Leoto la lefu la tsoekere

Lefu la tsoekere la lefu la tsoekere (SDS) ke motsoako oa "mellitus" e nang le "tsoekere" e nang le phetoho, e khetholloang ka liphetoho tse sebetsang metsong ea leoto. Pathology e ba teng ka lebaka la mathata a metabolic, a kenyang ts'enyeho ea marako a methapo ea mali le phallo ea mali butle-butle ka leotong la distal. Matšoao a eona ke mapetso a hae a le mong, hyperkeratosis, bohloko ba leoto, ulcerative necrotic lesion.

Bohlokoa ba leoto la tsoekere le khoutu ea eona ho latela ICD-10

Ho endocrinology, lefu lena le nkuoa e le phetoho e kholo ea liphetoho tse etsahalang khahlano le semelo sa lefu la mahlo, mathata a methapo ea kutlo, macro- le microangiopathy. Sena se kenyelletsa nts'etsopele ea karabelo ea purulent-necrotic e eketsang kotsi ea ho sithabela ha masapo le masapo a bonolo. Maemong a tsoetseng pele, SDS e tsamaea le gangrene, e atisang ho fihla maotong, empa le maotong a tlase. Maemong ana, bakuli ba bontšoa ho khaoloa ha karolo ea "terminal" e pheletsong e tlase.

Leoto la lefu la tsoekere ke lentsoe le akaretsang le kopanang le mathata a mangata a lefu la tsoekere. Tabeng ea kholo ea bona, liphetoho tsa methapo leotong li bonoa, li tsamaea le tšenyo ea masapo a amanang le masapo le mesifa. Ts'ebetso ea Necrotic e bonahala ka lebaka la mesebetsi e sa sebetseng ea lijana tsa pherekano, letlalo, methapo, manonyeletso le masapo.

Ho Classified ea Mafu a Machaba (ICD-10), lefu la endocrine le khetholloa e le lefu la tsoekere Mellitus E10-E14. O abeloa ho ngola coding E10.5 kapa E11.5, ho latela mofuta oa lefu lena.

Mabaka le mochine oa ntlafatso

Lihokela tsa bohlokoa tsa pathogenetic tsa SDS li kenyelletsa ts'oaetso, angiopathy le neuropathy. Ho bakuli ba nang le lefu la tsoekere, ka linako tse ling ho ba le hyperglycemia ea nako e telele e sa sebetseng, e ka bakang liphetoho tsa methapo ea methapo le methapo ea kutlo le methapo ea kutlo. Angiopathy e baka ho fokotseha ha matla le matla a marang-rang a capillary, keketseho ea tekanyo ea mali, ka lebaka leo ho nang le khahlano le phallo ea mali le phepo e nepahetseng ea methapo ea mesifa ea ligamentous.

Karolo ea bohlokoa ho pathogenesis ea lefu lena e bapaloa ke lintho tse susumetsang tse kang:

• Neuropathy - mathata a ts'ebetsong ea ts'ebetso ea methapo e bakoang ke tšenyo ea methapo ea mali le phepo e sa lekanang ea li-tishu.
• Macroangiopathy ke ho fokotseha ha molumo oa lebota la vascular ka lebaka la metabolism e senyehileng le lipid metabolism ho bakuli ba nang le lefu la tsoekere.
• Osteoarthropathy ke tšenyo ea masapo le manonyeletso a sephara khahlanong le semelo sa keketseho ea tsoekere ea mali le liphetoho phetohong ea leoto ka lebaka la nts'etsopele ea methapo ea kutlo.

Lefu la tsoekere ke o mong oa mathata a fumanehang seoelo hape a makatsang a li-endocrine pathologies. Ka lebaka la glycosylation e eketsehang ea liprotheine, motsamao oa manonyeletso a fokotsehileng, sebopeho sa masapo sea fetoha 'me moroalo leotong le senyehileng oa eketseha. Ka lebaka la ho fokotseha hoa kutlo ea lithane, tšenyo e nyane e lebisa ponahalong ea bofokoli ba ulcerative bo sa fole nako e telele.

Li-trophic ulc tse entsoeng letlalong la maoto li ka tšoaetsoa ke libaktheria tsa pathogenic:

• ketsona
• colibacilli
• staphylococci.

Likokoana-hloko li hlahisa hyaluronidase, e lokollang lisele, ka hona e theha necrosis ea lithane tsa adipose, mesifa ea mesifa le likarolo tsa masapo. Ka ho ruruha ho sa feleng ha letlalo, menyetla ea ho ba le tšoaetso ea puruse le ho ruruha ha leoto le eketseha.

Ka lefu la tsoekere le thellisitsoeng, menyetla ea liphetoho tsa lehae lising le matsoho ea eketseha. Ba bitsoa "mathata a maoto a manyane":

• Nautrowth,
• calluses
• letlalo la fungal,
• poone,
• onychomycosis,
• mapetso a serethe.

Mathata a leoto la tsoekere a bakoa ke ho roala lieta tse sa phutholoheng. Ka lebaka la ho fokotseha ha kutloisiso ea lithane, bakuli ha ba utloe eka lieta kapa lieta tse rekiloeng li itlotsa kapa li pepeta menoana le maoto.

Sehlopha sa lefu la tsoekere

Ho latela matšoao a lefu lena, ho ka khetholoha mefuta e meraro ea lefu la tsoekere:

1. Ischemic - e etsahala khahlano le semelo sa angiopathy mme e etsahala maemong a 7-10%. E tšoauoa ka phallo e phallang ea mali liphateng, ho senyeha hoa phepo e ntle le phapanyetsano ea khase liseleng. Sebopeho sa ischemic sa leoto la tsoekere se atisa ho tsamaisana le ho felisoa kapa ho senngoa ha methapo le methapo ea methapo. Lintho tse ka sehloohong tse hlahisang lefu lena ke: ho ruruha ha maoto, bohloko bo boholo maotong, khatello e matla ea letlalo, mokhathala ha o tsamaea, limp.
2. Neuropathic - sephetho sa ho senyeha ho hoholo ha leoto la mokokotlo. E etsahala maemong a 60-75% a tsoang ho mefuta eohle ea SDS. Matšoao a tloaelehileng a mofuta oa neuropathic oa leoto la tsoekere a kenyelletsa: anhydrosis, hyperkeratosis le frontturesous e fokotsang matla, mocheso o fokotsehileng (mocheso, tactile), letlalo le omeletseng, bofokoli ba metatarsus, maoto a sephara.
3. Ho kopantsoe - ho kopanya lipontšo tsa mefuta e kaholimo ea SDS. Sebopeho sa neuroischemic sa leoto la tsoekere se fumanoa ho 25-30% ea linyeoe.

Ho latela mathata, karohano e 'ngoe ea lefu lena e sebelisoa ho endocrinology, ho ea ka hore e arotsoe ka mefuta e mehlano:

• ho senyeha hoa letsoalo
• aakulu limb ischemia,
• leoto leoto,
• Menkeberg calcifying sclerosis,
• ulcer, localization, degree ho latela Wagner.

Botebo ba VDS

Ho latela boholo ba matšoao a lehlaba la lefu la tsoekere ho mellitus ea lefu la tsoekere, mehato e latelang ea thuto ea lefutso e ka khetholloa:

• 0 - liphetoho tsa methapo ea maoto le matsoho li ntse li le sieo, leha ho le joalo, litabatabelo tsa ho hlaha ha tsona li hlaha: deformation leoto, ho fokotseha ha kutlo ea mesifa, ho pepeta hoa letlalo.
• 1 - maqeba a pele a trophic a thehiloe holim'a letlalo, empa ho phatlalatsoa ha 'ona ho lekanyelitsoe feela ke leoto.
• 2 - eseng feela dermis, empa le mesifa e nang le tishu e kenang e qala ho senyeha. Mefuta ea masapo e nang le masapo libakeng tse boteng ba ho ruruha e ntse e sa sebetsoe.
• 3 - li-ligaments le masapo li kentse letsoho lits'ebetsong tsa ho ruruha, ka lebaka leo menyetla ea likotsi tsa leoto le eketsehang.
• 4 - ka lebaka la ho ruruha ho sa tloaelehang ha leoto, ho ruruha ha mofuta o fokolang.
• 5 - ho ata ha ho ruruha ho potlakisa ho baka tšenyo e kholo lithong tsa gangrene, eseng leotong feela, empa le leoto le tlase.

Mehatong ea pele ea nts'etsopele ea leoto la tsoekere, bakuli ba nang le lefu la tsoekere ha ba tsebe le ho ba teng ha mathata. Leoto le amehileng le shebahala joalo ka tloaelo, leha bohloko ba maikutlo le mocheso ho lona bo fokotseha. Bakuli ba nang le mofuta oa neuropathic oa lefu lena ba roala lieta tse sa phutholoheng, tse behang khatello ea menoana le ho sitisa phepelo ea mali liseleng tse bonolo, empa ba sa utloe bohloko.

Makhoaba a ileng a latela a le mong, borashe le ho ruruha ho hoholo li baka marapo a letlalo le lipekere.

Matšoao le lihlopha tse kotsing

Lipontšo tsa kliniki tsa SDS li khethoa ke mofuta oa lefu lena le boemo ba nts'etsopele ea methapo. Matšoao a pele a lefu la tsoekere ke:

• Ho ruruha hoa lipheo tse tlase,
• bohloko ha a ntse a tsamaea
• phetoho ho sensitivity ea dermis.

Batho ba nang le lefu la tsoekere ba lokela ho lemosa ho tepella le ho hlonama maotong esita leha ba phomotse. Ponahalo ea leoto la tsoekere hangata e bontšoa ke phetoho ea 'mala oa letlalo o amanang le phallo ea mali le ischemia ea tishu. Hape, bakuli ba lokela ho makatsoa ke pholiso e telele ea litlolo tse nyane le mapetso.

Matšoao a leoto la tsoekere la neuropathic

SDS e tšoauoa ka ho ba teng ha methapo ea methapo likarolong tseo tsa leoto e nang le khatello e kholo ha e ntse e tsamaea kapa e eme. Mabala a angoa haholo ke libaka tse arohaneng, serethe le mesamo ea menoana. Matšoao a bohlokoa le letšoao la leoto la tsoekere a kenyeletsa:

• Ho ruruha ha maoto ka tlas'a leqaqailana,
• ponahalo ea poone leotong,
• ho totobala ha letlalo feela,
• dermis e omeletseng
• ulcs on leoto
• deformation ea menoana.

Ka mofuta oa neuropathic oa SDS, maqeba a trophic a hlaha libakeng tseo a hatelloang haholo ha a ntse a tsamaea. Ha masapo a senyehile, deformation ea menoana ea hlaha, ka hona e fetoha sebopeho sa hook.

Lipontšo tsa maoto a ischemic diabetic

Ho qala ha lefu lena ho tšoauoa ka ho ba teng ha bohloko nakong ea ho tsamaea le mokhathala o potlakileng oa mesifa nakong ea motsamao. Ponahatso ea sebopeho sa mofuta ona oa thuto ea methapo ea mafu ke ho hlahella ka nakoana. Ka lebaka la phano e sa lekaneng ea mali liseleng le mahlaba maotong, mokuli o qobelloa ho hlonama ho fokotsa khatello ea maikutlo.

Litsebi li khetholla matšoao a latelang a mofuta oa ischemic oa lefu la tsoekere:

• Ho ruruha maqaqailaneng,
• letlalo blancing,
• Hyperpigation
• vidonda a le mong,
• ho haella ha methapo ka har'a methapo ea leoto,
• makhakhapha a 'mala o moputsoa ho liso tsa ka.

Haeba kutloisiso ea bophahamo bo ka tlase e fokotsehile, 'me libaka tsa khatello ea maikutlo li hlaha holim'a letlalo, hona ho ka bontša nts'etsopele ea sebopeho sa ischemic sa SDS.

Ho tseba karolo ea lefu lena, lekola sebaka seo mokuli a ka se hlola ntle le thuso. Haeba bolelele ba sebaka se tsamaeang ha bo feta 200 m, boemo ba 3 ba SDS bo fumanoa. Ka kholo ea lefu lena, necrosis ea mesifa e bonoa, ka lebaka leo lefu la sethoathoa le hlahang hamorao.

Lipontšo tsa lefu la tsoekere le tsoekere

Lesapo le kotsi ke motsoako o matla ka ho fetisisa oa lefu la tsoekere le bolaeang le SDS. E hlaha ka lebaka la phallo ea mali e sa senyeheng lipelong tse tlase, khaello ea phepo e ntle ea lisele le ts'oaetso e sa foleng ea libaka tse senyehileng tsa letlalo. Lebaka le ka 'nang la hlaha ka lebaka la koluoa ​​ke lefu la mokuli, ka hona, haeba ho fumanoa bothata, ba khetha ho khaoloa likarolo tse amehang tsa maoto le matsoho.

Lihlopha tsa likotsi

Kotsi ea mathata a tebileng e teng ho bohle ba lefu la tsoekere, empa hangata SDS e ba teng ho bakuli ba nang le:

• khatello ea kelello ea methapo
• polyneuropathy
• Hyperlipidemia,
• hyperkeratosis
• lefu la pelo
• leoto leoto
• atherosclerosis, jj.

Ho latela lipalo-palo, bakuli ba nang le lefu la tsoekere ba fetang 40% ba kotsing e kholo. Ho thibela mathata a kotsi, ho khothalletsoa ho etsa tlhahlobo ea tloaelo le setsebi bonyane nako e le 'ngoe ka selemo. Ka mokhoa o fokolitsoeng oa lefu lena, kalafo ea prophylactic e laeloa ho ntlafatsa phallo ea mali mangoleng le ho ntlafatsa lisele tsa trophic.

Ts'oaetso

Ha ho hlahlojoa bakuli ba nang le SDS, ho sebelisoa mokhoa o fapaneng oa ho sebelisa mekhoa e mengata. Ho tseba ka leoto la lefu la tsoekere ha ho kopane feela le ngaka ea lefu la tsoekere, empa le lingaka tse ikhethang tse amanang le tsona - ngaka ea methapo ea methapo, ngaka ea methapo, ngaka ea methapo, jj. Ho itlhahloba ho bapala karolo ea bohlokoa ho hlokeng lefu lena, leo sepheo sa lona e leng ho iphumanela ka nako liphetoho tse latelang tse latelang:

• ho holofala hoa monoana
• letlalo le omeletseng
• bohloko ha o tsamaea,
• mycotic lesion
• ho fifala ha letlalo.

Mekhoa ea ho hlahloba lefu la tsoekere ea maoto le lefu la tsoekere e khethoa ke lipontšo tsa lefu lena le mathata a amanang le ona. Ha ho se na matšoao a matla, ho sebelisoa mekhoa e latelang ea tlhahlobo:

1. Teko ea mali - e lekola boemo ba tsoekere, cholesterol le lipoprotein tse serum ea mali.
2. Tlhahlobo ea 'mele - e u lumella ho fumana tekanyo ea bohloko, ho sisinyeha, tactile le maikutlo a mocheso oa lisele.
3. Urinalysis - e senola ho kopana ha 'mele oa ketone le tsoekere.

Tekanyo ea tšenyo ea metsoako ea mesifa-ligamentous le masapo ka mokhoa oa ischemic oa SDS e ikemiselitsoe ho sebelisa mekhoa e kang:

• Phapang ea X-ray - tlhahlobo ea boemo ba methapo ea methapo ea mali lipelong tse tlase.
• Ultrasonic densitometry ke mokhoa o sa hlaseleng ho lekanya letsoalo la mineral mineral.
• Peripheral CT arteriography ke skographic scan ea methapo ea mali e etsoang bakeng sa ho fumana liso tsa methapo.
• Ultrasound ea lijana tsa maoto - tlhahlobo ea lebelo la phallo ea mali ea methapo lintlheng tse tlase.
• Ho khutlisoa ka morao ho litšila tsa purulent - moelelo oa ts'ebetso ea ts'oaetso ea ts'oaetso ka ts'enyo ea lithane tsa necrotic.

Nakong ea ts'oaetso, liphetho tsa lithuto tsohle tse boletsoeng kaholimo li nkuoe hloko. Haeba setsebi se belaela hore ke phofo ea mahlo, X-ray ea leoto e etsoa ka makhetlo a mabeli.

Phekolo ea maoto a lefu la tsoekere

Melao-motheo ea kalafo e itšetlehile ka mofuta le sethala sa tsoelo-pele ea lefu la tsoekere ho bakuli ba lefu la tsoekere. Phekolo e phethahetseng ea lefu la tsoekere le tsoekere e kenyelletsa:

• pharmacotherapy
• kalafo ea lehae ea li-ulc,
• khomarela lenaneo la ho ja,
• ts'ebetso ea bongaka.

Ho ntlafatsa maemo a tsoekere ea mali, ho hlokahala phetoho ea tekanyetso ea insulin kapa phetisetso ea mokuli ho ea kalafo e matla ea insulin. Boteng ba bofokoli ba ho ruruha le liso tsa maqeba, ba sebelisa ts'ebetso ea bongaka e sebelisang thipa.

Meriana

Phekolo e bolokang maoto a lefu la tsoekere lapeng e ka kenyelletsa mehato ea mantlha le e meng. Ho thibela phetoho ea pathological lipheletsong, lithethefatsi tse reretsoeng ho phekola lefu lena le tlase, i.e. lefu la tsoekere. Ha ho hlaha liso tsa trophic, kalafo ea meriana e thibelang likokoana-hloko e ka etsahala ka ho sebelisa litlhare tse latelang:

• Clindamycin, Rifampicin - senya ts'oaetso ea staph.
• Ertapenem, Ceftriaxone - senya likarolo tsa selefounu tsa libaktheria tsa coliform.
• Erythromycin, Amoxicillin - e thibela nts'etsopele ea streptococci.
• Daptomycin, Linezolid - senya mefuta e meng ea methapo ea methapo e sa sebetseng.

Maemong a tebileng a lefu lena, ho etsoa methapo ea methapo ea methapo ea methapo. Ho fokotseha ha bongata ba likokoana-hloko 'meleng ho khothaletsa pholiso ea liso le ho nchafatsoa hoa mesifa. Phekolo ea liso tsa leoto la lefu la tsoekere e kenyelletsa ho phekola maqeba ka litlolo tse nang le urea, li-antioxidants le li-antiseptics - Diaderm, Vitra, Ureata, Diaultraderm.

Ts'ebeliso e nepahetseng ea lithethefatsi e thibela tsoelo-pele ea mekhoa ea necrotic le ho ruruha.

Ho ikoetlisa ke prophylaxis e ntle ea lefu la tsoekere ho bakuli ba nang le lefu la tsoekere le bolileng. Meroalo e leka-lekaneng maotong e tlatsetsa ho tloaelehang ha phallo ea mali mangole le lithane tsa trophic. Boikoetliso bo joalo bo ka sebelisoa ho matlafatsa mesifa le ho eketsa elasticity ea methapo ea mali:

• ea pepeta bolo ea rabara ka menoana,
• ho phahamisa menoana
• o tsamaea ka hare le kantle ho leoto,
• ho palama leoto la lintho tsa cylindrical,
• ho nka lesela ho tloha fatše ka menoana ea hau.

Ho fihlela ts'ebetso e hlokahalang ea kalafo, ho khothalletsoa ho ikoetlisa letsatsi le leng le le leng hoseng le ka shoalane mantsiboea. Ho latela lipatlisiso tse sebetsang, kalafo ea boikoetliso e fokotsa kotsi ea mathata ka makhetlo a 2,5.

Hirudotherapy

SDS e phekoloa ka katleho ka li-leeches tsa bongaka. Ha a ts'oaroa ke letlalo, a qala ho patela hirudin, e amang likarolo tsa mali tsa hemodynamic, ka tsela eo, a ntlafatsa phallo ea mali le mangoleng. Hirudotherapy ha se boemo ba kalafo ba lefu la tsoekere, empa hangata bo sebelisoa ka lebaka la ts'ebeliso e phahameng ea bona.

Ntle le hirudin, leeches tsa bongaka li pata lintho tse 'maloa tse sebetsang tse nang le phello e ntle maemong a batho ba nang le lefu la tsoekere:

• viburnum - e thibela ho khomarela ha lisele tsa mali le ho etsoa ha methapo ea mali methapong e tebileng ea maoto,
• destabilase - e na le litlamorao tsa bacteriostatic, ka ho etsa joalo e fokotsa menyetla ea tšoaetso ea maqeba maotong,
• hyaluronidase - e potlakisa ho tsoa ha mokelikeli o kenang, o thibelang ho hlaha ha edema.

ho hirudotherapy, ho sebelisoa feela mahofi a 'mala o sootho kapa o botala bo bosehla, a patang li-enzyme tse itseng tse thibelang ho hoama ha mali.

Lijo tse nang le phepo e nepahetseng nakong ea kalafo ea lefu lena li na le tšusumetso e kholo ho katleho ea kalafo le lebelo la ho hlaphoheloa ha bakuli. Pheko ea kalafo ea SDS e etselitsoe ho rarolla mathata a 'maloa:

• khoholeho ea mali
• ho tsitsa tsoekere ea mali
• boima ba 'mele le mojaro liphateng,
• phetiso ya mmele ya ho haella ha divithamini.

Le ha ho khutlisoa ka mokhoa o sa lekanyetsoang oa ts'ebetso ea metabolic ho tsoekere ho thibela nts'etsopele ea mathata a methapo, ischemia le gangrene. Ho latela litsebi tsa phepo e nepahetseng, lihlahisoa tsa litlama li lokela ho hlaha lijong. E thibela ho kenngoa ha tsoekere ho tsoa ho lijo ho kena maling, e thusang ho khutlisetsa maemo a tsoekere ea plasma.

Ho latela lenaneo la lijo, batho ba nang le lefu la tsoekere ba lokela ho kenyelletsa lihlahisoa tse kang:

• linaoa tse tala
• eggplant
• likomkomere
• lierekisi tse tala
• khábeche
• li-beet
• radish
• li-mushroom
• Tomoso
• celery
• zucchini
• tee e tala.

Litsebi li khothaletsa ho felisa ka ho felletseng confectionery, lino tse tahang, semolina, mafura a liphoofolo, bohobe bo bosoeu, pasta le lihlahisoa tsa soya lijong. Likarolong tse fapaneng tsa 'mele, li na le tsoekere, e lebisang keketseho ea tsoekere ea mali.

Litlhare tsa setso

Ho fokotsa botebo ba ts'ebetso ea ho ruruha letlalong ka SDS, lithethefatsi tse lokiselitsoeng ho litlama tsa litlama le lihlahisoa tsa lijo li ka sebelisoa. Bongata ba tsona li na le li-antiflogistic, pholiso ea maqeba le thepa ea antiseptic.

Phekolo ea maoto a lefu la tsoekere ka litlhare tsa setso e ka sebelisoa e le tšebelisano le kalafo ea lithethefatsi tsa lehae.

Mekhoa e metle haholo e kenyelletsa:

1. Li-Lotions tse nang le oli ea clove: sengoathoana se halikiloeng ka metso e mengata se kolobisoa ka mokelikeli ebe se sebelisoa libakeng tse anngoeng ke lihora tse 2-3. Ts'ebetso e etsoa makhetlo a 'maloa ka letsatsi ho nolofatsa letlalo le ho potlakisa pholiso ea liso tsa trophic.
2. Raese ea phofo ea raese: raese e ntšoa ka mor'a moo ebe e tsoakoa le mokhoa o qhibilihileng. Khekhe e nyane e bopehile ho tsoa ho motsoako o teteaneng, o kenngoeng leotong, o koahetsoe ka filimi ea khalase le lesole le futhumetseng.
3. E kopantsoe le serum: sekhechana sa boea ba k'hothone kapa gauze se kolobisitsoe ka selikalikoe ebe se kenngoa mapetsong a lirethe kapa liso, ebe se koaheloa ka filimi ea khalase. Ts'ebetso e lokela ho phetoa makhetlo a 3-4 ka letsatsi ho thibela ho feteletsana.

Ha ua lokela ho sebelisa litlhare tsa setso sa batho ntle le hore u buisane le ngaka pele.

Lieta tsa Orthopedic

Demineralization ea masapo le ho fokotseha ha meroalo ea maoto a maoto ho eketsa monyetla oa ho lemala. Ho thibela ho fetoloa hoa masapo a masapo le ho qoba ho putlama, litsebi tsa lefu la tsoekere li eletsoa hore li roale lieta tsa orthopedic feela. Ha o e reka, o lokela ho tataisoa ke mekhoa e latelang ea khetho:

1. Palo e nyane ea li-seams tsa kahare.
2. E thata ebile e sa thellisehe.
3. Otlolla holimo.
4. Botebo bo lekaneng ba insole (bonyane 1 cm).
5. Bokhoni ba ho fetola molumo u sebelisa Velcro.

Lieta tse khethiloeng ka nepo li tla thusa ho fokotsa mojaro ho menoana le serethe, hammoho le ho thibela ho pepeta maoto le ho etsoa ha poone.

Ho buoa

Tlhokahalo ea kalafo e bakoa ke ho hlaha ha mathata a maholo. Matšoao a ho buuoa a ka kenyelletsa:

• tiska necrosis
• phlegmon
• mofufutso
• blockage ea methapo ea mali
• likotsi.

Ho latela mathata a kalafo ea lefu la tsoekere, mefuta e latelang ea ts'ebetso e ka sebelisoa:

• necenessomy - ho iponahatsa ha lisele tse sa sebetseng,
• angioplasty - ho senoloa ha methapo e amehang bakeng sa ho holisa bophara ba eona bo kahare le ho tsamaisa phallo ea mali,
• ho khaoloa - ho tlosoa ha leoto le matsohoang haeba ho na le lesapo la mokokotlo.

Opereishene ea sejoale-joale e khona ho fana ka bonyane mekhoa e 10 e sa hlokeng letho e reretsoeng ho khutlisetsa phepelo ea mali le maqhubu ho ea leotong. Bakeng sa ho fetofatsa li-trophism tsa tiske litsing tsa kokelo tsa bophelo ba bongaka, ho buuoa ka methapo e kang autovenous bypass, thromboembolectomy, endovascular dilatation, jj.

Litlhare tsa morao-rao

Ka lilemo tse ngata, bo-rasaense ba ntse ba qapa mekhoa e mecha ea ho felisa lefu lena, le reretsoeng ho folisa ka potlako liphooko tsa trophic le thibelo ea maloetse. Jeremane, mekhoa ea phekolo e sebetsang ea CDS e se e qalile ho hlahisoa, e kenyeletsang:

• kalafo ea biomeological
• mokhoa oa plasma jet
• kalafo ea mabaka a ho hola
• extracorporeal shock wave therapy.

Ho ea ka lingaka tse ngata, e 'ngoe ea libaka tse tšepisang haholo kalafong ea leoto la tsoekere ke mokhoa o sebelisang lisele tsa stem. Tšebeliso ea eona maemong a fapaneng a kalafo ea lefu lena e kenya letsoho ho intlafatso ea lisele tse senyehileng le pholiso ea maqeba a trophic.

Tlhokomelo ea maoto: Litaelo tse qaqileng

Haeba motho a tšoeroe ke lefu la tsoekere, ho bolela hore o ikenya sehlopheng sa tlokotsi. Ke ka lebaka leo batho ba nang le lefu la tsoekere ba lokelang ho batla thuso ho ngaka ha matšoao a fokolang a ho ruruha leoto a hlaha. Tlhokomelo ea maoto bakeng sa VDS e kenyelletsa melao e 'maloa:

• Ho hlatsoa kamehla. Bonyane habeli ka letsatsi, o hloka ho hlatsoa maoto, ho ela hloko ka ho khetheha sebaka se arohaneng. Kamora ts'ebetso, letlalo le lokela ho omisoa ka botlalo le ho phekoloa ka antiseptic.
• Ho qoba phapang ea mocheso. Litsebi tsa lefu la tsoekere li lokela ho ba hlokolosi ka ho fetelletsa le hypothermia ea liphihlelo, kaha sena se ka lebisa ho potoloha hantle leotong le kholo ea neuropathy.
• Ho hlahlojoa ha maoto le matsoho ka mehla. Ha ho shejoa makhoakhoahla, litlolo kapa makhopho, hoa hlokahala ho phekola letlalo ka sebolaya litlolo le litlolo tse folisang.
• Phetoho ea lisokisi tsa letsatsi le letsatsi. Bohloeki bo fokotsa kotsi ea ho ba le mycosis ea letlalo le lipekere. Ka hona, lingaka li khothaletsa ho fetola masokisi kapa setoko bonyane hanngoe ka letsatsi.
• Ho kuta menoana ka nepo. Ho thibela ho kenella ha lipolanete tsa lipekere linthong tse bonolo, li lokela ho khaoloa feela ka kotloloho ntle le ho potoloha likhutlo.

Phatlalatso le thibelo ea lefu la tsoekere

SDS ke phephetso e behang bophelo kotsing. Leha ho le joalo, ka ho fetisoa ka nako ka nako ea kalafo ea lithethefatsi le ho latela mekhoa ea thibelo, hoa khoneha ho fokotsa kotsi ea liso tsa trophic le gangrene. Thibelo ea leoto la tsoekere e kenyeletsa:

• ho hlatsoa maoto le ho hlahloba maoto kamehla,
• o apere lieta tsa orthopedic feela,
• ho lekola khafetsa maemo a tsoekere ea mali,
• ts'ebeliso ea lisokisi tse se nang mohloa le li-stockings,
• ho hana ts'ebeliso ea li-plasters tsa poone,
• ho ya ngakeng bakeng sa ho ruruha kapa ho lemala ha letlalo.

Ho latela tataiso e bonolo ea tlhokomelo ea maoto ho thusa ho qoba mathata maemong a 84%. E tlameha ho utloisisoa hore SDS ke e 'ngoe ea lisosa tse kholo tsa ho khaoloa ha litho le matsoho. Ho thibela li-necrosis tsa tishu, bakuli ba lokela ho lekola bophelo ba bona, ho phekola mafu a dermatological ka nako mme ba khone ho thibela likotsi tsa leoto.

Tlhahisoleseling ka kakaretso

Ho endocrinology, lefu la tsoekere la lehe la tsoekere le utloahala e le phetoho ea mafu a methapo ea methapo le methapo ea kutlo likarolong tse ka thoko tsa mokokotlo, e lebisa ho nts'etsopele ea li-ulcerative necrotic process tsa letlalo le lisele tse bonolo, masapo le manonyeletso a kopaneng. Liphetoho tse bonts'ang leoto la tsoekere hangata li ba le lilemo tse 15-20 kamora ho ba le lefu la tsoekere. Khatello ena e etsahala ho 10% ea bakuli, ba bang ba 40-50% ea bakuli ba nang le lefu la tsoekere ba kotsing. Bonyane 90% ea lefu la tsoekere le tsoekere le amahanngoa le lefu la tsoekere la mofuta oa 2.

Hajoale, mokhatlo oa ho hlokomela bakuli ba nang le lefu la tsoekere ha o felle moo ho phethahetseng: hoo e batlang e le halofo ea maemo, kalafo e qala maemong a morao, e lebisang tlhokeho ea ho khaoloa leoto, ho se sebetse hantle ha bakuli, le keketseho ea lefu.

Lisosa le mekhoa ea nts'etsopele ea lehe la tsoekere

Lihokela tse ka sehloohong tsa pathogenetic ho lefu la tsoekere la lefu la tsoekere ke angiopathy, neuropathy le ts'oaetso. Hyperglycemia ea nako e telele e sa nepahalang ho lefu la tsoekere ea mellitus e baka liphetoho tse khethehileng methapong ea mali (diabetesic macroangiopathy le microangiopathy), hammoho le methapo ea kutlo (lefu la tsoekere). Angiopathies e lebisa ho fokotseha ha elasticity le patency ea methapo ea mali, keketseho ea ponahalo ea mali, e tsamaeang le tlolo ea ts'ebetso ea polokeho le lithane tse tloaelehileng tsa trophic, tahlehelo ea kutlo ea methapo ea methapo.

Ho eketseha ha glycosylation ea liprotheine ho baka ho fokotseha ha motsamao o kopaneng, o kenyang deformation ka nako e ts'oanang ea masapo a maoto le tlolo ea mojaro o tloaelehileng oa biomechanical leotong (lefu la tsoekere la lefu la tsoekere, leoto la Charcot). Khahlano le semelo sa phallo ea mali e fetotsoeng, ho fokotseha hoa kutlo le ts'ebetso ea ts'ireletso ea li-tishu, leha e le efe, esita le ho sithabela ka leoto leoto le tlase (ho longoa hanyane, ho senyeha, makhopho, micropores) ho lebisa ho thehoeng hoa li-uloph tsa trophic tsa nako e telele. Bofokoli ba ulceric ulcer hangata bo tšoaelitsoe ke staphylococci, colibacilli, streptococci, anaerobic microflora. Bacterial hyaluronidase e lokolla lisele tse potileng, e kenya letsoho ho phatlalatseng ha tšoaetso le liphetoho tse amanang le mafura a akaretsang, mafura a mesifa le lisebelisoa tsa masapo. Ka tšoaetso ea ulcers, menyetla ea ho ba le lekhopho, phlegmon le gangrene ea leoto ea eketseha.

Leha ho na le kotsi e ka ba teng ea ho ba le leqhubu la tsoekere ho bakuli bohle ba nang le lefu la tsoekere, sehlopha se kotsing ea kotsi se kenyelletsa batho ba nang le peripheral polyneuropathy, vascular atherosclerosis, hyperlipidemia, lefu la pelo, coronary hypertension, joala le ba tsubang.

Liphetoho tsa mesifa ea lehae - tseo ho thoeng ke mathata a manyane a leoto: tšoaetso ea li-toenail, tšoaetso ea fungal ea lipekere, li-mycoses tsa letlalo, li-poone le poone, li-heel tse senyehileng, bohloeki bo sa lekaneng ba maoto bo eketsa kotsi ea ts'enyo e kholo ea lefu la tsoekere. Sesosa sa likoli tsena e ka ba lieta tse khethiloeng ka mokhoa o sa lokelang (tse tšesaane haholo kapa tse tiileng). Ho fokotsa botebo ba leoto ha ho lumelle mokuli hore a utloe hore lieta li hatelletse haholo, o a pikitla ebile o mo lematsa leoto.

Ts'oaretso ea mefuta ea lefu la tsoekere

Ho fanoa ka boholo ba karolo e itseng ea pathological, ischemic (5-10%), neuropathic (60-75%) le motsoako o kopaneng - neuroischemic (20-30%) oa leoto la lefu la tsoekere oa khetholoha. Ka mokhoa oa ischemic oa leoto la lefu la tsoekere, tlolo ea phepelo ea mali lethekeng ka lebaka la ho hloloa ha likepe tse kholo le tse nyane e tla pele. Coronary syndrome e etsahala ka edema e phehellang ea edema, ho arohana ha nakoana, bohloko maotong, mokhathala oa maoto, letlalo la letlalo, jj.

Leoto la tsoekere la lefu la tsoekere le hlaha ka tšenyo ea tsamaiso ea methapo ea kutlo. Matšoao a leoto la neuropathic ke letlalo le omeletseng, hyperkeratosis, anhydrosis ea pheletso, ho fokotseha hoa mefuta e fapaneng ea maikutlo (ho futhumala, bohloko, tactile, jj.), Deformation ea masapo a leoto, maoto a sephara, likhahla tse ikopileng.

Ka mofuta o kopaneng oa leoto la tsoekere, ischemic le neuropathic lintlha li boleloa ka mokhoa o tšoanang. Ho latela botebo ba liponahatso nakong ea lefu la tsoekere la lefu la tsoekere, methati e khetholleha:

0 - Kotsi e kholo ea ho ba le lehlaba le lefu la tsoekere: ho na le leoto le robehileng, poone, hyperkeratosis, empa ha ho na liphoso tsa ho ruruha. 1 - li-ulcers tsa sethala tse holimo, tse lebisitsoeng letlalong feela 2 - sethala sa ka mpeng se tebileng se kenyelletsang letlalo, mafura a ikhethileng, mesifa ea mesifa, mesifa empa ha e senyehe masapo 3 - sethala sa ulcer e tebileng ka ho senyeha ha masapo 4 - sethala sa "gangren" e fokolang 5 - sethala sa tlala e kholo.

Sebopeho sa Ischemic

Ho qalo, sebopeho sa ischemic sa lefu la tsoekere le fetoha le bohloko maotong ha u tsamaea, mokhathala o potlakileng oa maoto, o ntse o tsamaea ka limp, ka mor'a moo leoto la leoto le phehella. Leoto le boreleli ebile le bata ho ama, pulsation methapong ea leoto ea fokola kapa ha e eo. Khahlano le semelo sa letlalo le boreleli, libaka tsa hyperpigmentation hangata li bonahala.

Ka tloaelo, boteng ba poone bo sa fole nako e telele ho menoana, li-heel, bokantle ba manonyeletso a I le V, ankle. Kamora moo, ho na le liso tsa bohloko sebakeng sa tsona, tlase moo e koahetsoeng ke lehlaka la 'mala o sootho. Ho ruruha ho feteletseng ke atypical (necrosis e omileng ea letlalo).

Nakong ea sebopeho sa ischemic leoto la lefu la tsoekere, methati e mene ea khetholoha: mokuli ea nang le methati ea pele a ka tsamaea sebaka se le seng ka mokhoa o utloisang bohloko, ho tloha la bobeli - hoo e ka bang 200 m, ho tloha ho la boraro - tlase ho 200 m, maemong a mang bohloko bo hlaha phomolong, mophato oa bone o tšoauoa ka ischemia e bohloko le necrosis ea menoana, e lebisang ho gangrene ea leoto kapa leoto le tlase.

Sebopeho sa Neuropathic

Sebopeho sa neuropathic sa leoto la lefu la tsoekere se ka tsoela pele e le ulopathic ulcer, osteoarthropathy, le edopathic edema. Ho hlaha lesapo la neuropathic libakeng tsa leoto tse tlas'a khatello e kholo - lipakeng tsa menoana, letsohong, joalo-joalo. Ho ferella, libaka tse letsoang tsa hyperkeratosis, moo meralo ea liso e thehiloeng teng mona. Ka seso sa neuropathic, letlalo le futhumetse ebile le omme, masapo, makhopho a tebileng, liso tse bohloko tse nang le hyperemic, edematous edges li fumanoa leotong.

Osteoarthropathy kapa kopantsoeng ea Charcot, e le mofuta oa leoto la lefu la tsoekere, e tšoauoa ka ho timetsoa ha lisebelisoa tsa mokokotlo, tse bonahatsoang ke lefu la ho fokola ha masapo, ho choachoha ka matsoalo, ho ruruha le bofokoli ba manonyeletso (hangata lengole). Ka edema ea neuropathic, mokelikeli oa "metso" o bokellana liseleng tse katlase, tse eketsang liphetoho tsa methapo maotong.

Bakeng sa mefuta e fapaneng ea mofuta oa neuropathic oa leoto la tsoekere, ho tloaelehile ho boloka ho phahama ka har'a methapo ea methapo, ho fokotseha ha maikutlo le kutloelo-bohloko, bohloko bo sa utloiseng bohloko ba liso tsa morao-rao tsa maqhubu ka bongata bo feteletseng, ho hlopholla liso ka libaka libakeng tsa moroalo o eketsehileng (menoaneng, ho ea ka nqa e le 'ngoe), mefokolo e ikhethang ea leoto (ho ts'oaroa ka sebopeho-hamore, hamore-hamore-hamore menoana, lihlooho tsa masapo tse itšireletsang).