nokukhipha umzimba emzimbeni kuyadingeka.
Ukwelapha okuphezulu kwesilonda
Ukwelashwa kwezilonda zonyawo olude kusifo sikashukela kubandakanya imicimbi ezejwayelekile neyasendaweni. Ukwelapha kwasendaweni kususelwa kulezi zinqubo ezilandelayo:
- i-necrectomy (ukususwa kwezindawo ezifile) ngokubonakala kwezithelo zommbila;
- ukugeza amanxeba ngezixazululo zokwelapha;
- ukusetshenziswa kwendlela yokugqoka.
I-Necrectomy
Izicubu ezifile zibhekwa njengendawo enhle yamagciwane. Ngaphezu kwalokho, zivimbela ukuphuma okujwayelekile koketshezi kusuka endaweni yenxeba nokwakheka kwezicubu ezintsha zokuphulukiswa. Ngakho-ke, kuyadingeka ukususa indawo ye-necrosis ibe phezulu.
I-Excision ingenzeka kusetshenziswa isikhafu nesikhafu, ngomshini, kusetshenziswa isisetshenziswa esikhethekile esidonsa ijezi zamanzi, sisebenzisa indlela yamakhemikhali, sisebenzisa ama-enzyme e-proteinolytic. Enye indlela - udokotela usebenzisa ukugqoka okumanzi ukusiza izicubu ezifile ziklebhule.
Ukususwa kwezindawo ze-necrosis ngesikhafu nesikhala kuyindlela ejwayelekile, noma kunjalo, ayisetshenziswa uma ingezansi kwesilonda imelelwa ngumphezulu we-articular noma uma isici se-trophic ischemic. Ngesikhathi sokuhlinzwa, kusetshenziswa isipuni seVolkman - ithuluzi ngendlela yesipuni esinendawo encane. Ikuvumela ukuthi ususe ngokunembile izingcezu zezicubu ezifile ngaphandle kokubhubhisa imikhumbi.
I-Necrectomy yisigaba esibalulekile ekwelapheni ukonakala kwe-trophic
Kubalulekile! I-trophic ulcer emlenzeni kufanele ihlolwe ngecala lokuphenya, ngoba isici esingajulile ngokungahle sibe nesiteshi sokulimala esijulile.
Ngasikhathi sinye, amabele akhiwa eceleni komphetho wesilonda nawo ayasuswa. Lokhu kukuvumela ukuthi unciphise ingcindezi enxebeni uqobo futhi uthuthukise ukuphuma kokuqukethwe kwalo. Kunezikhathi ezidinga ukususwa kwepuleti lezipikili. Lokhu kwenzeka uma isilonda sitholakala ngokwengxenye embhedeni wezipikili noma esiqongweni somunwe.
Ukwelashwa okubabayo
Lesi sigaba sokwelashwa kwezilonda ezisesishubeni ku-mellitus yesifo sikashukela senziwa ukuze kuncishiswe inani lamagciwane ebusweni bendawo ethintekile. Kunemishini eminingana esetshenziselwa ukugeza, noma kunjalo, kufakazelwe ukuthi ukusetshenziswa kwesirinji enenalithi akuvezi mphumela mibi kakhulu.
Ungasebenzisi ukugeza iziphazamiso eziyinqaba:
I-neuropathy yesifo sikashukela semikhawulo ephansi- potassium permanganate solution;
- iodine;
- luhlaza okotshani;
- i-rivanol;
- izinto zokwelapha ezenzelwe utshwala.
Kusetshenziswa isixazululo esingu-3% se-hydrogen peroxide ngesikhathi sokuhlanza inxeba lesilonda kusuka ekuhlanjeni nasekuhlanganeni kwegazi. Kuvunyelwe ukugeza isilonda nge-saline yomzimba we-sodium chloride, Miramistin, Chlorhexidine, Dioxidin. Ekhaya, ungasebenzisa i-Acerbin fafaza.
Ukugqoka
Izinto ezisetshenziselwa ukugqoka kufanele zibe nalezi zakhiwo ezilandelayo:
- atraumatic;
- amandla okulondolozwa kwendawo enomswakama (kufakazelwa ukuthi ezimweni ezinjalo inqubo yokuphulukisa kwezilonda zezinhlamvu emilenzeni inesifo sikashukela iyasheshiswa);
- amandla okumunca okuqukethwe amanxeba;
- izakhiwo zesithiyo (ukuvimbela amagciwane);
- ukungabikho kwezithiyo ekugelezeni komoya okujwayelekile kwezicubu.
Ukugqoka kwe-alginate - ukugqoka kwesimanje okusetshenziselwa ukulwa namanxeba we-trophic
I-Gauze yokugqoka ayifaneleki, ngoba ingomile endaweni yesilonda futhi yephule ubuqotho bama-granerals lapho isuswe. Ingasetshenziswa uma kwenzeka ama-fistulas, ne-necrosis eyomile noma izilonda ezinomswakama ophezulu.
Izindlela zokwelapha zesimanje zisebenzisa ukugqoka kwama-mesh, ama-alginate, ama-hydrogels, izipanji ze-polyurethane, imicu ye-hydrophilic, njll.
Ingculazi
Izinto ezethuliwe zibonisa ukusebenza kahle ngokuhlanganiswa kwengubo yanamuhla.
- Izidakamizwa ze-antimicrobial - i-Argosulfan, iDermazan, iBetadine.
- Izivuseleli zokuvuselelwa kabusha - iBekaplermin, iCuriosin, i-Ebermin.
- Ama-enzyme ama-Proteolytic - i-Iruksol, iChymotrypsin.
Izithambiso zisetshenziselwa i-soluble yamanzi (i-Levomekol, i-Dioxizol) ne-fat-based (Solcoseryl, Actovegin).
Kwethulwa umthwalo ophansi
Elinye igxathu elibalulekile ekwelapheni ukungaphatheki kahle. Noma ngabe yiziphi izidakamizwa ezisetshenziswayo, isilonda se-trophic ngeke siphilise size isiguli sithathe umlenze obuhlungu. Ukukhuphuka okuphelele kuyisihluthulelo somphumela omuhle we-pathology.
Uma isilonda senziwe endaweni emlenzeni ophansi noma emuva konyawo, amadivayisi angeziwe wokulayisha awadingeki. Iphuzu kuphela isidingo sokuntuleka kokuxhumana kwesilonda ngezicathulo. Uma isilonda sisezithendeni noma uhlangothi lwethali lonyawo, kuyadingeka amadivayisi akhethekile. Okwamanje, isambatho sokulayisha esenziwe ngezinto ezenziwe nge-polymeric siyasetshenziswa. Ibekwe onyaweni nasemlenzeni ophansi. Kwethulwa ngesimo sebhuthi, esingasuswa noma singasuswa (njengoba kunconywe udokotela). Le ndlela yinhle ngoba ikuvumela ukuthi uhambe ngomgwaqo, usebenze, uqede umthwalo osendaweni ethintekile yomlenze.
Ukuthululwa kwesicathulwe kwesigamu - enye yezindlela zokuqeda umthwalo endaweni ethintekile
Ukulayisha kwenzeka ngenxa yezindlela eziningi:
- cishe ama-35% omthwalo wedluliselwa onyaweni kuya emlenzeni ongezansi;
- ubukhulu bokuthi ingcindezi isatshalaliswa ngokulinganayo;
- isilonda sivikelekile ekushayaneni okungaphezulu;
- ukuvuvukala kwesitho esithintekile kuyancipha.
Contraindication nokusetshenziswa kwe-polymer boot:
- Absolute - inqubo esebenzayo ye-purulent-necrotic ngokuthuthukiswa kwe-sepsis noma i-gangrene.
- Isihlobo - ukwephulwa okubucayi kokuhlinzekelwa kwegazi, isilonda esijulile nesilinganiso esincane, umswakama obalulekile esikhunjeni endaweni yokufaka isicelo, ukwesaba ukusebenzisa umshini we-polymer.
Ukusetshenziswa kwezinduku, izicathulo zamathambo, ukukhawulelwa okulula kokuhamba ekhaya, ukwakheka kwe "windi" lesilonda ku-insole kuyizindlela ezingamukeleki ekwelapheni izilonda ezisesimweni esibuhlungu.
Ukulawulwa kokutheleleka
Ukusetshenziswa kwendawo kwama-antiseptics ekubhujisweni kwamagciwane akubonisanga ukusebenza kwawo, okusho ukuthi okuwukuphela kwendlela ukusetshenziswa kwezidakamizwa ezingama-antibacterial. Lawa ma-ejenti akhonjiswa hhayi kuphela lapho isici sesivele sinegciwane, kodwa futhi lapho kunengozi enkulu yokukhula kwamagciwane (i-necrosis of ischemic izicubu, usayizi omkhulu wesilonda, isilonda esivele sikhona).
Imithi elwa namagciwane - indlela yokulwa nokutheleleka
Ama-ejenti e-causative ejwayelekile wokutheleleka kwenxeba:
- staphylococci;
- streptococci;
- I-Proteus;
- E. coli;
- i-enterobacteria;
- Klebsiella;
- pseudomonad.
Ukuqokwa kwemithi elwa namagciwane kwenzeka ngemuva kokuqukethwe kwe-bakseva enxebeni ngokuzimisela kokuzwela komuntu okukodwa kwe-pathogen. Esebenza kakhulu ama-penicillin, i-fluoroquinolones, i-cephalosporins, i-lincosamides, i-carbapenems.
Izindlela ezinamandla ze-pathology zidinga ukuphathwa okubuthakathaka kwama-antibiotics ezimeni zokuma. Ngokubambisana, kwenziwa imishini yokuhlinza amanxeba okuhlinzwa, i-detoxification therapy, kanye nokulungiswa kwesifo sikashukela. Inkambo yokwelashwa ingamaviki ama-2. Izigaba ezithambile zokutheleleka zivumela ukuthi ama-antibiotics athathwe ngomlomo ngendlela yamaphilisi ekhaya. Isifundo sifinyelela ezinsukwini ezingama-30.
Isinxephezelo sikashukela
Esinye isigaba esibalulekile, ngaphandle kwabo odokotela abangakwazi ukwelapha izilonda ezindexekile. I-endocrinologist ibandakanyeka kulungiswa kwezokwelapha lesi sifo esiyimbangela. Kubalulekile ukugcina amazinga kashukela wegazi angabi ngaphezu kuka-6 mmol / L. Ekhaya, ukulawula izinkomba kwenzeka ngosizo lwe-glucometer. Ngesifo sohlobo 1, imiphumela iqoshwa njalo emahoreni angama-3-4, ngohlobo 2 - izikhathi ezi-2 ngosuku.
Ukuthola isinxephezelo, kusetshenziswa izidakamizwa ze-insulin noma izidakamizwa ezinciphisa ushukela. Kufakwa insulin emfushane - ukwehlisa ngokushesha amazinga kashukela nemithi ende (kulawulwa izikhathi eziyi-1-2 ngosuku, ukugcina amazinga evamile usuku lonke).
Ukulawulwa kwe-glycemic yansuku zonke kuyisinyathelo esibalulekile sokuthola isinxephezelo se "sifo esimnandi"
Ukubuyiselwa kokugeleza kwegazi
Kunezindlela zezokwelapha nezokuhlinza okuhlose ukuvuselela ukuhanjiswa kwegazi endaweni ethintekile. Yonke imithi esetshenzisiwe ihlukaniswe ngamaqembu amakhulu amabili:
- okungewona ama-prostanoid;
- prostanoids.
Iqembu lokuqala lifaka iPentoxifylline, i-Ginkgo biloba ekhipha, amalungiselelo we-nicotinic acid, abanciphise igazi, iHeparin, iReopoliglyukin. Iqembu lesibili lisebenza ngempumelelo. Abamele bayo yiVazaprostan, Alprostan.
Izindlela zokuhlinzwa zokubuyisa ukugeleza kwegazi, i-balloon angioplasty isetshenziswa kabanzi. Lokhu kuyindlela "yokuqhakaza" umkhumbi othintekile ukuze wandise ukucaca kwawo. Ukuze wandise umphumela wokungenelela kokuhlinzwa, kufakwa i-stent kulo mkhumbi - insiza ebamba umthambo kusuka ekunciphiseni okuphindaphindwe.
Ukubekwa kwesiqu - indlela ephansi yokuvuselela imilenze
Enye indlela ukuhlinzwa okudlula lapho. Ama-Angiosurgeons akha ama-workaround egazi kusuka ezintweni zokwenziwa noma emithanjeni yesiguli uqobo. Le ndlela ikhombisa umphumela omude wokugcina.
Uma kwenzeka i-necrosis ebhebhethekile ngemuva kokuvuselelwa kabusha, ukuhlinzwa onyaweni kungenziwa:
- ukunqunywa okuncane okuyingxenye;
- i-necrectomy
- ukugcwala kwesilonda noma ipulasitiki yaso.
Yilwa nobuhlungu
Ukuqedwa kobuhlungu akusona isigaba esibalulekile ukwedlula okungenhla. Le mishanguzo elandelayo ibonwa njengama-ejenti asebenzayo:
- Ibuprofen;
- UKetanov;
- I-Ketorol;
- Solpadein;
- I-Phenazepam.
Ukusetshenziswa isikhathi eside kwama-NSAIDs akuvunyelwe ngenxa yengozi enkulu yokuphuma kwe-gastrointestinal. Ama-Derivatives we-metamizole (Baralgin, Tempalgin) angavusa i-agranulocytosis.
Ukwelashwa kwezinkinga zesifo sikashukela ngamakhambi abantu futhi kusetshenziswa kabanzi, kepha, kufanele kukhunjulwe ukuthi umuthi wokuzelapha unqatshelwe. Lokhu kungakhulisa inkinga. Ukuhambisana nezeluleko zokwelapha ochwepheshe kuyisihluthulelo somphumela omuhle we-pathology.
